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Acute Sinusitis

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  ACUTE SINUSITISDEFINITION / DESCRIPTION OF THE DISEASEWith acute sinusitis, the cavities around the nasa !assa es #sinuses$ %eco&e in'a&ed and s(oen) This inter*eres (ith draina e and causes &ucus to %uid u!) This co&&on condition is aso caed acute rhinosinusitis) PATHOPHYSIOLOGY Ris+ Factors ã Ha- *ever or another aer ic condition ã A nasa !assa e a%nor&ait- ã A &edica condition #c-stic .%rosis, astroeso!ha ea re'u disease #0ERD$, or an i&&une s-ste& disorder such as i&&uno o%uin or anti%od- de.cienc-$ ã Re uar e!osure to !outants ã 1ira in*ection rhinovirus, coronavirus, in'uen2a A and Ede&a, in'a&&ation, !o-!s, tu&ors, trau&a, scarrin , anato&ic variants #e , concha %uosa 4!neu&ati2ed &idde tur%inate5, se!ta deviation$, andnasa instru&entation #naso astric tu%es or !ac+in $6oss o* ciiated e!itheia ces7 cod air7 dr- air7 vira, %acteria, or environ&enta ciiotoins7 in'a&&ator- &ediators7 contact %et(eent(o &ucosa sur*aces7 scars7 and !ri&ar- ciiar- d-s+inesiaOver!roduction o* &ucusO%struction o* the natura sinus ostiaciiar- d-s*unction and aterations in &ucus Retention o* secretionsH-!oia (ithin the o%structed sinusover(he& the &ucociiar-   retained secretions (ithin the sinuses'uid accu&uation (ithin the sinusdisru!tion o* the ciiar-  C6INICA6 8ANIFESTATIONS  Facia !ain  Pressure over the a9ected sinus area  Nasa o%struction  Fati ue  Puruent nasa dischar e  Fever  Headache  Ear !ain  Denta !ain  Cou h  Decreased sense o* s&e  Sore throat  E-eid ede&a  Facia con estionDIA0NOSTIC / ASSESS8ENT FINDIN0S  Nasal endoscopy.  A thin, 'ei%e tu%e #endosco!e$ (ith a .%er:o!tic i ht inserted throu h -our nose ao(s -our doctor to visua- ins!ect the inside o* -our sinuses)  Imaging studies.  Images taken using computerized tomography (CT or magnetic resonance imaging (! I can sho# detai$s o% your sinuses and nasa$ area& These may identi%y a deep in%$ammation or physica$ o'struction thats di%%icu$t to detect using an endoscope&  Nasal and sinus cultures.  La'oratory tests are genera$$y unnecessary %or diagnosing acute sinusitis& Ho#e)er* in cases in #hich the condition %ai$s to respond to treatment or is progressing* tissue cu$tures may he$p pinpoint the cause* such as identi%ying a 'acteria$ cause&  An allergy test.  I% your doctor suspects that the condition may 'e 'rought on 'y a$$ergies* an a$$ergy skin test may 'e recommended& A skin test is sa%e and +uick* and can he$p pinpoint the a$$ergen thats responsi'$e %or your nasa$ %$are,ups&CO!PLICATIO-S  !eningitis  .rain a'cess  Ischemic in%arction  Osteomye$itis  Se)ere or'ita$ ce$$u$itis  Su'periostea$ a'scess  Ca)ernous sinus throm'osis!/0ICAL !A-AG/!/-T  1irst,$ine anti'iotics2 amo3ici$$in (Amo3i$* triemthoprim4su$%ametho3azo$e (.actrim* Septra* erythromycin&  Second,$ine anti'iotics2 ce%uro3ime a3eti$ (Ce%tin* ce%podo3ime (5antin* ce%prozi$ (Ce%zi$* amo3ici$$in c$a)u$anate (Augmentin  Course o% treatment o% anti'iotics is usua$$y 67 to 68 days&  9se o% ora$ and topica$ decongestant agents may decrease mucosa$ s#e$$ing o% nasa$ po$yps* there'y impro)ing drainage o% the sinuses&  Heated mist and sa$ine irrigation a$so may 'e e%%ecti)e %or opening '$ocked passages&  0econgestant agents such as pseudoephedrine (Suda%ed* 0imetapp ha)e pro)en e%%ecti)e 'ecause o% their )asoconstricti)e properties&   Antihistamines such as diphenhydramine (.enadry$* cetirizine (:yrtec* and %e3o%enadine (A$$egra may 'e used i% an a$$ergic component is suspected&S9 GICAL !A-AG/!/-T Surgery to clean and drain the sinuses may also be necessary, especially in patients whose symptoms fail to go away after 3 months, despite medical treatment, or in patients who have more than two or three episodes of acute sinusitis eachyear. An ENT specialist (also nown as an otolaryngologist! can perform this surgery. ost fungal sinus infections re#uire surgery. Surgical repair of a deviated septum or nasal polyps may prevent the condition from returning. Antral puncture and irrigation are used for diagnostic culture and sensitivity testing in immunosuppressed or critically ill patients if the organism must be identified. $owever, more recent data support the role of endoscopically guided middle meatus cultures insteadN%&S'N ANAE ENTThe nurse instructs the patient about methods to promote drainage such as)  Inha$ing steam (steam 'ath* hot sho#er* %acia$ sauna  Increasing %$uid intake  App$ying $oca$ heat (hot #et packsThe nurse a$so in%orms the patient a'out the side e%%ects o% nasa$ sprays and a'out re'ound congestion&The nurse stresses the importance o% %o$$o#ing the recommended anti'iotic regimen* 'ecause a consistent '$ood $e)e$ o% the medication is critica$ to treat the in%ection&The nurse teaches the patient ear$y signs o% a sinus in%ection and recommends pre)enti)e measures such as %o$$o#ing hea$thy practices and a)oiding contact #ith peop$e #ho ha)e upper respiratory tract in%ections&The nurse shou$d e3p$ain to the patient that %e)er* se)ere headache* and nucha$ rigidity are signs o% potentia$ comp$ications& I% %e)er persists despite anti'iotic therapy* the patient shou$d seek additiona$ care& 3i%io ra!h-We%sitesE&edicine);<<=)  Acute sinusitis. 4Onine5U!dated >< Fe% ;<<=) Avaia%e at htt!//e&edicine)&edsca!e)co&/artice/;?;@<:overvie( 4Accessed ;B u- ;<><5)8a-oCinic);<<)  Acute Sinusitis )4Onine5U!dated  u- ;<><) Avaia%e at htt!//((()&a-ocinic)co&/heath/acute:sinusitis/DS<<></DSECTIONtreat&ents:and:dru s 4Accessed ;B u- ;<><5)8edinePus);<><) Sinusitis. 4Onine5U!dated ;; u- ;<><) Avaia%e at htt!//((()n&)nih) ov/&edine!us/enc-/artice/<<<@)ht& 4Accessed ;B u- ;<><5)3oo+S&et2er, S) G 3are, 3), ;<<) Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. >< th  ed)Phiade!hia 6i!!incott Wiia&s G Wi+ins)
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