Allergic rhinitis


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Allergic rhinitis

  1. 1. ALLERGIC RHINITIS<br />Reynel Dan L. Galicinao<br />
  2. 2. definition<br />
  3. 3. ALLERGIC RHINITIS<br />an inflammation of the nasal mucosa <br />caused by an allergen<br />affects 10% to 25% of the population<br />most common atopic allergic reaction <br />most prevalent in young children and adolescents<br />
  4. 4. Etiology<br />
  5. 5. Caused by airborne allergens<br /><ul><li>House dust and dust mites that feed on the dust
  6. 6. Feathers (in pillows and quilts)
  7. 7. Molds
  8. 8. Tobacco smoke
  9. 9. Processed materials or industrial chemicals
  10. 10. Animal dander</li></li></ul><li><ul><li>Spring: tree pollens
  11. 11. oak, elm, maple, alder, birch, cottonwood)
  12. 12. Summer: grass and weed pollens
  13. 13. (fescue, bluegrass, English plantain, sheep sorrel)
  14. 14. Fall: weed pollens
  15. 15. (ragweed)
  16. 16. Occasionally in summer and fall: mold spores</li></li></ul><li>pathopysiology<br />
  17. 17.
  18. 18. Immunoglobulin (Ig) E-mediated type I hypersensitivity response to an environmental antigen (allergen) in a genetically susceptible person<br />Type I hypersensitivity causes local vasodilation and increased capillary permeability<br />
  19. 19. classification<br />
  20. 20. Allergic rhinitis was formerly classified as seasonal or perennial<br />Current classifications:<br /><ul><li>Intermittent
  21. 21. symptoms present less than 4 days per week and less then 4 weeks per year
  22. 22. Persistent
  23. 23. symptoms present more than 4 days per week and more than 4 weeks per year</li></li></ul><li>Severity is classified as:<br /><ul><li>Mild
  24. 24. No interference with daily activities or troublesome symptoms
  25. 25. Moderate-severe
  26. 26. Presence of at least one:
  27. 27. impaired sleep, daily activity, work, or school
  28. 28. troublesome symptoms</li></li></ul><li>complications<br />
  29. 29. Allergic asthma<br />Chronic otitis media<br />Hearing loss<br />Chronic nasal obstruction<br />Sinusitis<br />Orthodontic malocclusion in children<br />
  30. 30. Clinical manifestations<br />
  31. 31. Nasal<br /><ul><li>Mucous membrane congestion
  32. 32. Edema
  33. 33. Itching
  34. 34. Rhinorrhea with clear secretions
  35. 35. Sneezing</li></ul>Eyes<br /><ul><li>Edema
  36. 36. Itching
  37. 37. Burning
  38. 38. Tearing
  39. 39. Redness
  40. 40. Dark circles under eyes (allergic shiners)</li></li></ul><li>Ears<br /><ul><li>Itching
  41. 41. Fullness</li></ul>Other<br /><ul><li>Palatal itching
  42. 42. Throat itching
  43. 43. Nonproductive cough</li></li></ul><li>Diagnostic evaluation<br />
  44. 44. Skin testing<br /><ul><li>confirms a hypersensitivity to certain allergens</li></ul>Nasal smear<br /><ul><li>an increased number of eosinophils suggests allergic disease</li></ul>RAST<br /><ul><li>positive test result for offending allergens</li></li></ul><li>Rhinoscopy<br /><ul><li>Allows better visualization of the nasopharynx
  45. 45. Useful to rule out physical obstruction
  46. 46. Septal deviation
  47. 47. Nasal polyps</li></ul>Evaluation for asthma<br />
  48. 48. MANAGEMENT<br />Avoidance<br />Medications: Acute Phase<br />Medications: Preventive Therapy<br />Immunotherapy <br />
  49. 49. Avoidance<br />
  50. 50. Minimize contact with offending allergens, regardless of other treatment<br />Reduce dust mite exposure by encasing bed pillows and mattress in allergen-proof covering<br />Use of allergen-proof bedding in conjunction with broad environmental controls<br />
  51. 51. Medications: Acute Phase<br />
  52. 52. Antihistamines effectively block histamine effects (such as a runny nose and watery eyes) <br /><ul><li>Side effects: sedation, dry mouth, nausea, dizziness, blurred vision, nervousness</li></ul>Nonsedating antihistamines (cetirizine, loratadine)<br /><ul><li>produce fewer side effects
  53. 53. less likely to cause drowsiness</li></ul>Fexofenadine may be effective<br /><ul><li>carries a lower risk of cardiac arrhythmias</li></li></ul><li>Decongestants<br /><ul><li>shrink nasal mucous membrane by vasoconstriction
  54. 54. available OTC and in combination with antihistamines, pain relievers, and anticholinergics</li></ul>Anticholinergic agents<br /><ul><li>inhibit mucous secretions, act as drying agents</li></ul>Topical eye preparations <br /><ul><li>reduce inflammation and relieve itching and burning</li></li></ul><li>Medications: Preventive Therapy<br />
  55. 55. Intranasal corticosteroids<br />Reduce inflammation of nasal mucosa<br />Prevent mediator release<br />Can be used safely every day<br />May be given systemically for a short course during a disabling attack<br />Intranasal cromolyn sodium (Nasalcrom)<br /><ul><li>mast cell stabilizer
  56. 56. hinders the release of chemical mediators</li></li></ul><li><ul><li>Oral mast cell stabilizer cromolyn (Gastrocrom)
  57. 57. Ophthalmic solution cromolyn (Crolom) and lodoxamide (Alomide)
  58. 58. These medications are used before and during allergen season</li></ul>Leukotriene receptor antagonists<br /><ul><li>Montelukast (Singulair) and zafirlukast (Accolate)
  59. 59. Systemic agents used for asthma
  60. 60. Reduce the inflammation, edema, and mucous secretion of allergic rhinitis</li></li></ul><li>immunotherapy<br />
  61. 61. Administering subcutaneous injections of increasing amounts of an allergen to which the patient is sensitive to decrease sensitivity and reduce the severity of symptoms<br />Possible adverse effects<br />Systemic reactions - anaphylaxis is rare, but potentially fatal.<br />Local reactions - consist of erythema and induration at the site of injection.<br />
  62. 62.
  63. 63. Nursing assessment<br />
  64. 64. Obtain history of severity and seasonality of symptoms<br />Inspect for:<br /><ul><li>characteristic tearing
  65. 65. conjunctivalerythema
  66. 66. pale nasal mucous membranes with clear discharge
  67. 67. allergic shiners
  68. 68. mouth breathing</li></ul>Auscultate lungs for wheezing or prolonged expiration characteristic of asthma<br />
  69. 69. Nursing diagnoses<br />
  70. 70. Acute pain<br />Deficient knowledge (allergic response)<br />Disturbed sensory perception (olfactory) <br />Impaired skin integrity<br />Ineffective airway clearance<br />Ineffective breathing pattern <br />Ineffective coping <br />Ineffective health maintenance<br /> Risk for infection<br />
  71. 71. Key outcomes<br />
  72. 72. The patient will:<br />express feelings of comfort<br />verbalize the causes, effects, and treatment of allergic response<br />maintain olfactory functioning to the fullest extent possible<br />perform skin care routine<br />
  73. 73. The patient will:<br />maintain a patent airway<br />maintain a respiratory rate within five breaths of baseline<br />(and family will) verbalize feelings and concerns<br />maintain current health status<br />remain free from signs or symptoms of infection<br />
  74. 74. Nursing interventions<br />
  75. 75. Implement measures to relieve signs and symptoms and to increase the patient's comfort<br />Increase the patient's fluid intake to loosen secretions<br />Elevate the head of the bed and provide humidification to ease breathing<br />Monitor the patient's compliance with the prescribed drug regimen<br /><ul><li>Note changes in control of signs and symptoms as well as indications of drug misuse</li></li></ul><li>Before desensitization injections, assess the patient's symptoms<br />After giving the injection, observe him for 30 minutes to detect adverse reactions, including anaphylaxis and severe localized erythema.<br />Make sure epinephrine and emergency resuscitation equipment are immediately available and ready to use<br />
  76. 76. Patient education and health maintenance<br />
  77. 77. Instruct the patient to call the physician if he experiences a delayed reaction to the desensitizing injections<br />Instruct the patient to reduce environmental exposure to airborne allergens:<br /><ul><li>sleep with the windows closed
  78. 78. avoid the countryside during pollination season
  79. 79. use air conditioning, if possible, to filter allergens and minimize humidity & dust
  80. 80. keep pets outside</li></li></ul><li><ul><li>remove dust-collecting items from the home (wool blankets, deep-pile carpets, stuffed animals heavy draperies)</li></ul>Tell the patient to apply a skin protectant on and below the nose to help prevent excoriation from constant nose blowing<br />For patients with severe and resistant allergic rhinitis, discuss possible lifestyle changes (relocation to a pollen-free area seasonally or year-round)<br />Teach the patient about his medications (proper dosages, administration instructions, adverse effects)<br />
  81. 81.<br /><br /><br />THANK YOU!Have a nice day : )<br />- RDG<br />