Timby's MedSurg 14e

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CHAPTER 20 Caring for Clients With Upper Respiratory Disorders

Nutrition Notes

Sinusitis Sinusitis , also known as rhinosinusitis , is inflammation of the sinuses. It may be classified according to its duration as follows: • Acute sinusitis : generally lasts less than 4 weeks • Subacute sinusitis : does not get better with initial treat ment and generally lasts 4 to 8 weeks • Chronic sinusitis : occurs with repeated acute infections or inadequately treated infections—can last more than 12 weeks Recurrent sinusitis refers to three or more episodes in 1 year. The maxillary sinus is affected most often. Sinusitis can lead to serious complications, such as infection of the middle ear or brain. Pathophysiology and Etiology The principal causes are the spread of an infection from the nasal passages to the sinuses and the blockage of normal si nus drainage (Fig. 20-1). The infection can be bacterial or viral, generally occurring after a URI or with allergic rhini tis. Interference with sinus drainage predisposes a client to sinusitis because trapped secretions readily become infected. Other conditions that may interfere with sinus drainage in clude the following (Lane, n.d.): • Structural abnormalities, such as nasal polyps or a deviated septum • Enlarged adenoids • Diving and swimming • Tooth infections • Trauma to the nose • Foreign objects stuck in the nose • Secondhand smoke Measures that help reduce the incidence or severity of sinusitis include eating a well-balanced diet, getting plenty of rest, engaging in moderate exercise, avoiding allergens, and seeking medical attention promptly if a cold persists longer than 10 days or nasal discharge is green or dark yel low and foul smelling. Assessment Findings Signs and symptoms depend on which sinus is infected, in cluding headache, fever, pain over the affected sinus, nasal congestion and discharge, postnasal drip causing a cough, pain and pressure around the eyes, and malaise. A na sal smear or material obtained from irrigation of the sinus for culture and sensitivity testing identifies the infectious The Client With Rhinitis ■ There is strong evidence that vitamin C shortens the du ration of colds. Consuming at least 1 g of vitamin C per day did appear to reduce the duration of cold symptoms by an average of 15% in adults (Hemila & Chalker, 2023).

Nasal

A

microorganism and appropriate antibiotic therapy. Transil lumination and x-rays of the sinuses may show a change in the shape of or fluid in the sinus cavity. A thorough history, including an allergy history, usually confirms the diagnosis. In some instances, nasal endoscopy may be done and/or imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) may be also done. Medical and Surgical Management Medical management for acute sinusitis focuses on shrink ing the nasal mucosa, relieving pain, and treating infection (Mayo Clinic Staff, 2024). Acute sinusitis frequently responds to conservative treatment designed to help overcome the in fection. Intranasal saline irrigation or lavage of the maxillary sinus may be done to remove accumulated exudate and pro mote drainage. Such irrigation is accomplished by insertion of a catheter through the normal opening under the middle concha. Antibiotic therapy is necessary for severe infections, but may not be prescribed for 10 to 14 days if symptoms are not severe. Vasoconstrictors, such as phenylephrine nose drops, may be recommended for short-term use to relieve nasal congestion and aid in sinus drainage. Nasal corticoste roids, such as mometasone (Nasonex), may be ordered for B Figure 20-1 Edema can obstruct sinus drainage. (A) The maxillary sinuses normally drain through the openings that lie under the middle turbinates.The openings for the drainage are near the upper portion of the sinus. (B) Edema, which commonly accompanies upper respiratory infections, can obstruct the openings and prevent normal sinus drainage.

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