Causes of Nose conditions
Nose conditions Causes: Book Excerpts
Medications or substances causing Nose conditions:
The following drugs, medications, substances or toxins are some of the possible
causes of Nose conditions as a symptom.
This list is incomplete and various other drugs or substances
may cause your symptoms.
Always advise your doctor of any medications or treatments you are using,
including prescription, over-the-counter, supplements, herbal or alternative treatments.
Read more about medication causes of Nose conditions
Related information on causes of Nose conditions:
As with all medical conditions,
there may be many causal factors.
Further relevant information on causes of Nose conditions may be found in:
Causes of Nose conditions: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the causes of Nose conditions.
Nasal Congestion:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Upper respiratory infection
–Most common cause of nasal congestion
–Respiratory droplet spread, 1–2 day
incubation, duration 7–14 days
–Cough, rhinorrhea, fever, malaise
–Viral etiology (adenovirus, rhinovirus)
-
Perennial allergic rhinitis
–Family history of allergy
–Onset <20 years
–Persistent watery nasal discharge
–No variation with season
–Pale, bluish, watery, nasal mucosa
-
Seasonal allergic rhinitis
–Itchy, teary eyes
–Sneezing
–Watery nasal discharge
–Varies with season
–Exposure to allergen (dust, mold, pollen)
–Pale, bluish, watery, nasal mucosa
-
Perennial nonallergic rhinitis
–No variation with season
–Obstruction may alternate nares
–Swollen nasal mucosa -
Sinusitis (acute or chronic)
–Patients often have a history of sinusitis
–Craniofacial discomfort
–Sinus headaches
–Pain with percussion of teeth in maxillary sinusitis
–Retro-orbital pain upon coughing or sneezing in cases of ethmoid sinusitis
–Mucopurulent nasal drainage
-
Rhinitis medicamentosa (rebound rhinitis)
–Prolonged use of intranasal decongestants
-
NARES
-
Nasal polyps
-
Vasomotor rhinitis
-
Foreign body in nose
-
Intranasal cocaine use
–May see nasal septum perforation -
Medication side effects (e.g. aspirin, β-blockers, NSAIDs, oral contraceptives,
reserpine, and thioridazine)
-
Idiopathic rhinitis
-
Less common etiologies include cystic fibrosis, Wegener's granulomatosis, folliculitis of nasal hair, congenital abnormality, sarcoidosis
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» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Nasal Obstruction & Rhinorrhea:
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
-
Physiologic
–Nasal cycle
–Nasopulmonary reflex
–Puberty
–Menstruation and pregnancy
-
Congenital
–Choanal atresia or stenosis
–Cleft palate
–Craniofacial syndromes such as Treacher Collins, Crouzon
-
Cyst
–Dermoid, meningocele, or encephalocele
–Thornwaldt
- Infectious
–Bacterial rhinosinusitis with Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis, staph
–Viral rhinosinusitis with rhinovirus, adenovirus, coxsackie
-
Viral prodrome
–Measles, mumps, mono, polio
-
Fungal (if immunocompromised)
–Aspergillosis, mucormycosis
-
Inflammatory
–Allergic rhinitis
–Nasal polyps
–Adenoid hypertrophy
–Nasopharyngeal GERD
-
Granulomatous
–Sarcoidosis
–Wegener syndrome
–SLE
–Churg-Strauss syndrome
-
Traumatic
–Foreign body
–Septal hematoma
–Septal abscess
-
Neoplastic
–Chordoma
–Craniopharyngioma
–Juvenile angiofibroma
–Olfactory neuroblastoma
-
Cystic fibrosis
-
Thyroid disease (hypo- or hyper-)
-
Ciliary dyskinesia
–Kartagener, immotile cilia syndrome, etc.
-
Chronic rhinitis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Epistaxis (Nosebleed):
Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)
- Trauma
–Dry air, especially in winter months
–Digital trauma (nose-picking)
–Nasogastric or nasotracheal tube
–Blunt trauma, with or without fracture
–Foreign body: Usually accompanied by unilateral foul-smelling rhinorrhea
–Air pollution (indoor or outdoor)
–Barotrauma: Diving or airplane descent in
patient with upper respiratory infection
–Chemical or caustic burn
- Inflammation
–Upper respiratory infection (viral or bacterial)
–Rhinitis (allergic, nonallergic with eosinophilia, atrophic, chronic): Results in increased mucosal vascularity and increased trauma from sneezing, rubbing, and nose blowing
–Vestibulitis
-
Anatomic
–Nasal septal deviation
–Postoperative, following sinus surgery, adenoidectomy, septoplasty, etc.
-
Platelet dysfunction
–NSAID use, especially aspirin
–Idiopathic thrombocytopenic purpura
–Leukemia
-
Coagulopathy
–Von Willebrand disease
–Hemophilia
–Liver disease
–Anticoagulants (coumadin, heparin)
-
Benign masses
–Nasopharyngeal angiofibroma: Presents only in adolescent males
–Pyogenic granuloma
–Papilloma
-
Malignant neoplasms
–Rhabdomyosarcoma
–Lymphoma
- Vascular abnormalities
–Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease): Autosomal dominant, 90% with recurrent epistaxis
–Hemangioma
–Internal carotid pseudoaneurysm (suspect with massive bleed after head trauma)
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Butterfly rash:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
❑ Discoid lupus erythematosus. With discoid lupus erythematosus, a localized form of LE, the patient may come into your facility with a unilateral or butterfly rash that consists of erythematous, raised, sharply demarcated plaques with follicular plugging and central atrophy. The rash may also involve the scalp, ears, chest, or any part of the body exposed to the sun. Telangiectasia, scarring alopecia, and hypopigmentation or hyperpigmentation may occur later. Other accompanying signs include conjunctival redness, dilated capillaries of the nail fold, bilateral parotid gland enlargement, oral lesions, and mottled, reddish blue skin on the legs.
❑ Erysipelas. Erysipelas causes rosy or crimson swollen lesions, mainly on the neck and head and commonly along the nasolabial fold. It may cause hemorrhagic pus-filled blisters. Other signs and symptoms include fever, chills, cervical lymphadenopathy, and malaise.
❑ Polymorphous light eruption. Butterfly rash appears as erythema, vesicles, plaques, and multiple small papules that may later become eczematized, lichenified, and excoriated. Provoked by ultraviolet rays, the rash appears on the cheeks and bridge of the nose, the hands and arms, and other areas, beginning a few hours to several days after exposure. It may be accompanied by pruritus.
❑ Rosacea. Initially, butterfly rash may appear as a prominent, nonscaling, intermittent erythema limited to the lower half of the nose or including the chin, cheeks, and central forehead. As rosacea develops, the duration of the rash increases; instead of disappearing after each episode, the rash varies in intensity and is commonly accompanied by telangiectasia. With advanced rosacea, the skin is oily, with papules, pustules, nodules, and telangiectasis restricted to the central oval of the face. In men with severe rosacea, butterfly rash may be accompanied by rhinophyma — a thickened, lobulated overgrowth of sebaceous glands and epithelial connective tissue on the lower half of the nose and, possibly, the adjacent cheeks. This is more common in elderly patients.
❑ Seborrheic dermatitis. Butterfly rash appears as greasy, scaling, slightly yellow macules and papules of varying size on the cheeks and the bridge of the nose, in a “butterfly” pattern. The scalp, beard, eyebrows, portions of the forehead above the bridge of the nose, nasolabial fold, or trunk may also be involved. Associated signs and symptoms include crusts and fissures (particularly when the external ear and scalp are involved), pruritus, redness, blepharitis, styes, severe acne, and oily skin. Severe seborrheic dermatitis of the face occurs in acquired immunodeficiency syndrome.
❑ Systemic lupus erythematosus. Occurring in about 40% of patients with this connective tissue disorder, butterfly rash appears as a red, usually scaly, sharply demarcated macular eruption. The rash may be transient in patients with acute SLE or may progress slowly to include the forehead, the chin, the area around the ears, and other exposed areas. Common associated skin findings include scaling, patchy alopecia, mucous membrane lesions, mottled erythema of the palms and fingers, periungual erythema with edema, reddish purple macular lesions on the volar surfaces of the fingers, telangiectasia of the base of the nails or eyelids, purpura, petechiae, and ecchymoses.
Butterfly rash may also be accompanied by joint pain, stiffness, and deformities, particularly ulnar deviation of the fingers and subluxation of the proximal interphalangeal joints. Related findings include periorbital and facial edema, dyspnea, a low-grade fever, malaise, weakness, fatigue, weight loss, anorexia, nausea, vomiting, lymphadenopathy, photosensitivity, and hepatosplenomegaly.
Other causes
❑ Drugs. Hydralazine and procainamide can cause a lupuslike syndrome.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Nasal flaring:
Medical causes
(Handbook of Signs & Symptoms (Third Edition))
Acute respiratory distress syndrome (ARDS)
ARDS causes increased respiratory difficulty and hypoxemia, with nasal flaring, dyspnea, tachypnea, diaphoresis, cyanosis, scattered crackles, and rhonchi. It also produces tachycardia, anxiety, and a decreased level of consciousness (LOC).
Airway obstruction
Complete obstruction above the tracheal bifurcation causes sudden nasal flaring, absent breath sounds despite intercostal retractions and marked accessory muscle use, tachycardia, diaphoresis, cyanosis, a decreasing LOC and, eventually, respiratory arrest.
Partial obstruction causes nasal flaring with inspiratory stridor, gagging, wheezing, a violent cough, marked accessory muscle use, agitation, cyanosis, and hoarseness.
Anaphylaxis
Severe reactions can produce respiratory distress with nasal flaring, stridor, wheezing, accessory muscle use, intercostal retractions, and dyspnea. Associated signs and symptoms include nasal congestion, sneezing, pruritus, urticaria, erythema, diaphoresis, angioedema, weakness, hoarseness, dysphagia and, rarely, vomiting, nausea, diarrhea, urinary urgency, and incontinence. Cardiac arrhythmias and signs of shock may occur late.
Asthma (acute)
An asthma attack can cause nasal flaring, dyspnea, tachypnea, prolonged expiratory wheezing, accessory muscle use, cyanosis, and a dry or productive cough. Auscultation may reveal rhonchi, crackles, and decreased or absent breath sounds. Other findings include anxiety, tachycardia, and increased blood pressure.
Chronic obstructive pulmonary disease (COPD)
COPD can lead to acute respiratory failure secondary to pulmonary infection or edema. Nasal flaring is accompanied by prolonged pursed-lip expiration; accessory muscle use; a loose, rattling, productive cough; cyanosis; reduced chest expansion; crackles; rhonchi; wheezing; and dyspnea.
Pneumothorax
Pneumothorax is an acute disorder that can result in respiratory distress with nasal flaring, dyspnea, tachypnea, shallow respirations, hyperresonance or tympany on percussion, agitation, jugular vein distention, tracheal deviation, and cyanosis. Other findings typically include sharp chest pain, tachycardia, hypotension, cold and clammy skin, diaphoresis, subcutaneous crepitation, and anxiety. Breath sounds may be decreased or absent on the affected side; similarly, chest wall motion may be decreased on the affected side.
Similar findings can occur with hydrothorax, chylothorax, or hemothorax, depending on the amount of fluid accumulation.
Pulmonary edema
Pulmonary edema typically produces nasal flaring, severe dyspnea, wheezing, and a cough that produces frothy, pink sputum. Increased accessory muscle use may occur with tachycardia, cyanosis, hypotension, crackles, jugular vein distention, peripheral edema, and a decreased LOC.
Pulmonary embolus
Signs of pulmonary embolus, a potentially life-threatening disorder, may include nasal flaring, dyspnea, tachypnea, wheezing, cyanosis, a pleural friction rub, and a productive cough (possibly hemoptysis). Its other effects include sudden chest tightness or pleuritic pain, tachycardia, atrial arrhythmias, hypotension, a low-grade fever, syncope, marked anxiety, and restlessness.
Other causes
Diagnostic tests
Pulmonary function tests, such as vital capacity testing, can produce nasal flaring with forced inspiration or expiration.
Treatments
Certain respiratory treatments, such as deep breathing, can cause nasal flaring.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Nasal papillomas:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
A papilloma may arise as a benign precursor of a neoplasm or as a response to tissue injury or viral infection, but its cause is unknown. Both types of papillomas are most prevalent in males. Recurrence is common, even after surgical excision.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Nasal polyps:
Causes and incidence
(Professional Guide to Diseases (Eighth Edition))
Nasal polyps are usually produced by the continuous pressure resulting from a chronic allergy that causes prolonged mucous membrane edema in the nose and sinuses. Other predisposing factors include chronic sinusitis, chronic rhinitis, and recurrent nasal infections.
Nasal polyps are more common in adults than in children and tend to recur. They’re also commonly seen in patients with long-term allergic rhinitis. About 1 in 4 people with cystic fibrosis have nasal polyps.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Butterfly rash:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Discoid lupus erythematosus
Discoid lupus erythematosus is a localized form of lupus erythematosus characterized by a rash on one or both sides of the face that consists of erythematous, raised, sharply demarcated plaques with follicular plugging and central atrophy. The rash may also involve the scalp, ears, chest, and any part of the body exposed to the sun. Telangiectasia, scarring alopecia, and hypopigmentation or hyperpigmentation may occur later. Other accompanying signs include conjunctival redness, dilated capillaries of the nail fold, bilateral parotid gland enlargement, oral lesions, and mottled, reddish blue skin on the legs.
Erysipelas
Erysipelas causes rosy or crimson swollen lesions, mainly on the neck and head and commonly along the nasolabial fold. It may cause hemorrhagic pus-filled blisters. Other signs and symptoms include fever, chills, cervical lymphadenopathy, and malaise.
Polymorphous light eruption
A butterfly rash appears as erythema, vesicles, plaques, and multiple small papules that may later become eczematized, lichenified, and excoriated. Provoked by ultraviolet rays, the rash appears on the cheeks and bridge of the nose, the hands and arms, and other areas, beginning a few hours to several days after exposure. It may be accompanied by pruritus.
Rosacea
Initially, the rash may appear as a prominent, nonscaling, intermittent erythema limited to the lower half of the nose or including the chin, cheeks, and central forehead. As rosacea develops, the duration of the rash increases; instead of disappearing after each episode, the rash varies in intensity and is commonly accompanied by telangiectasia. In advanced rosacea, the skin is oily, with papules, pustules, nodules, and telangiectasia restricted to the central oval of the face. In men with severe rosacea, the butterfly rash may be accompanied by rhinophyma—a thickened, lobulated overgrowth of sebaceous glands and epithelial connective tissue on the lower half of the nose and, possibly, the adjacent cheeks. This is more common in elderly patients.
Seborrheic dermatitis
In this disorder, greasy, scaling, slightly yellow macules and papules of varying size appear on the cheeks and the bridge of the nose in a butterfly pattern. The scalp, beard, eyebrows, portions of the forehead above the bridge of the nose, nasolabial fold, or trunk may also be involved. Associated signs and symptoms include crusts and fissures (particularly when the external ear and scalp are involved), pruritus, redness, blepharitis, styes, severe acne, and oily skin. Severe seborrheic dermatitis of the face occurs in acquired immunodeficiency syndrome.
Systemic lupus erythematosus (SLE)
Occurring in about 40% of patients with SLE—a connective tissue disorder—a butterfly rash appears as a red, often scaly, sharply demarcated macular eruption. The rash may be transient in patients with acute SLE or may progress slowly to include the forehead, chin, the area around the ears, and other exposed areas. Common associated skin findings include scaling, patchy alopecia, mucous membrane lesions, mottled erythema of the palms and fingers, periungual erythema with edema, reddish purple macular lesions on the volar surfaces of the fingers, telangiectasia of the base of the nails or eyelids, purpura, petechiae, and ecchymoses.
The rash may be accompanied by joint pain, stiffness, and deformities, particularly ulnar deviation of the fingers and subluxation of the proximal interphalangeal joints. Related findings include periorbital and facial edema, dyspnea, low-grade fever, malaise, weakness, fatigue, weight loss, anorexia, nausea, vomiting, lymphadenopathy, photosensitivity, and hepatosplenomegaly.
Other causes
Drugs
Hydralazine and procainamide can cause a lupuslike syndrome.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nasal flaring:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Acute respiratory distress syndrome (ARDS)
ARDS causes increased respiratory difficulty and hypoxemia, with nasal flaring, dyspnea, tachypnea, diaphoresis, cyanosis, scattered crackles, and rhonchi. It also produces tachycardia, anxiety, and decreased level of consciousness.
Airway obstruction
Complete obstruction above the tracheal bifurcation causes sudden nasal flaring, absent breath sounds despite intercostal retractions and marked accessory muscle use, tachycardia, diaphoresis, cyanosis, decreasing level of consciousness and, eventually, respiratory arrest.
Partial obstruction causes nasal flaring with inspiratory stridor, gagging, wheezing, violent cough, marked accessory muscle use, agitation, cyanosis, and hoarseness.
Anaphylaxis
Severe reactions can produce respiratory distress with nasal flaring, stridor, wheezing, accessory muscle use, intercostal retractions, and dyspnea. Associated signs and symptoms include nasal congestion, sneezing, pruritus, urticaria, erythema, diaphoresis, angioedema, weakness, hoarseness, dysphagia and, rarely, vomiting, nausea, diarrhea, urinary urgency, and incontinence. Cardiac arrhythmias and signs of shock may occur late.
Asthma (acute)
An asthma attack can cause nasal flaring, dyspnea, tachypnea, prolonged expiratory wheezing, accessory muscle use, cyanosis, and a dry or productive cough. Auscultation may reveal rhonchi, crackles, and decreased or absent breath sounds. Other findings include anxiety, tachycardia, and increased blood pressure.
Chronic obstructive pulmonary disease
This disorder can lead to acute respiratory failure secondary to pulmonary infection or edema. Nasal flaring is accompanied by prolonged pursed-lip expiration; accessory muscle use; loose, rattling, productive cough; cyanosis; reduced chest expansion; crackles; rhonchi; wheezing; and dyspnea.
Pneumonia (bacterial)
With this condition, nasal flaring occurs with dyspnea, tachypnea, high fever, and sudden shaking chills. An initially dry and hacking cough later becomes productive. Stabbing chest pain worsens with movement and respirations. Auscultation reveals decreased or absent breath sounds, fine crackles, and pleural friction rub. Percussion reveals dullness.
Pneumothorax
This acute disorder can result in respiratory distress with nasal flaring, dyspnea, tachypnea, shallow respirations, hyperresonance or tympany on percussion, agitation, distended jugular veins, tracheal deviation, and cyanosis. Other findings typically include sharp chest pain, tachycardia, hypotension, cold and clammy skin, diaphoresis, subcutaneous crepitation, and anxiety. Breath sounds may be decreased or absent on the affected side; similarly, chest-wall motion may be decreased on the affected side.
Similar findings can occur with hydrothorax, chylothorax, or hemothorax, depending on the amount of fluid accumulation.
Pulmonary edema
This disorder typically produces nasal flaring, severe dyspnea, wheezing, and a cough that produces frothy, pink sputum. Increased accessory muscle use may occur with tachycardia, cyanosis, hypotension, crackles, jugular vein distention, peripheral edema, and decreased level of consciousness.
Pulmonary embolus
Signs of this potentially life-threatening disorder may include nasal flaring, dyspnea, tachypnea, wheezing, cyanosis, pleural friction rub, and productive cough (possibly hemoptysis). Its other effects include sudden chest tightness or pleuritic pain, tachycardia, atrial arrhythmias, hypotension, low-grade fever, syncope, marked anxiety, and restlessness.
Other causes
Diagnostic tests
Pulmonary function tests, such as vital capacity testing, can produce nasal flaring with forced inspiration or expiration.
Treatments
Certain respiratory treatments, such as deep breathing, can cause nasal flaring.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nasal obstruction:
Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))
Basilar skull fracture
A tear in the dura can lead to cerebrospinal rhinorrhea, which increases when the patient lowers his head. Associated findings may include epistaxis, otorrhea, and a bulging tympanic membrane from blood or fluid. A fracture may also cause headache, facial paralysis, nausea, vomiting, impaired eye movement, ocular deviation, vision and hearing loss, depressed level of consciousness, Battle’s sign, and raccoon eyes.
Common cold
Onset of the common cold is typified by a watery discharge along with sneezing and nasal obstruction. Edema of the nasal mucosa may lead to sinus pain and infection as well as loss of smell and taste. Related findings include sore throat, malaise, myalgia, arthralgia, and mild headache.
Hypothyroidism
An underactive thyroid gland may lead to a generalized hypoactive state. This can lead to vascular dilation in the nasal mucosa, resulting in nasal obstruction. Associated findings include fatigue, weight gain despite anorexia, cold intolerance, facial edema, impaired memory, brittle hair, thick skin and tongue, bradycardia, and a hoarse voice.
Nasal deformities
Deviation of the nasal septum may cause unilateral or bilateral nasal obstruction, snoring, and postnasal drip. Perforation of the nasal septum may result in a sensation of nasal congestion due to altered air flow.
Nasal fracture
Nasal obstruction develops because of trauma that results in nasal mucosal swelling, epistaxis, abscess, or a septal deviation. Periorbital ecchymoses and edema, nasal deformity and pain, and crepitation of the nasal bones may occur as well.
Nasal polyps
The most common signs and symptoms are nasal obstruction, anosmia, and clear, watery drainage. The patient may have a history of allergies, chronic sinusitis, trauma, cystic fibrosis, or asthma. Translucent, pear-shaped polyps that are unilateral or bilateral occur.
Nasal tumors
Benign and malignant nasal tumors may cause unilateral or bilateral nasal obstruction, rhinorrhea, epistaxis, pain, foul discharge, and cheek swelling. Most of these tumors are benign papillomas and minor salivary gland tumors; malignant ones are rare. Kaposi’s sarcoma of the nose may occur in acquired immunodeficiency syndrome.
Nasopharyngeal tumors
Benign and malignant tumors of the nasopharynx may cause nasal obstruction, rhinorrhea, epistaxis, otitis media, and nasal speech. Tumors usually reach a considerable size before symptoms develop. Cancer of the nasopharynx is the most common malignancy of the nasopharynx and may present first with a neck mass or conductive hearing loss.
Pregnancy
High levels of estrogen during pregnancy may cause vascular engorgement of the nasal mucosa, resulting in nasal obstruction. Associated findings include clear or blood-tinged drainage, sneezing, and edematous and bluish turbinates.
Rhinitis
Allergic rhinitis produces intermittent watery discharge and nasal obstruction. Common signs and symptoms include sneezing, increased lacrimation, decreased sense of smell, postnasal drip, and itching of the eyes, nose, or ears. The mucosa is edematous and pale.
Vasomotor rhinitis produces a profuse watery nasal discharge in addition to nasal obstruction. Sneezing, postnasal drip, and swollen turbinates occur as well.
With atrophic rhinitis, nasal obstruction is chronic and continuous. Associated findings include intermittent, purulent drainage, foul drainage odor, and nasal crusts that bleed on removal. The mucosa is pale pink and shiny.
Sarcoidosis
This systemic granulomatous disease occasionally affects the nasal tissues. Nasal membranes appear firm, woody, and erythematous, and their surfaces may be covered by foul-smelling, crusty secretions. These features may occur with a nonproductive cough, substernal pain, malaise, and weight loss. Related findings include tachycardia, arrhythmias, parotid enlargement, cervical lymphadenopathy, skin lesions, hepatosplenomegaly, and arthritis in the ankles, knees, and wrist.
Sinusitis
With acute sinusitis, the usual findings are marked nasal obstruction along with thick, purulent drainage and severe pain over the involved sinuses. Fever, inflamed nasal mucosa with purulent mucus, and facial tenderness and pressure occur.
With chronic sinusitis, nasal obstruction can be persistent or recurrent. Thick, intermittently purulent rhinorrhea and low-grade discomfort over the involved sinuses are also seen.
Chronic fungal sinusitis is clinically similar to chronic bacterial sinusitis. However, in immunocompromised patients the disease may rapidly progress to proptosis, blindness, and death.
Wegener’s granulomatosis
Besides nasal obstruction, other nasal findings include crusting, epistaxis, mucopurulent discharge, and cartilaginous necrosis of the septum and bridge of the nose.
Other causes
Drugs
Topical nasal vasoconstrictors may cause rebound rhinorrhea and nasal obstruction if used longer than 5 days. Antihypertensives may cause nasal congestion as well.
Surgery
Nasal obstruction may occur after sinus or cranial surgery, or even after rhinoplasty.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nasal Congestion/Discharge:
Differential Overview
(Field Guide to Bedside Diagnosis)
❑ Common cold
❑ Allergic rhinitis
❑ Vasomotor rhinitis
❑ Nasal polyp
❑ Sinusitis
❑ Drugs
❑ Deviated septum
❑ Intranasal foreign body
❑ Sarcoidosis
❑ Cerebrospinal fluid leak
❑ Wegener granulomatosis
Clinical Findings
Common cold The onset is acute, with a scratchy sore throat and cough. The nasal mucosa will appear red, boggy, and glassy. The nasal drainage will initially be clear but will later become colored (yellow-green).
Allergic rhinitis Acute allergic rhinitis is often associated with eye irritation, paroyxms of sneezing, itching of the eyes, nose, or palate, and postnasal drip with cough. The nasal mucosa is bluish and pale. Seasonal rhinitis is usually caused by inhaled pollens. Perennial rhinitis is caused by allergy to animals, dust, mites, or mold.
Vasomotor rhinitis Congestion is prominent, but rhinorrhea, sneezing, and itching are not. Rhinitis medicamentosa occurs after 3 to 4 days of continuous use of a topical vasoconstrictor. There will be initial relief with its use that is then followed by rebound with worsened congestion. Vasomotor rhinitis may also be precipitated by cold, emotion, or sexual arousal. The turbinates are red and boggy.
Nasal polyp Unilateral airflow will be obstructed and a polyp will be visible deep inside, beyond the turbinate, as a gray structure with the appearance of a skinned grape. There is an association between aspirin use, nasal polyps, and asthma, but the most common cause is chronic allergic rhinitis.
Sinusitis Drainage, if present, will be purulent, although colored drainage can be found in other conditions. There will be a sensation of facial fullness that worsens with bending forward, often accompanied by fever and a headache. On physical examination, there will be tenderness to concussion and pressure, overlying warmth, and fever. The affected sinus will not transilluminate.
Drugs Cocaine, beta-blockers, reserpine, and hydralazine can each cause nasal obstruction.
Deviated septum Deviation causes chronic unilateral obstruction, which is readily observed with a nasal speculum.
Intranasal foreign body There will be nasal obstruction associated with a chronic unilateral mucopurulent discharge with a foul odor.
Sarcoidosis Sarcoidosis presents with bilateral nasal congestion in as many as 20% of cases. Systemic symptoms such as fever, fatigue, or weight loss; pulmonary symptoms such as cough or dyspnea; or skin manifestations such as erythema nodosum or purple, waxy plaques are clues to the underlying diagnosis.
Cerebrospinal fluid leak Head trauma with a basilar skull fracture may go unrecognized. Clear nasal drainage tests positive for glucose using a urine dipstick.
Wegener granulomatosis Its earliest manifestation may be nasal obstruction, rhinorrhea, crusting, and chronic sinusitis with a fetid drainage. Development of a septal ulceration is classic.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Nose, fractured:
Causes
(Handbook of Diseases)
With low-energy injuries, noncomminuted nasal bone fragments are caused by low-velocity trauma. Such injuries could occur in the following situations:
❑ injuries created during fistfights (hand or fist blows only, no blunt instruments)
❑ uncomplicated falls such as tripping
❑ low-velocity motor vehicle collision.
With high-energy injuries, a higher amount of energy is absorbed by the nasal and facial bones, with comminution of bone fragments and associated injuries to the soft tissue and orbitonasal skeleton. These injuries would include:
❑ injuries sustained from a leveraged blow to the nose using an object such as a stick, pipe, or other blunt object
❑ falls from heights
❑ sport injuries with fast-moving projectiles, such as a ball or puck
❑ high-velocity motor vehicle collisions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Nasal papillomas:
Causes
(Handbook of Diseases)
A papilloma may arise as a benign precursor of a neoplasm or as a response to tissue injury or viral infection, but its cause is unknown.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Nasal polyps:
Causes
(Handbook of Diseases)
Nasal polyps are usually produced by the continuous pressure resulting from a chronic allergy that causes prolonged mucous membrane edema in the nose and sinuses. Other predisposing factors include chronic sinusitis, chronic rhinitis, and recurrent nasal infections. Approximately 1 in 4 people with cystic fibrosis has nasal polyps.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Epistaxis [Nosebleed]:
Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Angiofibroma (juvenile)
Angiofibroma is a rare disorder that usually occurs in males and is characterized by severe recurrent epistaxis and nasal obstruction.
Aplastic anemia
Aplastic anemia develops insidiously, eventually producing nosebleeds as well as ecchymoses, retinal hemorrhages, menorrhagia, petechiae, bleeding from the mouth, and signs of GI bleeding. Fatigue, dyspnea, headache, tachycardia, and pallor may also occur.
Barotrauma
Commonly seen in airline passengers and scuba divers, barotrauma may cause severe, painful epistaxis when the patient has an upper tract respiratory infection.
Biliary obstruction
Biliary obstruction produces bleeding tendencies, including epistaxis. Typical features are colicky, right-upper-quadrant pain after eating fatty food, nausea, vomiting, fever, flatulence and, possibly, jaundice.
Cirrhosis
With cirrhosis, epistaxis is a late sign that occurs along with other bleeding tendencies (bleeding gums, easy bruising, hematemesis, melena). Other typical late findings include ascites, abdominal pain, shallow respirations, hepatomegaly or splenomegaly, and fever of 101° to 103° F (38.3° to 39.4° C). The patient may also exhibit muscle atrophy, enlarged superficial abdominal veins, severe pruritus, extremely dry skin, poor tissue turgor, abnormal pigmentation, spider angiomas, palmar erythema and, possibly, jaundice and central nervous system disturbances.
Coagulation disorders
Such disorders as hemophilia and thrombocytopenic purpura can cause epistaxis along with ecchymoses, petechiae, and bleeding from the gums, mouth, and I.V. puncture sites. Menorrhagia and signs of GI bleeding, such as melena and hematemesis, can also occur.
Glomerulonephritis (chronic)
Glomerulonephritis produces nosebleeds as well as hypertension, proteinuria, hematuria, headache, edema, oliguria, hemoptysis, nausea, vomiting, pruritus, dyspnea, malaise, and fatigue.
Hepatitis
When hepatitis interferes with the clotting mechanism, epistaxis and abnormal bleeding tendencies can result. Associated signs and symptoms typically include jaundice, clay-colored stools, pruritus, hepatomegaly, dry and flaky skin, abdominal pain, fever, fatigue, weakness, dark amber urine, anorexia, nausea, and vomiting.
Hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease)
Rendu-Osler-Weber disease causes frequent, sometimes daily, epistaxis, as well as hemoptysis and GI bleeding. Telangiectases appear as pinpoint, purplish red spots or flat, spiderlike lesions on the mucous membranes of the lips, mouth, tongue, nose, and GI tract. They occasionally appear on the trunk and fingertips.
Hypertension
Severe hypertension can produce extreme epistaxis, usually in the posterior nose, with pulsation above the middle turbinate. It may be accompanied by dizziness, a throbbing headache, anxiety, peripheral edema, nocturia, nausea, vomiting, drowsiness, and mental impairment.
Infectious mononucleosis
In patients with infectious mononucleosis, blood may ooze from the nose. Characteristic features include sore throat, cervical lymphadenopathy, and a fluctuating fever with an evening peak up to 101° to 102° F (38.3° to 38.9° C).
Influenza
When influenza affects the capillaries, a slow, oozing nosebleed results. Other signs and symptoms of influenza include dry cough, chills, fever, malaise, myalgia, sore throat, hoarseness or loss of voice, conjunctivitis, facial flushing, headache, rhinitis, and rhinorrhea.
Leukemia
With acute leukemia, sudden epistaxis is accompanied by a high fever and other types of abnormal bleeding, such as bleeding gums, ecchymoses, petechiae, easy bruising, and prolonged menses. These may follow less-noticeable signs and symptoms, such as weakness, lassitude, pallor, chills, recurrent infections, and low-grade fever. Acute leukemia may also cause dyspnea, fatigue, malaise, tachycardia, palpitations, a systolic ejection murmur, and abdominal or bone pain.
With chronic leukemia, epistaxis is a late sign that may be accompanied by other types of abnormal bleeding, extreme fatigue, weight loss, hepatosplenomegaly, bone tenderness, edema, macular or nodular skin lesions, pallor, weakness, dyspnea, tachycardia, palpitations, and headache.
Maxillofacial injury
With a maxillofacial injury, a pumping arterial bleed usually causes severe epistaxis. Associated signs and symptoms include facial pain, numbness, swelling, asymmetry, open-bite malocclusion or inability to open the mouth, diplopia, conjunctival hemorrhage, lip edema, and buccal, mucosal, and soft-palatal ecchymoses.
Nasal fracture
Unilateral or bilateral epistaxis occurs with nasal swelling, periorbital ecchymoses and edema, pain, nasal deformity, and crepitation of the nasal bones.
Nasal tumor
Blood may ooze from the nose when a tumor disrupts the nasal vasculature. Benign tumors usually bleed when touched, but malignant tumors produce spontaneous unilateral epistaxis, along with a foul discharge, cheek swelling, and — in the late stage — pain.
Orbital floor fracture
Orbital floor fracture is a type of trauma that may damage the maxillary sinus mucosa and, on rare occasions, cause epistaxis. More typical features include periorbital edema and ecchymoses, diplopia, infraorbital numbness, enophthalmos, limited eye movement, and facial asymmetry.
Polycythemia vera
A common sign of polycythemia vera, spontaneous epistaxis may be accompanied by bleeding gums; ecchymoses; ruddy cyanosis of the face, nose, ears, and lips; and congestion of the conjunctiva, retina, and oral mucous membranes. Other signs and symptoms vary according to the affected body system but may include headache, dizziness, tinnitus, vision disturbances, hypertension, chest pain, intermittent claudication, early satiety and fullness, marked splenomegaly, epigastric pain, pruritus, and dyspnea.
Renal failure
Chronic renal failure is more likely than acute renal failure to cause epistaxis and a tendency to bruise easily. More common signs and symptoms are oliguria or anuria, weight loss, anorexia, abdominal pain, diarrhea, nausea, vomiting, tissue wasting, dry mucous membranes, uremic breath, Kussmaul’s respirations, deteriorating mental status, and tachycardia.
Skin changes include pruritus, pallor, yellow-bronze pigmentation, purpura, dry skin, excoriation, uremic frost, and brown arcs under the nail margins. Neurologic signs and symptoms may include muscle twitches, fasciculations, asterixis, paresthesia, and footdrop. Cardiovascular effects include hypertension, arrhythmias, signs of heart failure, signs of pericarditis, and peripheral edema.
Sarcoidosis
Oozing epistaxis may occur in sarcoidosis, along with a nonproductive cough, substernal pain, malaise, and weight loss. Related findings include tachycardia, arrhythmias, parotid enlargement, cervical lymphadenopathy, skin lesions, hepatosplenomegaly, and arthritis in the ankles, knees, and wrists.
Scleroma
With scleroma, oozing epistaxis occurs with a watery nasal discharge that becomes foul-smelling and crusty. Progressive anosmia and turbinate atrophy may also occur.
Sinusitis (acute)
With sinusitis, a bloody or blood-tinged nasal discharge may become purulent and copious after 24 to 48 hours. Associated signs and symptoms include nasal congestion, pain, tenderness, malaise, headache, low-grade fever, and red, edematous nasal mucosa.
Skull fracture
Depending on the type of fracture, epistaxis can be direct (when blood flows directly down the nares) or indirect (when blood drains through the eustachian tube and into the nose). Abrasions, contusions, lacerations, or avulsions are common. A severe skull fracture may cause severe headache, decreased level of consciousness, hemiparesis, dizziness, seizures, projectile vomiting, and decreased pulse and respiratory rates.
A basilar fracture may also cause bleeding from the pharynx, ears, and conjunctiva as well as raccoon eyes and Battle’s sign. Cerebrospinal fluid or even brain tissue may leak from the nose or ears. A sphenoid fracture may also cause blindness, whereas a temporal fracture may also cause unilateral deafness or facial paralysis.
Syphilis
Epistaxis is most common in patients with tertiary syphilis, as posterior septum ulcerations produce a foul, bloody nasal discharge. It may be accompanied by a painful nasal obstruction and nasal deformity. Occasionally, primary syphilis causes painful nasal crusting and bleeding accompanied by the characteristic chancre sores.
Systemic lupus erythematosus (SLE)
Usually affecting females younger than age 50, SLE causes oozing epistaxis. More characteristic signs and symptoms include butterfly rash, lymphadenopathy, joint pain and stiffness, anorexia, nausea, vomiting, myalgia, and weight loss.
Typhoid fever
Oozing epistaxis and dry cough are common. Typhoid fever may also cause abrupt onset of chills and high fever, vomiting, abdominal distention, constipation or diarrhea, splenomegaly, hepatomegaly, “rose-spot” rash, jaundice, anorexia, weight loss, and profound fatigue.
Other causes
Chemical irritants
Some chemicals — including phosphorus, sulfuric acid, hypochlorite, ammonia, printer’s ink, and chromates — irritate the nasal mucosa, producing epistaxis.
Drugs
Anticoagulants, such as warfarin, and anti-inflammatories, such as aspirin, can cause epistaxis. Cocaine use, especially if frequent, can also cause epistaxis.
Environment
Dry environments, as occurs during winter use of heaters without humidity, may cause nosebleeds.
Surgery and procedures
Rarely, epistaxis results from facial and nasal surgery, including septoplasty, rhinoplasty, antrostomy, endoscopic sinus procedures, orbital decompression, and dental extraction.
Vigorous nose blowing
Vigorous nose blowing may rupture superficial blood vessels, especially in elderly people and young people, and cause nosebleeds.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Butterfly rash:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Discoid lupus erythematosus
With discoid lupus erythematosus, a localized form of lupus erythematosus, the patient may have a unilateral or butterfly rash that consists of erythematous, raised, sharply demarcated plaques with follicular plugging and central atrophy. The rash may also involve the scalp, ears, chest, or any part of the body exposed to the sun. Telangiectasia, scarring alopecia, and hypopigmentation or hyperpigmentation may occur later. Other accompanying signs include conjunctival redness, dilated capillaries of the nail fold, bilateral parotid gland enlargement, oral lesions, and mottled, reddish blue skin on the legs.
Erysipelas
Occurring primarily in infants and adults older than age 30 following a streptococcal infection, erysipelas causes rosy or crimson swollen lesions, mainly on the neck and head and commonly along the nasolabial fold. It may cause hemorrhagic pus-filled blisters. Other signs and symptoms include fever, chills, cervical lymphadenopathy, and malaise.
Rosacea
Initially, with rosacea, butterfly rash may appear as a prominent, nonscaling, intermittent erythema limited to the lower half of the nose or including the chin, cheeks, and central forehead. As rosacea develops, the duration of the rash increases; instead of disappearing after each episode, the rash varies in intensity and is commonly accompanied by telangiectasia. With advanced rosacea, the skin is oily, with papules, pustules, nodules, and telangiectasis restricted to the central oval of the face. In men with severe rosacea, butterfly rash may be accompanied by rhinophyma — a thickened, lobulated overgrowth of sebaceous glands and epithelial connective tissue on the lower half of the nose and, possibly, the adjacent cheeks. This is more common in elderly patients.
Seborrheic dermatitis
With seborrheic dermatitis, butterfly rash appears as greasy, scaling, slightly yellow macules and papules of varying size on the cheeks and the bridge of the nose, in a “butterfly” pattern. The scalp, beard, eyebrows, portions of the forehead above the bridge of the nose, nasolabial fold, or trunk may also be involved. Associated signs and symptoms include crusts and fissures (particularly when the external ear and scalp are involved), pruritus, redness, blepharitis, styes, severe acne, and oily skin. Severe seborrheic dermatitis of the face occurs in acquired immunodeficiency syndrome.
Systemic lupus erythematosus
Occurring in about 40% of patients with SLE (a connective tissue disorder), butterfly rash appears as a red, commonly scaly, sharply demarcated macular eruption. The rash may be transient in patients with acute SLE or may progress slowly to include the forehead, chin, the area around the ears, and other exposed areas. Common associated skin findings include scaling, patchy alopecia, mucous membrane lesions, mottled erythema of the palms and fingers, periungual erythema with edema, reddish purple macular lesions on the volar surfaces of the fingers, telangiectasia of the base of the nails or eyelids, purpura, petechiae, and ecchymoses.
Butterfly rash may also be accompanied by joint pain, stiffness, and deformities, particularly ulnar deviation of the fingers and subluxation of the proximal interphalangeal joints. Related findings include periorbital and facial edema, dyspnea, low-grade fever, malaise, weakness, fatigue, weight loss, anorexia, nausea, vomiting, lymphadenopathy, photosensitivity, and hepatosplenomegaly. (See Associated disorder: Lupus.)
Other causes
Drugs
The drugs hydralazine and procainamide can cause a lupus-like syndrome, which is evidenced by the butterfly rash.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nasal obstruction:
Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Basilar skull fracture
A tear in the dura can lead to cerebrospinal rhinorrhea, which increases when the patient lowers his head. Associated findings may include epistaxis, otorrhea, and a bulging tympanic membrane from blood or fluid. A fracture may also cause headache, facial paralysis, nausea, vomiting, impaired eye movement, ocular deviation, vision and hearing loss, depressed level of consciousness, Battle’s sign, and raccoon eyes.
Common cold
Onset of the common cold is typified by a watery discharge along with sneezing and nasal obstruction. Edema of the nasal mucosa may lead to sinus pain and infection as well as loss of smell and taste. Related findings include sore throat, malaise, myalgia, arthralgia, and mild headache.
Hypothyroidism
An underactive thyroid gland may lead to a generalized hypoactive state. This can lead to vascular dilation in the nasal mucosa, resulting in nasal obstruction. Associated findings include fatigue, weight gain despite anorexia, cold intolerance, facial edema, impaired memory, brittle hair, thick skin and tongue, bradycardia, and a hoarse voice.
Nasal deformities
Deviation of the nasal septum may cause unilateral or bilateral nasal obstruction, snoring, and postnasal drip. Perforation of the nasal septum may result in a sensation of nasal congestion due to altered air flow.
Nasal fracture
Nasal obstruction develops because of trauma that results in nasal mucosal swelling, epistaxis, abscess, or a septal deviation. Periorbital ecchymoses and edema, nasal deformity and pain, and crepitation of the nasal bones may also occur.
Nasal polyps
The most common signs and symptoms of nasal polyps are nasal obstruction, anosmia, and clear, watery drainage. The patient may have a history of allergies, chronic sinusitis, trauma, cystic fibrosis, or asthma. Translucent, pear-shaped polyps that are unilateral or bilateral occur.
Nasal tumors
Benign and malignant nasal tumors may cause unilateral or bilateral nasal obstruction, rhinorrhea, epistaxis, pain, foul discharge, and cheek swelling. Most of these tumors are benign papillomas and minor salivary gland tumors; malignant ones are rare. Kaposi’s sarcoma of the nose may occur in acquired immunodeficiency syndrome.
Nasopharyngeal tumors
Benign and malignant tumors of the nasopharynx may cause nasal obstruction, rhinorrhea, epistaxis, otitis media, and nasal speech. Tumors usually reach a considerable size before symptoms develop. Cancer of the nasopharynx is the most common malignancy of the nasopharynx and may present first with a neck mass or conductive hearing loss.
Pregnancy
High levels of estrogen during pregnancy may cause vascular engorgement of the nasal mucosa, resulting in nasal obstruction. Associated findings include clear or blood-tinged drainage, sneezing, and edematous and bluish turbinates.
Rhinitis
Allergic rhinitis produces intermittent watery discharge and nasal obstruction. Common signs and symptoms include sneezing, increased lacrimation, decreased sense of smell, postnasal drip, and itching of the eyes, nose, or ears. The mucosa is edematous and pale.
Vasomotor rhinitis produces a profuse watery nasal discharge in addition to nasal obstruction. Sneezing, postnasal drip, and swollen turbinates occur as well.
With atrophic rhinitis, nasal obstruction is chronic and continuous. Associated findings include intermittent, purulent drainage, foul drainage odor, and nasal crusts that bleed on removal. The mucosa is pale pink and shiny.
Sinusitis
With acute sinusitis, the usual findings are marked nasal obstruction along with thick, purulent drainage and severe pain over the involved sinuses. Fever, inflamed nasal mucosa with purulent mucus, and facial tenderness and pressure occur.
With chronic sinusitis, nasal obstruction can be persistent or recurrent. Thick, intermittently purulent rhinorrhea and low-grade discomfort over the involved sinuses are also seen.
Chronic fungal sinusitis is clinically similar to chronic bacterial sinusitis. However, in immunocompromised patients the disease may rapidly progress to proptosis, blindness, and death.
Other causes
Drugs
Topical nasal vasoconstrictors may cause rebound rhinorrhea and nasal obstruction if used longer than 5 days. Antihypertensives may cause nasal congestion as well.
Surgery
Nasal obstruction may occur after sinus or cranial surgery or even after rhinoplasty.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nasal Discharge:
Principal Causes of Nasal Discharge
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
- Anatomic
- Choanalatresia /stenosis
- Adenoid hypertrophy
- Rhinitis
- Infectious
- Viral
- Bacterial
- Allergic rhinitis
- Nonallergic rhinitis with eosinophilia
- Nonallergic rhinitis without eosinophilia
- Drug-induced
- Sinusitis
- Foreign body
- Cerebrospinal fluid rhinorrhea
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Butterfly rash:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Discoid lupus erythematosus.With discoid lupus erythematosus, the patient may have a unilateral or butterfly rash that consists of erythematous, raised, sharply demarcated plaques with follicular plugging and central atrophy. The rash may also involve the scalp, ears, chest, or any part of the body exposed to the sun. Telangiectasia, scarring alopecia, and hypopigmentation or hyperpigmentation may occur later. Other accompanying signs include conjunctival redness, dilated capillaries of the nail fold, bilateral parotid gland enlargement, oral lesions, and mottled, reddish blue skin on the legs.
Erysipelas.Erysipelas causes rosy or crimson swollen lesions, mainly on the neck and head and commonly along the nasolabial fold. It may cause hemorrhagic pus-filled blisters. Other signs and symptoms include fever, chills, cervical lymphadenopathy, and malaise.
Polymorphous light eruption.A butterfly rash appears as erythema, vesicles, plaques, and multiple small papules that may later become eczematized, lichenified, and excoriated. Provoked by ultraviolet rays, the rash appears on the cheeks and bridge of the nose, the hands and arms, and other areas, beginning a few hours to several days after exposure. It may be accompanied by pruritus.
Rosacea.Initially, a butterfly rash may appear as a prominent, nonscaling, intermittent erythema limited to the lower half of the nose or including the chin, cheeks, and central forehead. As rosacea develops, the duration of the rash increases; instead of disappearing after each episode, the rash varies in intensity and is commonly accompanied by telangiectasia. With advanced rosacea, the skin is oily, with papules, pustules, nodules, and telangiectasis restricted to the central oval of the face. In men with severe rosacea, butterfly rash may be accompanied by rhinophyma—a thickened, lobulated overgrowth of sebaceous glands and epithelial connective tissue on the lower half of the nose and, possibly, the adjacent cheeks. This is more common in elderly patients.
Seborrheic dermatitis.A butterfly rash appears as greasy, scaling, slightly yellow macules and papules of varying size on the cheeks and the bridge of the nose, in a “butterfly” pattern. The scalp, beard, eyebrows, portions of the forehead above the bridge of the nose, nasolabial fold, or trunk may also be involved. Associated signs and symptoms include crusts and fissures (particularly when the external ear and scalp are involved), pruritus, redness, blepharitis, styes, severe acne, and oily skin. Severe seborrheic dermatitis of the face occurs in acquired immunodeficiency syndrome.
Systemic lupus erythematosus.Occurring in about 40% of patients with this connective tissue disorder, a butterfly rash appears as a red, usually scaly, sharply demarcated macular eruption. The rash may be transient in patients with acute SLE or may progress slowly to include the forehead, the chin, the area around the ears, and other exposed areas. Common associated skin findings include scaling, patchy alopecia, mucous membrane lesions, mottled erythema of the palms and fingers, periungual erythema with edema, reddish purple macular lesions on the volar surfaces of the fingers, telangiectasia of the base of the nails or eyelids, purpura, petechiae, and ecchymoses.
A butterfly rash may also be accompanied by joint pain, stiffness, and deformities, particularly ulnar deviation of the fingers and subluxation of the proximal interphalangeal joints. Related findings include periorbital and facial edema, dyspnea, a low-grade fever, malaise, weakness, fatigue, weight loss, anorexia, nausea, vomiting, lymphadenopathy, photosensitivity, and hepatosplenomegaly.
Other causes
Drugs.Hydralazine and procainamide can cause a lupuslike syndrome, producing a butterfly rash.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Nasal flaring:
Medical causes
(Nursing: Interpreting Signs and Symptoms)
Acute respiratory distress syndrome (ARDS).ARDS causes increased respiratory difficulty and hypoxemia, with nasal flaring, dyspnea, tachypnea, diaphoresis, cyanosis, scattered crackles, and rhonchi. It also produces tachycardia, anxiety, and decreased level of consciousness (LOC).
Airway obstruction.Complete obstruction above the tracheal bifurcation causes sudden nasal flaring, absent breath sounds despite intercostal retractions and marked accessory muscle use, tachycardia, diaphoresis, cyanosis, decreasing LOC and, eventually, respiratory arrest.
Partial obstruction causes nasal flaring with inspiratory stridor, gagging, wheezing, a violent cough, marked accessory muscle use, agitation, cyanosis, and hoarseness.
Anaphylaxis.Severe anaphylactic reactions can produce respiratory distress with nasal flaring, stridor, wheezing, accessory muscle use, intercostal retractions, and dyspnea. Associated signs and symptoms include nasal congestion, sneezing, pruritus, urticaria, erythema, diaphoresis, angioedema, weakness, hoarseness, dysphagia and, rarely, vomiting, nausea, diarrhea, urinary urgency, and incontinence. Cardiac arrhythmias and signs of shock may occur late.
Asthma (acute).An asthma attack can cause nasal flaring, dyspnea, tachypnea, prolonged expiratory wheezing, accessory muscle use, cyanosis, and a dry or productive cough. Auscultation may reveal rhonchi, crackles, and decreased or absent breath sounds. Other findings include anxiety, tachycardia, and increased blood pressure.
Chronic obstructive pulmonary disease (COPD).COPD can lead to acute respiratory failure secondary to pulmonary infection or edema. Nasal flaring is accompanied by prolonged pursed-lip expiration; accessory muscle use; a loose, rattling, productive cough; cyanosis; reduced chest expansion; crackles; rhonchi; wheezing; and dyspnea.
Pneumothorax.Pneumothorax is an acute disorder that can result in respiratory distress with nasal flaring, dyspnea, tachypnea, shallow respirations, hyperresonance or tympany on percussion, agitation, jugular vein distention, tracheal deviation, and cyanosis. Other findings typically include sharp chest pain, tachycardia, hypotension, cold and clammy skin, diaphoresis, subcutaneous crepitation, and anxiety. Breath sounds may be decreased or absent on the affected side; similarly, chest wall motion may be decreased on the affected side.
Similar findings can occur with hydrothorax, chylothorax, or hemothorax, depending on the amount of fluid accumulation.
Pulmonary edema.Pulmonary edema typically produces nasal flaring, severe dyspnea, wheezing, and a cough that produces frothy, pink sputum. Increased accessory muscle use may occur with tachycardia, cyanosis, hypotension, crackles, jugular vein distention, peripheral edema, and decreased LOC.
Pulmonary embolus.Signs of pulmonary embolus, a potentially life-threatening disorder, may include nasal flaring, dyspnea, tachypnea, wheezing, cyanosis, a pleural friction rub, and a productive cough (possibly hemoptysis). Its other effects include sudden chest tightness or pleuritic pain, tachycardia, atrial arrhythmias, hypotension, a low-grade fever, syncope, marked anxiety, and restlessness.
Other causes
Diagnostic tests.Pulmonary function tests, such as vital capacity testing, can produce nasal flaring with forced inspiration or expiration.
Treatments.Certain respiratory treatments, such as deep breathing, can cause nasal flaring.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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