Nasal flaring
Nasal flaring is the abnormal dilation of the nostrils. Usually occurring during inspiration, nasal flaring may occasionally occur during expiration or throughout the respiratory cycle. It indicates respiratory dysfunction, ranging from mild difficulty to potentially life-threatening respiratory distress.
Emergency interventions
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.
History and physical examination
When the patient’s condition is stabilized, obtain a pertinent history. Ask about cardiac and pulmonary disorders such as asthma. Does the patient have allergies? Has he experienced a recent illness, such as a respiratory tract infection, or trauma? Does the patient smoke or have a history of smoking? Obtain a drug history.
Medical causes
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.
Special considerations
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’s 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.
Pediatric pointers
Nasal flaring is an important sign of respiratory distress in infants and very young children, who can’t verbalize their discomfort. Common causes include airway obstruction, hyaline membrane disease, croup, and acute epiglottiditis. The use of a croup tent may improve oxygenation and humidification for such patients.
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Nose symptoms
Read excerpts from these other book chapters related to Nose symptoms:
Medical Books Excerpts
- Nasal flaring
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nosebleed
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Nose symptoms
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Fractured nose (Professional Guide to Diseases (Eighth Edition))
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