Nasal Fracture

What is it?

Causes?

accounts for 40% of bone injuries in cases of facial trauma.

Normally caused by a substantial blow to the face.

unilateral- typically no displacement

bilateral- most common, give the nose a flattened look

complex- may also involve subsequent damage to adjacent facial structures such as the teeth, eyes or other facial bones.

Nasal Fractures:

Diagnostics?

Treatment?

Nursing managment?

Dx: health hx and phys exam. radiographic imaging. Assess ability to breathe through each side of the nose and note the presence of edema, bleeding, or hematoma. Ecchymosis may be under one or both eyes. Inspect for CLEAR drainage, this indicates CSF. Test with the glucose test for CSF, it's quick and able to do at bedside.Repair of fracture may need to wait 5-10 days until edema has decreased.

NURSING MANAGMENT- maintain airway, reduce edema, prevent complications and provide emotional support. Apply ice to the face and nose, this will help reduce edema and bleeding.

Goal is have fractured nose realigned if indicated.

Rhinoplasty

What is it?

The surgical reconstruction of the nose, is performed for cosmetic reasons or to imporve airway function when trauma or developmental deformities result in nasal obstruction.

Sometimes nasal tissue is added or removed, and the nose may be lengthened or shortened.

Rhinoplasty:

Nursing Management

Before surgery instruct pt not to take ASA containing drugs or NSAIDS for 2 weeks prior to reduce the risk of bleeding.

Immediate post op:

maintnance of airway, assessment of respiratory status, pain managment, and observation of the surgical site for bleeding, infection, and edema.

Teaching:

The patient needs to be able to detect early and late complications at home. edema and ecchymosis is expected.

Epistaxis

what is it?

collaborative care and nursing managament

Nosebleeds- children less than 10 and adults over age 50 most affected.

Use simple first aid measures to control bleeding.

1. keep the pt quiet 2. place the pt in a sitting position 3. apply direct pressure by pinching the entire soft lower portion of the nose for 10-15 minutes 4. partially insert a small gauze pad into bleeding nostril and apply digital pressure if bleeding conintues. 5. obtain medical assistance if bleeding does not stop

Allergic Rhinitis

What is it?

Causes?

Clinical manifestations?

The reaction of the nasal mucosa to a specific allergen. Although "seasonal" and "perennial" are still widely used, the two types are called "intermittent and persistent".

Intermittitent- s/s are present less than 4 days a week or less than 4 weeks per year.

persistent- s/s present more than 4 days a week or more than 4 weeks per year.

Specific triggers cause it when the person is exposed

S/S initially: sneezing, itchy, watery eyes and nose. altered sense of smell, and thin watery nasal discharge that can lead to a more sustained nasal congestion.

Allergic Rhinitis

Nursing management

The goal is to stay away from triggers to prevent recurrence.

medication therapy: reduce inflammation and reduce nasal symptoms so that the patient has no adverse effects and can sleep well at night to avoid daytime sleepiness.

antihistmines, intranasal corticosteroids, and leukotrienes.

Immunotherapy is also available if meds are unsuccessful at treating therapy.

Acute Viral Rhinitis

what is it?

s/s?

"the common cold"

Caused by adenovirus that invades the upper respiratory tract and often accompanies URI.

s/s intially: tickling, irriation, sneezing or dryness of the nose or nasopharynx, followed by copious nasal secretions, some nasal obstruction, watery eyes, elevated temp, general malaise and headache. After early profuse secretions, the nose becomes more obstructed and the discharge is thicker.

Acute Viral Rhinitis

tx?

complications?

rest, fluids, proper diet, antipyretics, and analgesics are recommended.

complications include pharyngitis, sinusitis, otitis media, tonsillitis, and lung infections.