is a group of disorders characterized by inflammation

and irritation of the mucous membranes of the nose.

Rhinitis may be acute or chronic, nonallergic or
allergic.
Asthma, allergic and exposure to airborne particles
such as dust, dander, or plant pollens. Seasonal rhinitis
occurs during pollen seasons, and perennial rhinitis
occurs throughout the year.
changes in several factors such as: temperature,
humidity, age, odor, systemic disease and infection.
Allergens. Pharmaceutical. The most common cause is
the common cold.
the signs and symptoms of rhinitis include rhinorrhea
(excessive nasal drainage, runny nose); nasal congestion; nasal
discharge (purulent with bacterial rhinitis); sneezing; and
pruritus of the nose, roof of the mouth, throat, eyes, and ears.
Headache may occur, particularly if rhinosinusitis is also
present.
It depends on the cause; which can be determined from the history and physical examination.
The patient asked by nurse about recent symptoms and possible exposure to allergens in the
surrounding environment. If a viral infection is the cause, medications may be prescribed to
relieve symptoms. But if the infection is allergic, allergy tests are performed to determine the
allergen and give vaccinations. Finally, if the inflammation is a bacterial infection, an
antimicrobial agent is used.
medication therapy for allergic and nonallergic rhinitis focuses on symptom
relief. Antihistamines and corticosteroid nasal sprays may be useful.
Antihistamines remain the most common treatment and are administered
for sneezing, pruritus, and rhinorrhea. The choice of medications depends
on the symptoms, adverse reactions, adherence factors, risk of drug
interactions, and cost to the patient.
the nurse instructs the patient with allergic rhinitis to avoid or reduce exposure to
allergens and irritants. the patient is cautioned to read drug labels before taking any
OTC medication. In the case of infectious rhinitis, the nurse reviews hand hygiene
technique with the patient as a measure to prevent transmission of organisms,
especially, the very young, the elderly, or people who are immunosuppressed.
is the most frequent viral infection in the
general population. The term common cold
often is used when referring to a URI
that is self-limited and caused by a virus.
infectious, acute inflammation of the
mucous membranes of the nasal cavity
characterized by nasal congestion,
rhinorrhea, sneezing, sore throat, allergic
and general malaise.
Signs and symptoms are low-grade fever, nasal
congestion, rhinorrhea and nasal discharge,
halitosis, sneezing, tearing watery eyes,
“scratchy” or sore throat, general malaise, chills,
and often headache and muscle aches. As the
illness progresses, cough usually appears. In some
people, the virus exacerbates herpes simplex,
commonly called a cold sore. The symptoms of
viral rhinitis may last from 1 to 2 weeks. Allergic
conditions can affect the nose, mimicking the
symptoms of a cold.
Management consists of symptomatic therapy that includes an adequate
fluid intake, rest, prevention of chilling, and use of expectorants as
needed. Warm salt-water gargles soothe the sore throat, and nonsteroidal
anti-inflammatory drugs (NSAIDs) relieve aches and pains. Antihistamines
are used to relieve sneezing, rhinorrhea, and nasal congestion. Guaifenesin
(Mucinex), an expectorant, is available without a prescription and is used
to promote removal of secretions. Several antiviral medications are
available by prescription; these medications can reduce the severity of
symptoms and may reduce the duration of the common cold. Antimicrobial
agents (antibiotics) should not be used, because they do not affect the
virus or reduce the incidence of bacterial complications. In addition,
topical nasal decongestants and herbal medicine should be used.
Teaching Patients Self-Care

Most viruses can be transmitted in several ways: direct contact with

infected secretions; inhalation of large particles from others’ coughing or
sneezing; or inhalation of small particles (aerosol). The nurse teaches the
patient how to break the chain of infection with appropriate handwashing
or hand hygiene and the use of tissues to avoid the spread of the virus
with coughing and sneezing. Also, she teaches methods to treat symptoms
of the common cold and provides both verbal and written information.
It’s formerly called sinusitis, is an inflammation
of the paranasal sinuses and nasal cavity.
Uncomplicated rhinosinusitis is rhinosinus
without extension of inflammation outside of the
paranasal sinuses and nasal cavity. Rhinosinusitis
is classified by duration of symptom as acute
(less than 4 weeks), subacute (4 to 12 weeks),
and chronic (more than 12 weeks). Rhinosinusitis
can be a bacterial or viral infection.
Allergies. Anatomical abnormalities such
as: adenoid hypertrophy, deviated nasal
septum and nasal polyps. Asthma. Foreign
body. Gastroesophageal reflux. Primary
and acquired immunodeficiency. Primary
and secondary ciliary dyskinesia. Smoking.
Upper respiratory tract infection.
Acute rhinosinusitis usually follows a viral URI or cold, such as an
unresolved viral or bacterial infection, or an exacerbation of
allergic rhinitis. Normally, the sinus openings into the nasal
passages are clear and infections resolve promptly. However, if
their drainage is obstructed by a deviated septum or by
hypertrophied turbinates, spurs, or nasal polyps or tumors, sinus
infection may persist as a smoldering (persistent) secondary
infection or progress to an acute suppurative process (causing
purulent discharge). Nasal congestion, caused by inflammation,
edema, and transudation of fluid secondary to URI, leads to
obstruction of the sinus cavities. This provides an excellent
medium for bacterial growth. Bacterial organisms account for
more than 60% of the cases of acute sinusitis. Fungal infections
occur most often in immunosuppressed patients.
Symptoms are include purulent nasal drainage
(anterior, posterior, or both) accompanied by
nasal obstruction or a combination of facial pain,
pressure, or a sense of fullness (referred to
collectively as facial pain–pressure–fullness), or
both. The patient may also report cloudy or
colored nasal discharge congestion, blockage, or
stuffiness as well as a localized or diffuse
headache.
Treatment of acute rhinosinusitis depends on the cause;
oral therapies can include antibiotics for bacterial cases
and oral corticosteroids for acute inflammation. The goals
of treatment of acute rhinosinusitis are to shrink the nasal
mucosa, relieve pain, and treat infection. Because of
inappropriate use of antibiotics for nonbacterial illness,
including viral rhinosinusitis, caution must be used if oral
antibiotics are prescribed. Saline lavage is an alternative
to oral antibiotics and has been effective in relieving
symptoms, reducing inflammation. If the patient continues
to have symptoms after 7 to 10 days, the sinuses may need
to be irrigated.
Teaching Patients Self-Care

Patient teaching is an important aspect of nursing care for the

patient with acute rhinosinusitis. The nurse instructs the patient
about symptoms of complications that require immediate follow-
up. Referral to a physician is indicated if periorbital edema and
severe pain on palpation occur. The nurse instructs the patient
about methods to promote drainage of the sinuses, including
humidification of the air in the home and use of warm compresses
to relieve pressure. The patient is advised to avoid swimming,
diving, and air travel during the acute infection. Patients using
tobacco are instructed to immediately stop smoking or using any
form of tobacco. Most patients use nasal sprays incorrectly,
which can lead to several side effects that include nasal
irritation, nasal burning, bad taste, and drainage in the throat or
even epistaxis.
Therefore, if an intranasal corticosteroid is prescribed, it is
important to teach the patient the correct use of prescribed nasal
sprays through demonstration, explanation, and return demonstration
to evaluate the patient’s understanding of the correct method of
administration. The nurse also teaches the patient about the side
effects of prescribed and OTC nasal sprays and about rebound
congestion, medicamentosa. Once the decongestant is discontinued,
the nasal passages close and congestion results. The nurse tells
patients with recurrent sinusitis to begin decongestants at the first
sign of rhinosinusitis. This promotes drainage and decreases the risk
of bacterial infection. The nurse explains to the patient that fever,
severe headache, and nuchal rigidity (stiffness of the neck or inability
to bend the neck) are signs of potential complications.
Acute pharyngitis is a sudden painful
inflammation of the pharynx, the back
portion of the throat that includes the
posterior third of the tongue, soft palate,
and tonsils. It is commonly referred to as
a sore throat.
Environmental exposure to viral agents
and poorly ventilated rooms. Viral
pharyngitis spreads easily in droplets of
coughs and sneezes and unclean hands
that have been exposed to contaminated
fluids.
Viral infection causes most cases of acute pharyngitis.
Responsible viruses include the adenovirus, influenza virus,
Epstein-Barr virus, and herpes simplex virus. Bacterial infection
accounts for the remainder of cases. Streptococcal pharyngitis
warrants use of antibiotic treatment. The body responds by
triggering an inflammatory response in the pharynx. This results
in pain, fever, vasodilation, edema, and tissue damage, manifested
by redness and swelling in the tonsillar pillars, uvula, and soft
palate. A creamy exudate may be present in the tonsillar pillars.
Uncomplicated viral infections usually subside promptly, within 3
to 10 days after the onset.
The signs and symptoms of acute pharyngitis include a
fiery-red pharyngeal membrane and tonsils, lymphoid
follicles that are swollen and flecked with white-purple
exudate, enlarged and tender cervical lymph nodes, and
no cough. Fever (higher than 38.3°), malaise and sore
throat also may be present. Occasionally, patients with
GAS pharyngitis exhibit vomiting, anorexia, and a
scarlatina-form rash with urticaria known as scarlet
fever. The roof of the mouth is often erythematous and
may demonstrate petechiae. Bad breath is common.
Viral pharyngitis is treated with
supportive measures because antibiotics
have no effect on the causal organism.
Bacterial pharyngitis is treated with a
variety of antimicrobial agents.
If the cause of pharyngitis is bacterial,
penicillin is usually the treatment of choice. For
patients who are allergic to penicillin or have
organisms that are resistant to erythromycin
(one fifth of GAS and most S. Severe sore
throats can also be relieved by analgesic
medications, as prescribed. In severe cases,
gargles with benzocaine may relieve symptoms.
Nursing care for patients with viral pharyngitis focuses on
symptomatic management. For patients who demonstrate signs of
strep throat and have a history of rheumatic fever, who appear
toxic, who have clinical scarlet fever, or who have symptoms
suggesting peritonsillar abscess, nursing care focuses on prompt
initiation and correct administration of prescribed antibiotic
therapy. The nurse instructs the patient about signs and symptoms
that warrant prompt contact with the physician. These include
dyspnea, drooling, inability to swallow, and inability to fully open
the mouth. Stay in bed during the fever phase of illness and rest
as frequently as once. Depending on the severity of the pharyngitis
and the degree of pain, a warm saline gargle or throat wash is used.
The benefits of this treatment depend on the temperature being
applied.
They are composed of lymphatic tissue and are
situated on each side of the oropharynx. The
faucial or palatine tonsils and lingual tonsils are
located behind the pillars of fauces and tongue,
respectively. They frequently serve as the site
of acute infection (tonsillitis). The adenoids or
pharyngeal tonsils consist of lymphatic tissue
near the center of the posterior wall of the
nasopharynx. Infection of the adenoids
frequently accompanies acute tonsillitis.
• Allergy.
• Asthma.
• Sinusitis.
• tonsillectomy or adenoidectomy.
The symptoms are include sore throat, fever,
snoring, and difficulty swallowing. Enlarged
adenoids may cause mouth-breathing,
earache, draining ears, frequent head colds,
bronchitis, foul-smelling breath, voice
impairment, and noisy respiration. Infection
can extend to the middle ear and may lead to
acute otitis media.
It is treated through the use of supportive measures
that include increased fluid intake, analgesics, salt-
water gargles, and rest. Bacterial infections are
treated with penicillin (first-line therapy) or
cephalosporins. Viral tonsillitis is not effectively
treated with antibiotic therapy. Tonsillectomy and
adenoidectomy continue to be commonly performed
surgical procedures, with evolving surgical techniques
aimed at reducing complications and improving
postoperative recovery.
Providing Postoperative Care

Continuous nursing observation is required in the

immediate postoperative and recovery periods because of
the significant risk of hemorrhage. In the immediate
postoperative period, the most comfortable position is
prone, with the patient’s head turned to the side to allow
drainage from the mouth and pharynx. The nurse must not
remove the oral airway until the patient’s gag and
swallowing reflexes have returned. The nurse applies an ice
collar to the neck, and a basin and tissues are provided for
the expectoration of blood and mucus.
Teaching Patients Self-Care

Tonsillectomy and adenoidectomy are usually performed as outpatient surgery and

the patient is sent home from the recovery room once awake, oriented, and able
to drink liquids and void. The patient and family must understand the signs and
symptoms of hemorrhage. As previously stated, bleeding may occur up to 8 days
after surgery. The nurse instructs the patient about use of liquid acetaminophen
with or without codeine for pain control and explains that the pain will subside
during the first 3 to 5 days. The nurse informs the patient about the need to take
the full course of any prescribed antibiotic. Alkaline mouthwashes and warm saline
solutions are useful in coping with the thick mucus and halitosis that may be
present after surgery. The nurse should explain to the patient that a sore throat,
stiff neck, minor ear pain, and vomiting may occur in the first 24 hours. The
patient should eat an appropriate diet of soft foods. Milk and dairy products may
be restricted because they make removing mucus more difficult for some
patients.