Prepared by; John Micahel Orias SN UM

Sinusitis, Laryngitis, and

pharyngitis

Objectives: Within 30 mins. Of my discussion, my co-student nurse

will be able to: To discuss what is sinusitis and its types and according

to its location To know what are the primary causes of sinusitis To discuss what is the pathophysiology sinusitis Know the difference between laryngitis and pharyngitis To discuss what are the pathophysiology of laryngitis

and pharyngitis And to discuss its primary causes To know what are the medical management and its

prevention

Sinusitis

What are sinuses? The sinuses are cavities, or air-filled pockets,

near the nasal passage. Like the nasal passage, the sinuses are lined with mucous membranes. There are four different types of sinuses

four different types of sinuses:

ethmoid sinus - located inside the face, around the area of the bridge of the nose. This sinus is present at birth, and continues to grow.

maxillary sinus - located inside the face, around the area of the cheeks. This sinus is also present at birth, and continues to grow.

frontal sinus - located inside the face, in the area of the forehead. This sinus does not develop until around 7 years of age.

sphenoid sinus - located deep in the face, behind the nose. This sinus does not develop until adolescence

What is sinusitis?

Sinusitis is an infection of the sinuses near the nose. These infections usually occur after a cold or after an allergic inflammation.

There are four types of sinusitis:

acute - symptoms of this type of infection last less than four weeks and get better with the appropriate treatment.

subacute - this type of infection does not get better with treatment initially, and symptoms last four to eight weeks.

chronic - this type of infection happens with repeated acute infections or with previous infections that were inadequately treated. These symptoms last eight weeks or longer.

recurrent - three or more episodes of acute sinusitis a year

Acute sinusitisPathophysiology

An infection of the paranasal sinuses. Because there is unresolved viral or bacterial

infection, or exacerbation of allergic rhinitis it frequently develop.

Nasal congestion, caused by inflammation, edema and transudation of fluids, leads to obstruction of the sinus cavities

Signs and symptoms

Facial pain Pressure in the affected

sinus area Nasal obstruction Fatigue Purulent Nasal discharge Fever Headache Ear pain or fullness

Dental pain Cough Decreased sense of

smell Sore throat Eyelid edema Facial congestion of

fullness

How is sinusitis diagnosed?

sinus x-rays computed tomography (Also called CT

or CAT scan.) cultures from the sinuses

Treatment for sinusitis:

antibiotics (antibiotics are usually given for at least 14 days)

Amoxicillin Antihistamines acetaminophen (for pain or discomfort) a decongestant (i.e., pseudoephedrine

[Sudafed®]) and/or mucus thinner (i.e., guaifenesin [Robitussin®])

cool humidifier in your child's room nasal spray to reduce inflammation

surgery

Surgery should be considered only if other treatments have failed.

endoscopic sinus surgery

Complication

Meningitis Brain abscess Ischemic infarction osteomyelitis

Chronic sinusitis

An inflammation of the sinuses that persists for more than 3 weeks in an adult and 2 weeks in a children.

It is estimated that 32 million people a year develop chronic sinusitis

Pathopysiology

Narrowing or obstruction in the ostia of the frontal, maxillary and anterior ethmoid sinuses. preventing adequate drainage to the nasal passage.

The combined is known as the osteomeatal complex.

The blockage that persists for greater than 3 weeks because infection, allergy, or structural abnormalities.

Signs and symptoms

Impaired mucociliary clearnce and ventilation Cough chronic hoarseness Chronic headaches in the periorbital area Fatigue, nasal stuffiness, decrease smell and

taste Usually in the morning

prevention

Perform hand hygiene often Use disposable tissues Avoid crowds during the flu season Avoid individuals with colds or respiratory infection Obtain influenza vaccination, if recommended Practice good health habits Eat nutritious foods Get plenty of sleep and rest Avoid or reduce stress if possible

Exercise appropriately Avoid smoking or second-hand smoke and

excessive intake of alcohol Increase humidity of the house Practice adequate hygiene Avoid allergens are associated with upper

respiratory infections

Reduced irritants (dust, chemical, tabacco smoke) when possible

Limit exposure to animals and house pets

Laryngitis

An inflammation of the larynx, often occurs as a result of voice abuse or exposure to dust, chemicals, smoke, and other pollutant.

It may also caused by isolated infection involving only the vocal cords

Causes:

Temperature changes Dietary deficiencies Malnutrition Immunosuppressed state Acute laryngitis: Viral infection such as those cause a cold Vocal strain, caused by yelling or over using

of voice Bacterial infections

Chronic Laryngitis: Inhaled irritants, such as chemicals fumes,

allergens and smoking Acid reflux, also called gastro esophageal

reflux disease GERD Chronic sinusitis Excessive alcohol abuse Habitual overuse of your voice Smoking

Clinical manifestation: Tickling sensation and rawness of your throat Sore throat Dry throat Dry cough Acute: Hoarseness and aphonia Chronic: Severe cough

Medical Management: Resting of voice Avoiding or smoking cessation Inhaling cool steam or an aerosol Avoiding second-hand smoking Topical corticosteroids (vanceril) Nursing management: Instruct the patient to rest the voice Maintain well humidified environment If secretion is present: expectorant Increase oral fluid intake up to 3L/day

Medication

Antibiotics

Corticosteroids

Test and Diagnosis

Laryngoscopy

Biopsy

Nursing Diagnosis;

Impaired verbal communication Hypertermia Impaired swallowing Imbalance nutrition less than

bodyrequirments

Acute Pharyngitis

- Is an infection or inflammation in the throat, usually caused by a viral organism.

- Common in patient younger than 25 years old

Pathophysiology

The inflammatory response results in the throat, with pain, fever, vasodilatation, edema, and tissue damage (redness and swelling, in the tonsillar pillars, uvula, and soft palate ).

Pharyngitis caused by streptococcus is a more severe illness because of dangerous complications

Signs and Symptoms

Feiry red pharyngeal membrane and tonsils. Lymphoid follicles swollen and freckled with

white-purple exudate Cervical lymph nodes enlarged and tender Fever, malaise, and sore throat Hoarseness

Diagnostic Methods

Rapid screening test for streptococcal antigens

optical immunoassay Steptolysin titers Throat cultures nasal swabbing and blood cultures

Medical Management

Antibiotic agents- to treat pharyngitis caused by bacteria.(Penicillin and Cephalosphorin)

Analgesic and antitussive medications liquid or soft diet is recommended IV fluid is given if patient cannot swallow

Nursing Management Encourage bed rest during febrile stage of

illness Implement secretion precautions to prevent

spread of infection Administer warm saline gargles or irrigations to

ease pain. Performed mouth care to prevent fissures of lips

and inflammation of the mouth Inform patient and family of symptoms to watch

for that may indicate development of complications, including nephritis and rheumatic fever.

Chronic Pharyngitiscommon in: Adults who work or live in dusty surrounding Use their voices to excess Chronic cough Habitually use alcohol and tobacco

Signs and Symptoms

Constant sense of irritation or fullness in the throat.

Mucous that collects in the throat and is expelled by coughing

Difficulty swallowing

Medical Management

Treatment is based on symptoms relief, avoidance of exposure to irritants

Nasal sprays- to relieve nasal congestion Aspirin or Acetaminophen- to control

inflammation and relieve discomfort

Nursing Management Advise patient to avoid contact with others until

fever has subsided completely to prevent infection from spreading

Instruct patient to avoid alcohol, tobacco, secondhand smoke, exposure to cold, and environmental and occupational pollutant.

Suggest to wear disposable mask for protection Encourage to increase OFI and encourage

gargling with warm salt water to relieve throat discomfort

Nursing Diagnoses

hyperthermia Impaired oral mucous membrane Impaired swallowing

PrognosisA sore throat usually goes away quickly on its own. If you

have had a sore throat for more than a week, or you have a fever, swollen lymph nodes, or a rash, you should call your doctor right away. Fever, swollen lymph nodes, or a rash may indicate strep throat or a complication such as rheumatic fever

Nursing process: Assessment With upper airway infection; sinusitis,

laryngitis, and pharyngitis A health assessment may reveal sign and

symptoms: Head ache Sore throat Pain around the eyes on either side of the

nose Difficulty of swallowing Cough

Hoarseness Fever Stuffiness Generalized discomfort Fatigue

Inspection may reveal: Swelling, redness, ulceration, lesion,

evidence of drainage, enlargement, asymmetry of the nose as well as bleeding or discharge

Palpation Tenderness Inflammation Enlargement of the lympnodes

Nursing Diagnosis:

Ineffective airway clearance related to excessive mucus production secondary to retained secretion and inflammation

Acute pain related to upper airway irritation secondary to infection

Impaired verbal communication related to physiologic changes and upper airway irritation secondary to infection or swelling

Deficient fluid volume related to increase fluid loss secondary to diaphoresis associated with fever

Deficient knowledge regarding prevention of the upper respiratory infection treatment regimen, surgical procedure, of post operative

Planning goals:

Maintenance of a patent airway Relief of pain Maintenance of effective means of

communication Normal hydration Knowledge of how to prevent upper airway

infection Absence of complications

Nursing intervention:

Maintaining a patent airway Promoting comfort Promoting communication Encouraging fluid intake Health teaching

Evaluation

Maintains a patent airways by managing secretions

Reports of felling more comfortable Demonstrate ability to communicate needs

and wants, level of discomfort Maintains adequate fluid intake Identifies strategies of preventions Free from sig and symptoms

thank you for listening!!!!