8/6/2019 Allergic Rhinitis and Sinusitis

1/23

Allergic

Rhinitis

By: Kristine Charisse V.Tanedo

BSN III MSU-IIT

8/6/2019 Allergic Rhinitis and Sinusitis

2/23

what is

Allergic Rhinitis? -Inflammation of mucous membranes of the

nose

-reactions in nasal mucosa from repeated

allergen exposure that causes hypersensitivity

-may be seasonal or perennial

8/6/2019 Allergic Rhinitis and Sinusitis

3/23

Causes:

InhaledInhaled Pollens

Grasses

Weeds

House dust Dust mite

Animal dander

Feathers

IngestedIngested Wheat

Eggs

Milk nuts

Seasonal

Perennial

8/6/2019 Allergic Rhinitis and Sinusitis

4/23

Seasonal Rhinitis

\ CommonCommon Allergens:Allergens: pollens

Symptoms:Symptoms:

Watery nasal drainage

Nasal congestion

Repetitive sneezing

Itchy eyes, ears, nose and throat

Nose rubbing

8/6/2019 Allergic Rhinitis and Sinusitis

5/23

Pathophysiology

-allergic reaction is an exaggerated orinappropriate immune reaction that causesdamage to host

-Type I immediate hypersensitivity reaction

-mediated by IgEIgE antibodiesantibodies which triggermast cells and basophils to releasepharmacogically active agents.

8/6/2019 Allergic Rhinitis and Sinusitis

6/23

How are symptoms caused?

ItchingItching and sneezingand sneezing irritation of free nerveendings

RhinorrheaRhinorrhea-increase mucus production

CongestionCongestion-vasodilation

OedemaOedema-increase vascular permeability

8/6/2019 Allergic Rhinitis and Sinusitis

7/23

Other Symptoms:

Weakness

Discomfort or uneasiness Irritability

Fatigue

Difficulty concentrating Decrease appetite

8/6/2019 Allergic Rhinitis and Sinusitis

8/23

Nursing Management:

Educate

Avoid exposure to allergens

Saline nasal sprays

8/6/2019 Allergic Rhinitis and Sinusitis

9/23

Anti-histamines

-prevent histamine from binding to H1

receptors

-control sneeze , itch and rinorrhea

-ineffective in relieving nasal blockage

8/6/2019 Allergic Rhinitis and Sinusitis

10/23

Anti-histamines

1st generation anti-histamines:

ChlorpheniramineChlorpheniramine

DiphenylhydramineDiphenylhydramine

2nd generation anti-histamines:

CetrizineCetrizine

AzelastineAzelastine

FexotenadineFexotenadine

LoratidineLoratidine

8/6/2019 Allergic Rhinitis and Sinusitis

11/23

Topical Nasal Corticosteroids-reduce mucosal inflammation and all nasal symptoms

-use with persistent rhinitis of the lowest effectivedose BudesonideBudesonide

Side-effects:

Immunosuppressant

Salt and water retention

Non-steroidal nasal sprays:

CromolynCromolyn ((nasalcromnasalcrom)) very safe

8/6/2019 Allergic Rhinitis and Sinusitis

12/23

Sinusitis

8/6/2019 Allergic Rhinitis and Sinusitis

13/23

Sinuses

FrontalFrontal-above eyes in forehead bone

MaxillaryMaxillary-cheek

SphenoidSphenoid-center skull, behind eyes and nose

EthmoidEthmoid-eyes and nose

8/6/2019 Allergic Rhinitis and Sinusitis

14/23

What is Sinusitis?

-follows after rhinitis

-may be viral or allergic

-result of abrupt pressure changes -inflammation of edema of mucous membranes

-provides opportunistic bacteria invasion

-inflammation produces mucoid drainage -postnasal drainage causes obstruction of nasal

passages and inflamed throat

8/6/2019 Allergic Rhinitis and Sinusitis

15/23

Etiology

70% is caused by bacteria:

StreptococcusStreptococcus pneumoniapneumonia

HaemophilusHaemophilus influenzainfluenza

MoraxellaMoraxella catarrhaliscatarrhalis

Others:

StaphylococcusStaphylococcus aureusaureus

StreptococcusStreptococcus pyogenespyogenes GramGram--negativenegative bacillibacilli

Respiratory virusesRespiratory viruses

8/6/2019 Allergic Rhinitis and Sinusitis

16/23

Predisposing factors:

-allergies, nasal deformities, cystic fibrosis,nasal polyps, HIV infection

-cold weather

-high pollen places

-exposure to smoke/smoking

-reinfection from siblings

8/6/2019 Allergic Rhinitis and Sinusitis

17/23

Clinical Manifestations:

-Maxillary and anterior ethmoidal sinuses

-Facial pain or pressure on affected area

-Nasal obstruction

-Fatigue-Purulent nasal discharge

-Fever, headache, ear pain

-Decrease sense of smell

-Sore throat-Early morning periorbital edema

-Cough that worsens in supine position

8/6/2019 Allergic Rhinitis and Sinusitis

18/23

Complications:

Meningitis (Brudzinskis, Kernigs)

Brain abscess

Ischemic brain infarction

8/6/2019 Allergic Rhinitis and Sinusitis

19/23

Diagnostic Tests:

Sinus radiographs

Ultrasonograms

CT Scan if unresponsive to 48 hours

8/6/2019 Allergic Rhinitis and Sinusitis

20/23

Medical Management:

Antibiotics:

AmoxicillineAmoxicilline

AmpicillineAmpicilline

ErythromycinErythromycin TM 2:TM 2: SeptraySeptray BactivaBactiva

2nd line:

CephalosporinCephalosporin cefuroximecefuroxime axetilaxetil ((CeftrinCeftrin))

AmoxicillinAmoxicillin clavulanateclavulanate ((augmentinaugmentin)

8/6/2019 Allergic Rhinitis and Sinusitis

21/23

NewerDrugs

Macrolides

ClarithromycinClarithromycin ((biaxinbiaxin))

AzithromycinAzithromycin ((ZithromaxZithromax))

Quinolones

LevofloxacinLevofloxacin ((LevaquinLevaquin))

LevofloxacinLevofloxacin ((LevaquinLevaquin)) Side effect:

Nephrotoxic

Hepatotoxic

2-3 liters water

8/6/2019 Allergic Rhinitis and Sinusitis

22/23

Nasal decongestants:

PseudophedrinePseudophedrine hydrochloride (hydrochloride (Sudafed)Sudafed)

Other:

Oral topical decongestants

Antihistamines BenadrylBenadryl

8/6/2019 Allergic Rhinitis and Sinusitis

23/23

Nursing Management:

Educate

Steam inhalation

Avoid: (during acute infection)

Swimming Diving

Air travel

Explain to patient fever, severe headache, nuchal rigidity, signs of

potential complications