Treatments for Nose conditions
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Nasal Congestion:
Treatment
(In a Page: Signs and Symptoms)
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Initial symptomatic treatment with intranasal saline lavage may provide short-term symptomatic relief
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Intranasal decongestants (e.g., oxymetazoline, phenylephrine) or oral decongestants (e.g., pseudoephedrine, phenylephrine, ipratropium)
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Treat sinusitis (but never viral URI) with antibiotics
–First-line agents include amoxicillin, trimethoprimsulfamethoxazole, or doxycycline
–Amoxicillin plus clavulanic acid is indicated if a
β-lactamase-producing strain is suspected
–Surgery may be indicated for recurrent disease
-
Allergic rhinitis
–Intranasal steroids: Budesonide, fluticasone
–First- or second-generation antihistamines
–Cromolyn sodium
–Allergen avoidance
-
Perennial nonallergic rhinitis is treated with decongestants and intranasal steroids for symptoms
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Source: In a Page: Signs and Symptoms, 2004
Nasal Obstruction & Rhinorrhea:
Treatment
(In A Page: Pediatric Signs and Symptoms)
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Antibiotics for bacterial rhinosinusitis
–Endoscopically guided middle meatus cultures correlate well with maxillary sinus contents; routine nasal cultures do not
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Surgical correction of congenital anomalies
–Must establish airway (e.g., intubation) if respiratory distress
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Nasal steroids for rhinitis
-
Allergic rhinitis may need nonsedating antihistamine or even immunotherapy
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Medications for rhinosinusitis (URI symptoms for >10 days) should include antibiotics (covering β-lactamase organisms), nasal steroids, and topical
decongestants (no rebound effect if used with steroids)
-
Adenoidectomy for obstructive adenoid hypertrophy or for chronic or recurrent rhinosinusitis refractory to antibiotic therapy
-
Endoscopic resection of nasal polyps
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Source: In A Page: Pediatric Signs and Symptoms, 2007
Epistaxis (Nosebleed):
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Humidification
–Nasal saline sprays
–Aquaphor or antibiotic ointment to anterior septum
–Vaporizer at night
-
Pinch cartilaginous nose for >5–10 minutes
-
Remove (physician suctioning or patient blowing out) all blood clots
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Vasoconstrictive (decongestive) sprays (oxymetazoline)
-
Nasal packing
–Petroleum gauze (many meters may be needed)
–Premade packs: Absorbable (cellulose, gelatin), nonabsorbable, inflatable balloons
–Posterior packing requires ICU observation
-
Cauterization
–Chemical: Silver nitrate
–Electrical: Monopolar, bipolar
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Angiography with embolization
-
Surgical ligation or clipping of feeding arteries
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Source: In A Page: Pediatric Signs and Symptoms, 2007
Nasal flaring:
Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))
If you note nasal flaring in the patient, quickly evaluate his respiratory status. Absent breath sounds, cyanosis, diaphoresis, and tachycardia point to complete airway obstruction. As necessary, deliver back blows or abdominal thrusts (Heimlich maneuver) to relieve the obstruction. If these don’t clear the airway, emergency intubation or tracheostomy and mechanical ventilation may be necessary.
If the patient’s airway isn’t obstructed but he displays breathing difficulty, give oxygen by nasal cannula or face mask. Intubation and mechanical ventilation may be necessary. Insert an I.V. line for fluid and drug access. Begin cardiac monitoring. Obtain a chest X-ray and samples for arterial blood gas (ABG) analysis and electrolyte studies.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Fractured nose:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment restores normal facial appearance and re-establishes bilateral nasal passage after swelling subsides. Reduction of the fracture corrects alignment; immobilization (intranasal packing and an external splint shaped to the nose and taped) maintains it. Reduction is best accomplished in the operating room under local anesthesia for adults and general anesthesia for children. Severe swelling may delay treatment. CSF leakage calls for close observation, a CT scan of the basilar skull, and antibiotic therapy; septal hematoma requires incision and drainage to prevent necrosis.
Start treatment immediately. While waiting for X-rays, apply ice packs to the nose to minimize swelling. Wrap the ice packs in a light towel to prevent ice from directly contacting the skin. To control anterior bleeding, gently apply local pressure. Posterior bleeding is rare and requires an internal tamponade applied in the emergency department.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Nasal papillomas:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The most effective treatment is wide surgical excision or diathermy, with careful inspection of adjacent tissues and sinuses to rule out extension. The use of surgical lasers is becoming more popular. Ibuprofen or acetaminophen and decongestants may relieve symptoms.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Nasal polyps:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Generally, treatment consists of corticosteroids (either by direct injection into the polyps or by local spray) to temporarily reduce the polyp. A short course of oral corticosteroids (such as prednisone) may be beneficial. Treatment for the underlying cause may include antihistamines to control allergy, and antibiotic therapy if infection is present. Local application of an astringent shrinks hypertrophied tissue. However, medical management alone is seldom effective.
Consequently, the treatment of choice is polypectomy, which is usually performed under a local anesthetic. The use of surgical lasers is becoming more popular. Continued recurrence may require surgical opening of the ethmoid, sphenoid, and maxillary sinuses and evacuation of diseased tissue.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Nasal flaring:
Emergency Interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))
If you note nasal flaring in the patient, quickly evaluate his respiratory status. Absent breath sounds, cyanosis, diaphoresis, and tachycardia point to complete airway obstruction. As necessary, deliver back blows or abdominal thrusts (Heimlich maneuver) to relieve the obstruction. If these don’t clear the airway, emergency intubation or tracheostomy and mechanical ventilation may be necessary.
If the patient’s airway isn’t obstructed but he displays breathing difficulty, give oxygen by nasal cannula or face mask. Intubation and mechanical ventilation may be necessary. Insert an I.V. line for fluid and drug access. Begin cardiac monitoring. Obtain a chest X-ray and samples for arterial blood gas and electrolyte studies.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nasal obstruction:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Tell the patient not to use over-the-counter nasal vasoconstrictor sprays for more than 5 days.
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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Nose, fractured:
Treatment
(Handbook of Diseases)
Treatment restores normal facial appearance and reestablishes bilateral nasal passage after swelling subsides. Reduction of the fracture corrects alignment; immobilization (intranasal packing and an external splint shaped to the nose and taped) maintains it. Reduction is best accomplished in the operating room under local anesthesia for adults and general anesthesia for children.
CLINICAL TIP: Early or late repair is possible, but most physicians prefer to delay reduction for 5 to 10 days after the injury, especially if severe swelling is present.
CSF leakage calls for close observation, a CT scan of the basilar skull, and antibiotic therapy; septal hematoma requires incision and drainage to prevent necrosis.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Nasal papillomas:
Treatment
(Handbook of Diseases)
The most effective treatment is wide surgical excision or diathermy, with careful inspection of adjacent tissues and sinuses to rule out extension. The use of surgical lasers is another option. Aspirin or acetaminophen and decongestants may relieve symptoms.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Nasal polyps:
Treatment
(Handbook of Diseases)
Generally, treatment consists of a corticosteroid (either by direct injection into the polyps or by local spray) to temporarily reduce the polyp. Treatment of the underlying cause may include an antihistamine to control allergy and antibiotic therapy if infection is present. Local application of an astringent shrinks hypertrophied tissue. However, medical management alone is rarely effective.
Consequently, the treatment of choice is polypectomy, which is usually performed under a local anesthetic. The use of surgical lasers is becoming more popular. Continued recurrence may require surgical opening of the ethmoid and maxillary sinuses and evacuation of diseased tissue.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Epistaxis [Nosebleed]:
Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
Until the bleeding is completely under control, continue to monitor the patient for signs of hypovolemic shock, such as tachycardia and clammy skin. If external pressure doesn’t control the bleeding, insert cotton that has been impregnated with a vasoconstrictor and local anesthetic into the patient’s nose.
If bleeding persists, expect to insert anterior or posterior nasal packing. (See Types of nasal packing, page 135.) Administer humidified oxygen by facemask to a patient with posterior packing.
A complete blood count may be ordered to evaluate blood loss and detect anemia. Clotting studies, such as prothrombin time and activated partial thromboplastin time, may be required to test coagulation time. Prepare the patient for X-rays if he has had a recent trauma.
Patient teaching
Advise the patient about proper pinching pressure techniques. For prevention, tell him to apply liberal amounts of petroleum jelly to nostrils to prevent drying, cracking, and avoid picking and to avoid bending and lifting. Instruct the patient to sneeze with his mouth open. Use of a humidifier at night and trimming fingernails are also recommended. Emphasize the need for follow-up care and periodic blood studies after an episode of epistaxis. Advise the patient to seek prompt medical treatment for nasal infections or irritation.
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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007
Butterfly rash:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to avoid exposure to the sun or to use a sunscreen. Suggest that he use hypoallergenic makeup to help conceal facial lesions. Provide the patient with contact information for the Lupus Foundation of America.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Nasal obstruction:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Tell the patient not to use over-the-counter nasal vasoconstrictor sprays for more than 5 days. If the patient requires nasal surgery, advise him to limit such activities, as bending at the waist, exercising vigorously, and sneezing with his mouth open.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Butterfly rash:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for immunologic studies, complete blood count and, possibly, liver studies.
▪ Obtain a urine specimen if needed.
▪ Withhold photosensitizing drugs, such as phenothiazines, sulfonamides, sulfonylureas, and thiazide diuretics.
Patient teaching
▪ Instruct the patient to avoid prolonged exposure to the sun and to use sunscreen whenever outside.
▪ Suggest that the patient use hypoallergenic makeup to help conceal facial lesions.
▪ Teach the patient about the cause of the butterfly rash and the treatment plan afetr a diagnosis is established.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
Nasal flaring:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To help ease breathing, place the patient in high Fowler's position.
▪ If he's at risk for aspirating secretions, place him in a modified Trendelenburg or side-lying position.
▪ If necessary, suction frequently to remove oropharyngeal secretions.
▪ Administer humidified oxygen to thin secretions and decrease airway drying and irritation.
▪ Provide adequate hydration to liquefy secretions.
▪ Reposition the patient every hour, and encourage coughing and deep breathing.
▪ Avoid administering sedatives or opiates, which can depress the cough reflex or respirations.
▪ Continually assess the patient's respiratory status, and check his vital signs and oxygen saturation every 30 minutes, or as necessary.
▪ Prepare the patient for diagnostic tests, such as chest X-rays, a lung scan, pulmonary arteriography, sputum culture, complete blood count, ABG analysis, and 12-lead electrocardiogram.
Patient teaching
▪ Explain all procedures and treatments to the patient.
▪ Review treatment of the underlying disorder.
▪ Discuss the continued importance of not smoking.
▪ Demonstrate how to use an inhaler correctly.
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Source: Nursing: Interpreting Signs and Symptoms, 2007
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