NSC 305

SINUSITIS

INTRODUCTION

The respiratory system is the network of organs and tissues that help you breathe. It
includes your airways, lungs and blood vessels. The muscles that power your lungs
are also part of the respiratory system. These parts work together to move oxygen
throughout the body and clean out waste gases like carbon dioxide. The upper
respiratory tract (upper airway) consists of the nose, mouth, sinuses, pharynx (upper
section of the throat), and larynx (voice box). The lower respiratory tract consists of
the trachea (windpipe), bronchial tubes, and lungs.

Sinuses are four paired of bones around the head which are connected together
by a narrow channel. The mucus membrane is drained from the sinus to the nose. This
part of the body supposed to be filled with air, but when replaced with fluid supported
the growth of bacteria, hence causing the inflammation of these sites, a condition
known as SINUSITIS.

AN ANATOMICAL DIAGRAM OF THE SINUSIS

What is sinusitis?

Sinusitis is an inflammation, or swelling, of the tissue lining the sinuses. The sinuses
are four paired cavities (spaces) in the head. They are connected by narrow channels.
The sinuses make thin mucus that drains out of the channels of the nose. This
drainage helps keep the nose clean and free of bacteria. Normally filled with air, the
sinuses can get blocked and filled with fluid. When that happens, bacteria can grow
and cause an infection (bacterial sinusitis). This is also called rhinosinusitis, with
“rhino” meaning “nose.” The nasal tissue is almost always swollen if sinus tissue is
inflamed.

What are the different types of sinuses near the nose and eyes?

The paranasal sinuses are located in your head near your nose and eyes. They are
named after the bones that provide their structure.

The ethmoidal sinuses are located between your eyes.

The maxillary sinuses are located below your eyes.

The sphenoidal sinuses are located behind your eyes.

The frontal sinuses are located above your eyes.

The biggest sinus cavity is the maxillary cavity, and it is one of the cavities that most
often become infected.

There are different types of sinusitis:

Acute bacterial sinusitis: This term refers to a sudden onset of cold symptoms such as
runny nose, stuffy nose, and facial pain that does not go away after 10 days, or
symptoms that seem to improve but then return and are worse than the initial
symptoms (termed “double sickening”). It responds well to antibiotics and
decongestants.

Chronic sinusitis: This term refers to a condition defined by nasal congestion,

drainage, facial pain/pressure, and decreased sense of smell for at least 12 weeks.

Sub acute sinusitis: This term is used when the symptoms last four to twelve weeks.

Recurrent acute sinusitis: This term is used when the symptoms come back four or
more times in one year and last less than two weeks each time.

Who gets sinusitis?

A sinus infection can happen to anyone. However, people with nasal allergies, nasal
polyps, asthma and abnormal nose structures are all more likely to get sinusitis.
Smoking can also increase how often you get a sinus infection.

There are an estimated 31 million people in the United States with sinusitis

CAUSES OF SINUSITIS

 The common cold

 Nasal and seasonal allergies
 Polyps(growth)
 A deviated septum
 A weak immune system from illness or medication
 PATHOPHYSIOLOGY

The most common cause of acute sinusitis is an upper respiratory tract infection
(URTI) of viral origin. The viral infection can lead to inflammation of the sinuses that
usually resolves without treatment in less than 14 days. If symptoms worsen after 3 to
5 days or persist for longer than 10 days and are more severe than normally
experienced with a viral infection, a secondary bacterial infection is diagnosed. The
inflammation can predispose to the development of acute sinusitis by causing sinus
ostial blockage. Although inflammation in any of the sinuses can lead to blockade of
the sinus ostia, the most commonly involved sinuses in both acute and chronic
sinusitis are the maxillary and the anterior ethmoid sinuses. The anterior ethmoid,
frontal, and maxillary sinuses drain into the middle meatus, creating an anatomic area
known as the ostiomeatal complex.

The nasal mucosa responds to the virus by producing mucus and

recruiting mediators of inflammation, such as white blood cells, to the lining of the
nose, which cause congestion and swelling of the nasal passages. The resultant sinus
cavity hypoxia and mucus retention cause the cilia which move mucus and debris
from the nose to function less efficiently, creating an environment for bacterial
growth. If the acute sinusitis does not resolve, chronic sinusitis can develop from
mucus retention, hypoxia, and blockade of the Ostia. This promotes mucosal
hyperplasia, continued recruitment of inflammatory infiltrates, and the potential
development of nasal polyps. However, other factors can predispose to sinusitis.
When bacterial growth occurs in acute sinusitis, the most common organisms include
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. In
chronic sinusitis, these organisms, plus Staphylococcus aureus, coagulase-negative
Staphylococcus species, and anaerobic bacteria, are the most likely involved
organisms. Organisms isolated from patients with chronic sinusitis increasingly are
showing antibiotic resistance. In fact, penicillin resistance rates for S. pneumoniae are
as high as 44% in parts of the United States. These resistant organisms commonly
occur in patients who have received two or more recent courses of antibiotics.

TREATMENT

The most common cause of acute sinusitis is an upper respiratory tract infection
(URTI) of viral origin. The viral infection can lead to inflammation of the sinuses that
usually resolves without treatment in less than 14 days. If symptoms worsen after 3 to
5 days or persist for longer than 10 days and are more severe than normally
experienced with a viral infection, a secondary bacterial infection is diagnosed. The
inflammation can predispose to the development of acute sinusitis by causing sinus
ostial blockage. Although inflammation in any of the sinuses can lead to blockade of
the sinus ostia, the most commonly involved sinuses in both acute and chronic
sinusitis are the maxillary and the anterior ethmoid sinuses. The anterior ethmoid,
frontal, and maxillary sinuses drain into the middle meatus, creating an anatomic area
known as the ostiomeatal complex.

The nasal mucosa responds to the virus by producing mucus and

recruiting mediators of inflammation, such as white blood cells, to the lining of the
nose, which cause congestion and swelling of the nasal passages. The resultant sinus
cavity hypoxia and mucus retention cause the cilia which move mucus and debris
from the nose to function less efficiently, creating an environment for bacterial
growth. If the acute sinusitis does not resolve, chronic sinusitis can develop from
mucus retention, hypoxia, and blockade of the Ostia. This promotes mucosal
hyperplasia, continued recruitment of inflammatory infiltrates, and the potential
development of nasal polyps. However, other factors can predispose to sinusitis.
When bacterial growth occurs in acute sinusitis, the most common organisms include
Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. In
chronic sinusitis, these organisms, plus Staphylococcus aureus, coagulase-negative
Staphylococcus species, and anaerobic bacteria, are the most likely involved
organisms. Organisms isolated from patients with chronic sinusitis increasingly are
showing antibiotic resistance. In fact, penicillin resistance rates for S. pneumoniae are
as high as 44% in parts of the United States. These resistant organisms commonly
occur in patients who have received two or more recent courses of antibiotics.

Clinical manifestations

 Running nose
 Loss of smell
 cough or congestion
 fever
 bad breath
 fatigue

Complications of sinusitis include the following:

1) Orbital cellulitis

2) Subperiosteal abscess

3) Orbital abscess

4) Mastoiditis

5) Frontal or maxillary osteomyelitis

6) Subdural abscess

7) Cavernous sinus thrombosis

8) Brain abscess
Prevention of Sinusitis

There is no sure-fire way to prevent sinusitis. But there are some things that might
help;

1) Don’t smoke, and avoid other people's smoke.

2) Wash your hands often, especially during cold and flu season, and try not to touch
your face.

3) Stay away from things you know you’re allergic to. Talk to your doctor to see if
you need prescription medicines, allergy shots, or other forms of immunotherapy

Nursing Management

1) Apply warm compress in the sinus area

2) Increase fluid intake

3) Educate the patient to avoid cold environment

4) Promote oral hygiene

5) Avoid smoking

6) Avoid blowing nose

Rhinitis
Entry Behaviour
Students have previous knowledge of Anatomy and Physiology of Respiratory System,
diagnostic investigations. This is established by asking the following questions:
1. Describe the Nose
2. Describe the respiratory process
3. Mention 3 diagnostic investigations of respiratory System disorders.
Instructional objectives
At the end of this lecture the students will be able to:
1. Define rhinitis
2. State the causes of rhinitis.
3. Explain the pathophysiology of rhinitis
4. Outline the symptoms of rhinitis
Content
Rhinitis is common, affecting nearly everyone at one time or the other
Definition of rhinitis; it is a group of disorders characterized by inflammation
and irritation of the mucous membranes of the nose
Types/causes of rhinitis
1. Acute or chronic
2. Nonallergic or allergic

Allergic rhinitis is commonly associated with exposure to airborne particles such as

dust, plant pollens in people who are allergic to these substances
Pathophysiology
Rhinitis is caused by a variety of factors, including changes in temperature, odours,
infection, age, use of OTC. Allergic rhinitis may occur with exposure to allergens
such as food, medications, and particles in the indoor and outdoor environment. The
most common cause o nonallergic rhinitis is common cold. Drug induced rhinitis may
occur with antihypertensive agents such as ACE inhibitors and beta blockers
Signs and symptoms
1. Rhinorrhea {runny nose}
2. Nasal congestion
3. Nasal discharge
4. Sneezing
5. Headache may occur
6. Pruritus of the nose, roof of the mouth, eyes, and ears.
Diagnosis
Diagnosis is made based on history obtained from the patient and physical
examination of the nose. Observe for discharge, nasal congestion

Nursing Management
The nurse asks the patient about recent symptoms as well as possible allergens in the
home, environment or workplace and advise the patient to stay away from or reduce
exposure to allergies
The nurse instructs the patient on correct administration of nasal medications.
The nurse reviews hand hygiene with the patient as a measure to prevent transmission
of organisms in case of infectious rhinitis.

Medical Management
The management of rhinitis depends on the cause. For allergic and nonallergic rhinitis,
Antihistamines and corticosteroids nasal sprays may be useful
Prevention
Stay away from allergies
Complication
This include:
1. Otitis media
2. Sleep disturbance or apnea
3. Acute or chronic sinusitis
4. Dental problems
Summary So far we have been able to discuss rhinitis which is the disease or
inflammation of the mucous membranes of the nose causes/types, signs and
symptoms, pathophysiology, management, prevention and complication.
In conclusion, it is good to note here that nurses have gotten role to play in
preventing occurrence of rhinitis in our society by health educating people on the
predisposing factors of this condition.
- What is rhinitis
- What are the causes of this condition?
- Enumerate 2 types of rhinitis
- How can this disease condition be prevented
- What are the likely complications?

Tonsilitis
Entry Behaviour
Students have previous knowledge of Anatomy and Physiology of Respiratory System,
diagnostic investigations and inflammation disorders related to Respiratory system.
This is established by asking the following questions:
1. Describe the Anatomy of the Tonsils
2. Describe the inflammatory process
3. Describe measures to treat an inflammation
Instructional objectives
At the end of this lecture the students will be able to:
1. Define Tonsillitis.
2. List the types of Tonsillitis.
3. Explain the pathophysiology of Tonsillitis.
4. State the management guidelines for tonsillitis.
Content
The tonsils are a set of lymphoid organs facing into the aero digestive tract. There are
four major types of tonsils which are the adenoid tonsil, the two tubal tonsils, two
palatine tonsils, and the lingual tonsils.
Definition of Tonsillitis: Tonsillitis is an acute inflammation of the tonsils. It is
common and often a painful condition usually caused by beta haemolytic
streptococcus
Types of tonsillitis

[Link] Tonsillitis: this is a situation in which the tonsil is involved in general

inflammation
[Link] tonsillitis: This is a situation in which the crypts of the tonsils are filled
with pus and can be seen as small yellowish spots scattered over the surface of the red
and swollen tonsils
[Link] tonsils: this is a condition in which the infection spreads into the
surrounding tissue producing a peritonsilar abscess or quinsy
Causes of tonsillitis include:
 Streptococcus bacteria
 Adenoviruses
 Epstein-barr virus
 Enteroviruses
 Herpes simplex virus
N.B: children are at greater risk of having tonsillitis
Pathophysiology
The pathophysiology is basically an inflammation process. When the inflammation
sets in, the organ becomes reddened, painful and swollen and because of its
anatomical position, swallowing becomes difficult or painful(dysphagia). The
accompanying toxaemia produces other symptoms like fever, malaise and headache
Signs and symptoms
The symptoms include:
1. Enlarged tonsils
2. Dysphagia
3. Fever
4. Malaise
5. Headache
6. Soreness in the throat
Complications:
1. Peritonsilar abscess
2. Hypertrophy of the tonsils
3. septicaemia
The diagnostic indices for tonsillitis includes:
 Throat swab for microscopic culture: to identify the causative organism
 Laboratory analysis of blood: full blood count may reveal leucocytosis
 Oral examination will reveal swollen reddened tonsils

Nursing management of tonsillitis

[Link]: the patient requires bed rest to conserve energy. It also helps to mobilize
defence mechanism against the infection

2. Nutrition and Fluid: high proteinous, semi-solid diet is given when the patient can
swallow. Adequate fluid intake should be encouraged.
[Link] hygiene: oral hygiene should be carried out at frequent intervals because of
patients predisposition to mouth infections and halitosis

[Link]: Vital should be duly monitored and measures to reduce temperature

should be done
Medical Management
[Link] depending on the laboratory result
2. Analgesics e.g. aspirin gargle can be given to relieve pain
3. Vitamins especially vitamin C to aid healing

Surgical management
This involves the removal of the tonsils- tonsillectomy
Prevention
 Regular washing of hands, especially before touching the nose or mouth
 Not sharing personal items such as toothbrush, utensils etc
Summary
In today’s class we have been able to successfully discuss tonsillitis- inflammation of
the tonsils, the types , causes. Also we’ve discussed the pathophysiology which is an
inflammatory process. The management both medical and nursing has been duly
explained.

It is important to note the roles and responsibilities of a nurse in the management of

patient with tonsillitis and those that will be undergoing tonsillectomy
Questions
 what are the clinical manifestations of tonsillitis
 which group of people are majorly at risk of having tonsillitis
 what are the preventive measures of tonsillitis