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Course: Medical Surgical Nursing

Topic: Rhinitis and Viral Rhinitis

The Nurses International Community

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Module Goals

Learners will be able to:

Describe the pathophysiology of Rhinitis and viral Rhinitis.
Outline the clinical manifestations of both conditions.
Describe the medical management of both conditions.
Discuss the nursing management of both conditions.

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Rhinitis

Inflammation of the mucous membrane lining the nasal passages
Presentation

Nasal congestion
Sneezing
Nasal and palatal itching
Rhinorrhea
Postnasal drainage

Beard, 2014

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Rhinitis: Classification

Three distinct rhinitis subgroups:

Allergic rhinitis (AR)
Infectious rhinitis
Non-allergic, non-infectious rhinitis

Liva, 2021

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Classification: Allergic Rhinitis

Hypersensitive response to an inhaled environmental allergen
Characterized by:

Anterior or posterior rhinorrhea
Nasal congestion/blockage
Itching of the nose
Sneezing occurring for more than one hour on two or more consecutive days.

Liva, 2021

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Allergic Rhinitis: Pathophysiology

Result of an immunoglobulin (Ig) E-mediated allergic reaction.
Antigen-presenting cells (APCs) engulf allergens in the nasal mucosa.
The cells break the allergens into antigenic peptides.
APCs present the antigenic peptides to naive T cells (Th0) When activated, Th0 cells differentiate into the Th2 subtype.

Beard, 2014

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Allergic Rhinitis: Pathophysiology (Continued)

The Th2 cells release interleukin (IL)-4, which stimulates B cells to produce IgE.

IgE attaches to mast cells and basophils make them releases a host of mediators including histamine and prostaglandin.

Histamine is a major pathway for nasal inflammation.

Beard, 2014

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Classification: Non-Allergic Rhinitis (NAR)

A chronic rhinitis without clinical manifestations of endonasal infection and systemic allergic inflammation

May be classified into at least six subgroups:

Drug-induced rhinitis
Hormone-induced rhinitis
Senile rhinitis or rhinitis of the elderly
Gustatory rhinitis
Occupational rhinitis
Idiopathic rhinitis
Atrophic rhinitis

Liva, 2021

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Classification: Infectious Rhinitis

Acute viral rhinitis is the most common form of upper respiratory infection.

Common causes:

Rhinovirus, coronavirus, adenovirus
Influenza virus, parainfluenza virus
Respiratory syncytial virus
Enterovirus

Çatlı, Atilla & Miller, 2019

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Critical Thinking Question

Which of the following statements best explains the pathophysiology of allergic rhinitis?

Allergen-specific immunoglobulin E (IgE) tests are usually negative
Hormones are the most common causative agents
It is a hypersensitive response to an inhaled environmental allergen
It is caused by the respiratory syncytial virus

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Infectious Rhinitis: Viral Rhinitis

Physical findings are similar to other types:

Excessive mucus production and rhinorrhea
Nasal blockage
Sneezing
Watery eyes
Reddish nose tip
Occasional fever
Some degree of nasal and ocular pruritus
Cervical Lymphadenopathy

Çatlı, Atilla & Miller, 2019

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Rhinitis: Diagnosis

History
Physical examination
A skin prick test can be performed for confirmation (ie., dermatographism).
Allergen-specific IgE serum testing based on the client’s history can be useful.

Beard, 2014

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Allergic Rhinitis: Treatment

Minimize exposure to pollens
Nasal Irrigation:

Saltwater nasal sprays or douches (a stream of water sprayed into the nose)

Medication:

Intranasal corticosteroids
Antihistamines
Decongestant sprays
Decongestant tablets
Immunotherapy

Health Direct, 2020

Contact info: info@nursesinternational.org

Minimize exposure to pollens:

Stay indoors until after midday, especially when the pollen count is high, it’s windy or after thunderstorms.
Wear sunglasses, carry tissues, shower when you arrive home, and rinse your eyes with water.
If your trigger is grass, avoid mowing, playing or walking in grassy areas, and don't go camping.
Keep windows closed at home and in the car, and use recirculating air conditioning in the car.
Avoid outdoor picnics during pollen season.
Try to plan holidays out of the pollen season, or holiday at the seaside.
If gardening at home, research which plants are less likely to trigger hay fever.
Remove any weeds or vegetation outside your bedroom window that might trigger symptoms.

Intranasal corticosteroids: These effectively reduce inflammation in the lining of the nose caused by hay fever or other conditions.
Antihistamines: These manage symptoms of hay fever by blocking the action of histamine, which the body releases in response to exposure to an allergen.
Decongestant sprays: These unblock and dry the nose, but they should not be used for more than a few days.
Decongestant tablets: These also unblock and dry the nose but they can have stimulant side effects such as tremors, difficulty sleeping, anxiety or increased blood pressure.
Allergen-specific immunotherapy, also known as ‘desensitisation’, is a therapy designed to reduce the intensity of the body’s reaction to an allergen. Immunotherapy works by gradually exposing someone to increasing doses of allergen extracts, either by injection or under the tongue.

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Viral Rhinitis: Treatment

Hydration with plenty of fluids
Herbal and nutritional supplements (vitamin C, selenium, zinc, etc.)
Homemade soups
Honey
Multi-ingredient (antihistamine, oral/topical decongestant, anti-inflammatory, etc.)
Over-the-counter (OTC) drugs
Bed rest, smoking cessation

Çatlı, Atilla & Miller, 2019

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Critical Thinking Question

Which of the following clinical manifestations are consistent with the diagnosis of viral rhinitis? Select all that apply.

Cervical lymphadenopathy
Excessive mucus production
Nasal blockage
Rhinorrhea
Sneezing

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Viral Rhinitis: Prevention

Vaccination
Education:

Concerning transmission routes of viruses
Viral dissemination and cold transmission
*Hand-washing (most effective method to prevent infection)

Çatlı, Atilla & Miller, 2019

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Allergic Rhinitis: Prevention

Dust mite control

Encase bedding in dust mite covers
Wash bedding and toys at 60°C or higher
Avoid carpets

Eliminate or reduce occupational exposure to allergens
Pollen control

Keep windows closed
Use air conditioning
Limit outdoor exposure

Liva, 2021

Contact info: info@nursesinternational.org

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Allergic Rhinitis: Prevention

Mold control

Avoid long periods in basements
Reduce household humidity

Pets

Avoid pets in the home
Confine pets to uncarpeted rooms
Bathe pets frequently
Equip rooms with high-efficiency particulate air filters

Liva, 2021

Contact info: info@nursesinternational.org

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Rhinitis: Nurses Role

Obtain a thorough history of allergy and seasonal variations
Understand the triggers
Education for use of nasal sprays
Encourage medication compliance
Encourage avoiding triggers
Smoking cessation counselling
Education:

Transmission routes of viruses
Hand-washing/ hygiene
Vaccine

Akhouri, House, & Doerr,2022

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What Would the Nurse Do?

The nurse is educating the client about allergic rhinitis prevention. Which of the following measures should the nurse include in the teaching plan? Select all that apply.

Avoid carpets
Educate the client about possible triggers
Encourage smoking cessation
Limit outdoor exposure
Reduce occupational exposure to allergens

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Red Flags

Disturbed sleep
Tiredness during the day
Headaches
Poor concentration

Health Direct, 2020

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued)

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may affect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

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References

Agency for Healthcare Research. (2020). Health Literacy Universal Precautions Toolkit, 2nd Edition. https://www.ahrq.gov/health-literacy/improve/precautions/tool10.html

Akhouri, S., House, S.A., & Doerr, C. (2022). Allergic Rhinitis (Nursing). Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568690/

Beard, S. (2014). Rhinitis. Prim Care;41(1):33-46. doi: 10.1016/j.pop.2013.10.005. Epub 2013 Nov 28. PMID: 24439879; PMCID: PMC7119310

Çatlı, T., Atilla, H., & Miller, E.K. (2019). Acute Viral Rhinitis. All Around the Nose. doi: 10.1007/978-3-030-21217-9_23. PMCID: PMC7123171.

Health Direct. (2020). Hay Fever ( Allergic Rhinitis). https://www.healthdirect.gov.au/hay-fever

Liva, G.A.; Karatzanis, A.D.; Prokopakis, E.P. (2021). Review of Rhinitis: Classification, Types, Pathophysiology. J. Clin. Med. https://doi.org/ 10.3390/jcm10143183

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