By: Kristine Charisse V.

Tanedo BSN III MSU-IIT

Allergic Rhinitis

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

Causes:
Inhaled
Pollens Grasses Weeds House dust Dust mite Animal dander Feathers

Seasonal

Ingested
Wheat Eggs Milk nuts

Perennial

Seasonal Rhinitis \
Common Allergens: pollens

Symptoms:
Watery nasal drainage Nasal congestion Repetitive sneezing Itchy eyes, ears, nose and throat Nose rubbing

Pathophysiology
-allergic reaction is an exaggerated or inappropriate immune reaction that causes damage to host -Type I immediate hypersensitivity reaction -mediated by IgE antibodies which trigger mast cells and basophils to release pharmacogically active agents.

How are symptoms caused?

Itching and sneezing irritation of free nerve endings Rhinorrhea Rhinorrhea-increase mucus production Congestion Congestion-vasodilation Oedema Oedema-increase vascular permeability

Other Symptoms:

Weakness Discomfort or uneasiness Irritability Fatigue Difficulty concentrating Decrease appetite

Nursing Management:
Educate Avoid exposure to allergens Saline nasal sprays

Anti-histamines
-prevent histamine from binding to H1 receptors -control sneeze , itch and rinorrhea -ineffective in relieving nasal blockage

Anti-histamines
1st generation anti-histamines: Chlorpheniramine Diphenylhydramine 2nd generation anti-histamines: Cetrizine Azelastine Fexotenadine Loratidine

 Topical Nasal Corticosteroids

-reduce mucosal inflammation and all nasal symptoms -use with persistent rhinitis of the lowest effective dose
Budesonide

Side-effects: Immunosuppressant Salt and water retention Non-steroidal nasal sprays: Cromolyn (nasalcrom) very safe nasalcrom)

Sinusitis

Sinuses
Frontal Frontal-above eyes in forehead bone Maxillary Maxillary-cheek Sphenoid Sphenoid-center skull, behind eyes and nose Ethmoid Ethmoid-eyes and nose

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

Etiology
70% is caused by bacteria: Streptococcus pneumonia Haemophilus influenza Moraxella catarrhalis Others: Staphylococcus aureus Streptococcus pyogenes GramGram-negative bacilli Respiratory viruses

Predisposing factors:
-allergies, nasal deformities, cystic fibrosis, nasal polyps, HIV infection -cold weather -high pollen places -exposure to smoke/smoking -reinfection from siblings

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

Complications:
Meningitis (Brudzinskis, Kernigs) Brain abscess Ischemic brain infarction

Diagnostic Tests:
Sinus radiographs Ultrasonograms CT Scan if unresponsive to 48 hours

Medical Management:
Antibiotics: Amoxicilline Ampicilline Erythromycin TM 2: Septray Bactiva 2nd line: Cephalosporin cefuroxime axetil (Ceftrin) Ceftrin) Amoxicillin clavulanate (augmentin augmentin)

Newer Drugs
Macrolides Clarithromycin (biaxin) biaxin) Azithromycin (Zithromax) Zithromax) Quinolones Levofloxacin (Levaquin) Levaquin) Levofloxacin (Levaquin) Levaquin)
Side effect:
Nephrotoxic Hepatotoxic 2-3 liters water

Nasal decongestants:
Pseudophedrine hydrochloride (Sudafed) (Sudafed)
Other:
Oral topical decongestants Antihistamines Benadryl

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