Rhinitis

Subject: Medical and Surgical Nursing II (Theory)

Overview

A category of illnesses known as rhinitis are characterized by irritation and inflammation of the nose's mucous membrane. Rhinitis can be viral, vascular, allergic, acute or chronic (common cold). An IgE-mediated immunologic reaction to airborne allergens on the nasal mucosa results in allergic rhinitis. Some persons may also get nonallergic rhinitis after taking sedatives, antidepressants, oral contraceptives, or medications for erectile dysfunction. Rhinitis medicament ossa, a kind of non-allergic rhinitis, can be brought on by overusing decongestant nasal sprays. One of the most prevalent infectious disorders affecting people is the common cold, commonly known as viral rhinitis. Most colds are brought on by rhinoviruses in the early fall and spring. Winter colds are typically brought on by other viruses, and those infections' symptoms might be more severe. There is no proof that stepping outside in chilly or wet weather increases your risk of becoming sick.

Rhinitis

A group of illnesses known as rhinitis are characterized by irritation and inflammation of the nose's mucous membrane.

Rhinitis may be:

  • Acute or chronic,
  • Allergic or nonallergic,
  • Vasomotor,
  • Viral (common cold).

Allergic Rhinitis:

It is an immunologic reaction to airborne allergens that is IgE-medicated. Two distinct clinical types exist:

  • Seasonal.
  • Perennial.

Aetiology:

  • Inhalant allergens,
  • Pollens, dust, spores, debris,
  • Rare: food allergy,
  • Genetic predisposition: chances of children developing are 20% and 47%,
  • Respectively, If one or both parents suffer from allergic diathesis..

Pathogenesis:

  • Inhaled allergies,
  • Product specific IgE antibody in genetically predisposed individuals,
  • This antibody becomes fixed to the blood basophils or tissue mast cells,
  • On subsequent exposure, antigen combines with IgE antibody,
  • Degranulation of mast cells with release of several chemical mediators,
  • Depending on the tissue involved, there may be vasodilation, mucosal edema, infiltration wth eosinophils, excessive secretion from nasal glands or smooth muscle contraction.

Clinical Features:

  • Paroxysmal sneezing,
  • 10 to 20 sneeze at a time,
  • Nasal obstruction,
  • Watery nasal discharge,
  • Itching in the nose, itching may also involve eyes, palate, or pharynx,
  • Loss of sense of smell,
  • Hearing impairment.

Signs of Rhinitis:

  • Nasal Signs: Transverse crease, pale and edematous nasal mucosa, swollen turbinates, watery mucoid discharge.
  • Ocular Signs: Edema of lids, congestion, cobblestone appearance of the conjunctiva, dark circle under eyes.
  • Otologic: Retracted tympanic membrane, otitis media.
  • Pharyngeal Signs: Granular pharyngitis.
  • Laryngeal Signs: Edema of vocal cord, hoarseness of voice.

Nonallergic Rhinitis

Aetiology:

  • Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. 
  • Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
  • A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example.
  • Foods and beverages. Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages also may cause the membranes inside your nose to swell, leading to nasal congestion.
  • Certain medications. Some medications can cause nonallergic rhinitis. These include aspirin, ibuprofen (Advil, Motrin IB, others), and high blood pressure (hypertension) medications, such as beta-blockers.
  • Hormone changes. Hormonal changes due to pregnancy, menstruation, oral contraceptive use or other hormonal condition such as hypothyroidism may cause nonallergic rhinitis.

Symptoms

  • Stuffy nose,
  • Runny nose,
  • Sneezing,
  • Mucus (phlegm) in the throat (postnasal drip),
  • Cough.

Viral Rhinitis

The term "cold" describes a feverish, infectious, acute inflammation of the nasal cavity's mucous membrane. Because a virus is shed for two days or more before symptoms manifest and over the first several days of the asymptomatic phase, the common cold is extremely infectious. Despite the fact that it can happen at any time of year, three times of the year account for the epidemic:

  • In September,
  • In late January,
  • Toward the end of April.

Signs and Symptoms:

  • Nasal congestion,
  • Rhinorrhoea,
  • Sneezing,
  • General malaise and muscle ache,
  • Tearing watery eyes,
  • Scratching or a sore throat,
  • Low-grade fever and headache,
  • Cough,
  • Chills.

Diagnosis:

  • History taking and physical exam,
  • Total and differential count,
  • Nasal smear,
  • Skin test,
  • Radio allergy or bent test,
  • Nasal provocation test.

Treatment

  • Medical management,
  • Avoidance of allergens,
  • Treatment with drugs,
  • Immunotherapy.

Treatment with Drugs

  • Antihistamine and oral congestion,
  • Sympathomimetic drugs,
  • Corticosteroids,
  • Sodium cromoglycate,
  • Nursing management,
  • Instructing patient with allergic rhinitis to avoid or reduce exposure to allergens.
  • To read drug labels before taking any OTC medication to prevent possible drug interaction.
  • Instructing patient about importance of sanitation,
  • Teaching proper hand washing technique.
  • Instructing patient in proper technique for administering nasal medications.
  • Teaching methods to treat symptoms of common cold and preventive measures.

Reference

  • Lewis, Sharon Mantik, Medical  Surgical Nursing; assessment and mangemnt of clinical problem, 3rs edition
  • Long, Barbara C, Medical- Surgical Nursing: a Nursing Process Appoach, 3rd edition
  • Mayo Clinic. 1998. 26 January 2016 http://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/symptoms-causes/dxc-20179169
  • MedicineNet. 1996. 2017 http://www.medicinenet.com/chronic_rhinitis/article.htm
  • Medline Plus. 05 January 2017 https://medlineplus.gov/ency/article/000813.htm
  • Medscape. 1994. 2017 http://emedicine.medscape.com/article/134825-overview
  • Mandal, G.N. Textbook of Adult Nursing. Kathmandu: Makalu Publication House, 2013.
  • Web MD. 2005. 2017 http://www.webmd.com/allergies/nonallergic-rhinitis#1
Things to remember
  • A category of illnesses known as rhinitis are characterized by irritation and inflammation of the nose's mucous membrane.
  • Rhinitis can be viral, vascular, allergic, acute or chronic (common cold).
  • An IgE-mediated immunologic reaction to airborne allergens on the nasal mucosa results in allergic rhinitis.
  • Some people may also experience nonallergic rhinitis after taking sedatives, antidepressants, oral contraceptives, or medications for erectile dysfunction.
  • Rhinitis medicament ossa, a type of non-allergic rhinitis, can be brought on by overusing decongestant nasal sprays.
  • One of the most prevalent infectious diseases affecting people is the common cold, also known as viral rhinitis.
  • Most colds are brought on by rhinoviruses in the early fall and spring.
  • Winter colds are typically brought on by other viruses, and those viruses' symptoms can be more severe.
  • There is no proof that going outside in chilly or rainy weather increases your risk of getting sick.
Questions and Answers
  1. Allergic rhinitis:

It is an IgE-medicated immunologic response to nasal mucosa to airborne allergens. Two clinical types have been recognized:

  1. Seasonal
  2. Perennial

Aetiology:

  1. Inhalant allergens
  2. Pollens, dust, spores, debris
  3. Rare: food allergy
  4. Genetic predisposition: chances of children developing are 20% and 47%
  5. Respectively,. If one or both parents suffer from allergic diathesis

Nonallergicrhinitis:

Aetiology:

  1. Environmental or occupational irritants. Dust, smog, secondhand smoke or strong odors, such as perfumes, can trigger nonallergic rhinitis. Chemical fumes, such as those you might be exposed to in certain occupations, also may be to blame.
  2. Weather changes. Temperature or humidity changes can trigger the membranes inside your nose to swell and cause a runny or stuffy nose.
  3. A common cause of nonallergic rhinitis is a viral infection — a cold or the flu, for example.
  4. Foods and beverages. Nonallergic rhinitis may occur when you eat, especially when eating hot or spicy foods. Drinking alcoholic beverages also may cause the membranes inside your nose to swell, leading to nasal congestion.
  5. Certain medications. Some medications can cause nonallergic rhinitis. These include aspirin, ibuprofen (Advil, Motrin IB, others), and high blood pressure (hypertension) medications, such as beta-blockers.

Nonallergic rhinitis can also be triggered in some people by sedatives, antidepressants, oral contraceptives or drugs used to treat erectile dysfunction. Overuse of decongestant nasal sprays can cause a type of nonallergic rhinitis called rhinitis medicament ossa.

  1. Hormone changes. Hormonal changes due to pregnancy, menstruation, oral contraceptive use or other hormonal condition such as hypothyroidism may cause nonallergic rhinitis.

 

Viral Rhinitis

The common cold, also called viral rhinitis, is one of the most common infectious diseases in humans. The infection is usually mild and improves without treatment. Because of a large number of people who get the common cold, this illness results in nearly 26 million days of missed school and 23 million days of absence from work every year in the United States. The average American has 1 to 3 colds per year.

The common cold is an upper respiratory infection that is caused by several families of viruses. Within these virus families, more than 200 specific viruses that can cause the common cold have been identified. The virus family that causes the most colds is called rhinovirus.

Treatment with drugs

  1. Antihistamine and oral congestion
  2. Sympathomimetic drugs
  3. Corticosteroids
  4. Sodium cromoglycate
  5. Nursing management:
  6. Instructing patient with allergic rhinitis to avoid or reduce exposure to allergens.
  7. To read drug labels before taking any OTC medication to prevent possible drug interaction.
  8. Instructing patient about importance of sanitation,
  9. Teaching proper hand washing technique.
  10. Instructing patient in proper technique for administering nasal medications.
  11. Teaching methods to treat symptoms of common cold and preventive measures.

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