Presentation by group 16 on Sinusitis

Objectives

• By the end of the presentation the student will be able to :
• Define sinusitis.
• Identify the classifications of sinusitis .
• List five risk factors of sinusitis.
• Enumerate four signs and symptoms of sinusitis.
• List five medical management of sinusitis
• State four nursing management of sinusitis
• Give five preventive measures of sinusitis.
• State two complications of sinusitis

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INTRODUCTION

• Several bones surrounding the nasal cavity contain paranasal sinuses ,air-filled cavities.
• Sinuses are located in the ethmoid, frontal, maxillary and sphenoid bone adjacent to the nasal cavity .The sinuses lighten the skull and serve as sound resonating chamber during speech. The sinuses open into the nasal cavity and they lined with cilliated mucous membrane that continues with the mucous membrane of the nasal cavity.

DEFINITION OF SINUSITIS

• Sinusitis refers to an inflammation of the tissues that line the sinuses, which are the air spaces within the bones of the face close to the nose.
• It most often cause by an infection within these spaces.
• The sinuses are small, air-filled cavities behind your cheekbone and forehead.
• The mucous produced by sinuses usually drains into your nose through small channels.
• In sinusitis ,these channels become blocked because the sinus linings are inflamed(swollen)

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incidence

• Approximately 0.5% of all upper respiratory tract infection are complicated by sinusitis
• The incidence of acute sinusitis ranges from 15 -40 episodes per 1000 patients per year.
• It is much more common in adults than in children.

CAUSATIVE ORGANISM

• Streptococcus pneumonia (bacteria infection
• Haemophilus influenza (bacteria infection)
• Moraxella catarrhalis (viral infection)
• Aspergillums candida (fungal infection)

General risk factors of sinusitis

• Dental infection (an infected tooth can also cause the sinuses to become inflamed)
• Foreign body in the nose
• Cocaine abuse
• Trauma to the nose

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Risk factors con’t

• Occupational exposures to such chemical irritants eg chlorine gas.
• People with weak immune system eg people with diabetes, AIDS and patient taking medications which lower their immune system such as cancer medications.
• Nasal polyps (abnormal growth inside the nose that protruding from mucous membrane)
• Common cold

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CLASSIFICATIONS

• Acute sinusitis
• Chronic sinusitis

ACUTE SINUSITIS

• It usually has a rapid onset; It is often a complication of the common cold but can also be triggered by allergies, bacterial infections, or fungal infections.It last for 3 to 4 weeks

Risk factors of acute sinusitis

• Weakened immune system
• Allergies
• Nasal passages abnormalities
• Smoking or frequent inhalation of pollutant
• Activities that leads to pressure changes
• Spending a lot of time in daycare ,preschool or area where contagious viruses are frequently present

Acute pathophysiology

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Acute sinusitis usually follows a viral URI or cold, such as an unresolved viral or bacterial infection, or an increase in the severity of allergic rhinitis. Normally, the sinus openings into the nasal passages are clear and infection resolves promptly,however if their drainage is obstructed by a deviated septum or by hypertrophied turbinates(nasal conchae) or nasal polyps or tumors, sinus infection may persist as a smoldering (persistent) secondary infection or progress to an acute suppurative process (causing) purulent discharge).

Pathophysiology cont.

• Nasal congestion, caused by inflammation, edema, and transudation of fluid secondary to URI,leads to obstruction of the sinus cavities. This provides an excellent medium for bacterial growth. Other conditions that can block the normal flow of sinus secretions include abnormal structures of the nose,

Pathophysiology cont.

tooth infection, trauma to the nose, tumors, and the pressure of foreign objects. Some people are more prone to sinusitis because exposure to environmental hazards such as paint, sawdust, and chemicals may result in chronic inflammation of the nasal passages.

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Clinical manifestation of acute sinusitis

• Headache and pain over the affected sinuses
• Drainage from the nose often changes from a clear color to a thicker, yellowish green discharges.
• Fever
• Facial pains elevated by movement of the head
• Cough
• Pain in the jaws and teeth
• Sore throat and bad breath usually occurring in the chronic sinusitis
• Swelling around the eye and unusual irritability and fatigue are associated with sinusitis in children.
• Purulent nasal discharge

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CHRONIC SINUSITIS

• This is a type of sinusitis that last longer than 8 weeks, or keeps recurring [4 or more times for years].It is diagnosed when the patient has experienced 12weeks or longer or 2 or more of the following symptoms
• Mucopurulent drainage,nasal obstruction,facial pain,decrease sense of smell
• Itis accompanied by nasal polyps

RISK GROUP

CHRONIC SINUSITIS

• Asthma about 20% of people with chronic sinusitis have asthma. Treating asthma may have the added benefit of improving your sinusitis symptoms.
• Aspirin sensitivity that causes upper respiratory symptoms.

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Chronic pathophysiology

Mechanical obstruction in the ostia(openings) of the frontal, maxillary and anterior ethmoid sinuses (known collectively as the ostiomeatal complex) is the usual cause of chronic sinusitis and recurrent acute sinusitis. Obstruction prevents adequate drainage of the nasal passages, resulting in accumulation of secretions and an ideal medium for bacterial growth. Persistent blockage in an adult may occur because of infection, allergy, or structural abnormalities.

Chronic Pathophysiology cont.

Other associated conditions and factors may include cystic fibrosis,neoplastic disorders, gastroesophageal reflux disease, tobacco use, and environmental pollution.

MEDICAL MANAGEMENT

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• Quinolones such as ciprofloxacin (Cipro), levofloxacin (Levaquin) (used with severe penicillin allergy), and sparfloxacin (Zagam) have also been used.
• The course of treatment is usually 10 to 14 days.

Medical management cont.

• Use of oral and topical decongestant agents may decrease mucosal swelling of nasal polyps, thereby improving drainage of the sinuses. Heated mist (droplets of water suspended in the air) and saline irrigation also may be effective for opening blocked passages. Decongestant agents such as pseudoephedrine (Sudafed, Dimetapp) have proven effective because of their vasoconstrictive properties. Topical decongestant agents such as oxymetazoline (Afrin) may be used for up to 72 hours.

Medical management cont.

• . It is important to administer them with the patient’s head tilted back to promote maximal dispersion of the medication. Guaifenesin (Is medicine that promotes the secretion of sputum)a mucolytic agent, may also be effective in reducing nasal congestion.
• Antihistamines such as diphenhydramine (Benadryl), may be used if an allergic component is suspected.

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Medical management cont.

• If the patient continues to have symptoms after 7 to 10 days, the sinuses may need to be irrigated and hospitalization may be required

Nursing Management�EDUCATING PATIENTS ON SELF-CARE�

Patient teaching is an important aspect of nursing care for the patient with acute sinusitis.

• Instructs the patient about methods to promote drainage such as inhaling steam (steam bath, hot shower, and facial sauna), increasing fluid intake, and applying local heat (hot wet packs).

Nursing management cont.

• Educates the patient about the side effects of nasal sprays and about rebound congestion.
• In the case of rebound congestion, the body’s receptors, which have become dependent on the decongestant sprays to keep the nasal passages open, close and congestion results after the spray is discontinued.
• Stress on the importance of following the recommended antibiotic regimen, because a consistent blood level of the medication is critical to treat the infection.

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nursing management cont

• Teach patient the early signs of a sinus infection and recommends preventive measures such as following healthy practices and avoiding contact with people who have upper respiratory infections .
• Explain to the patient that fever, severe headache, and nuchal rigidity are signs of potential complications. If fever persists despite antibiotic therapy, the patient should seek additional care.

SURGICAL MANAGEMENT

• When standard medical therapy fails, surgery, usually endoscopic, may be indicated to correct structural deformities that obstruct the ostia (openings) of the sinus.
• Correcting a deviated septum, incising and draining the sinuses, aerating the sinuses,
• Removing tumors are some of the specific procedures performed.

PREVENTION

• Prevention of sinusitis involves the usual standards of good hygiene to cut down the number of common colds an individual catches
• Avoid cigarette smoking and other air pollutant .
• Minimize your contact with people who have cold.
• Wash hands after and before meals.
• Use humidifier in dry weather to keep your sinuses moist and healthy.
• Eat a healthy diet to keep your immune system strong .
• People with allergies should minimize their exposure to known allergens as well as using decongestants

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Complications of sinusitis

• Meningitis (the infection causes inflammation of the membranes and fluid surrounding your brain and spinal cord)
• Partial or complete loss of sense of smell
• Other infections such as osteomyelitis or cellulitis because the infection can spread to the bone.
• Vision problems

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References

• Brunner and Suddarth (2015). Textbook for medical and surgical nursing (12^th edition).
• Stanley E.R (2^nd edition).Anatomy and Physiology with integrated study guide.
• Medical –Surgical Nursing by Lewis Dirksen Bucher
• America online medical nursing note.
• en.wikipedia.org/wikisinusitis. 10^th May,2017.20:09pm

Group members

• Atobrah Osei Dominic
• Kyere Victor
• Akrong Lucy