Nasal polyps (2)

Nasal polyp

OPTHALMOLOGY & OTORINOLARYNGOLOGY

NURSING DNC 206

1. Understand the Definition of Nasal Polyp 2. Know the Statistic / incidence of Nasal Polyp3. List the Etiology/Risk factors Nasal Polyp4. Know the Clinical manifestations of Nasal

Polyp 5. Know the Complications of Nasal Polyp 6. Know the Diagnostic tests of Nasal Polyp7. Know the Prevention of Nasal Polyp 8. Explain the Nursing management of Nasal

Polyp9. Know the Medical management of Nasal Polyp10. Know the Nursing care plan for Nasal Polyp11. Know the Prognosis of Nasal Polyp12. Explain the Health Education for Nasal Polyp 13. Summary

In the end of this presentation, students will able to…

Objective

Non – cancerous growth (benign)Develop on the lining of the passages

at sinusesGrowth :

-small growth(may cause no problem)-big growth(cause many complications)

Come in many sizes and shapes.

(1998-2010 Mayo Foundation for Medical Education and Research (MFMER), 20th February,2009)

definitionNasal polyp…

Common in adult.Rare in children.4 times are common in men

than women.1 and 20 out of every 1000

people will develop Nasal Polyp.

(www.mayoclinic.com/health/nasal -polyps/ds00498)

incidence

Triggering factors

Viral infections, bacterial infections, allergies, fungus, chronic inflammation, asthma,

chronic sinus infections, hayfever, sinusitis.

Allows fluid to build up in the cells of nose and sinuses.

Over time, as gravity pulls on these fluid- filled cells.

Nasal polyp developed.

Proliferation of fibroblastsAnd myoblasts

pathophysiology

Etiology

Sinusitis

Viral and bacterial infection

Allergic rhinitis(hayfever)

Chronic inflammation

Asthma Allergic fungal

sinusitis

Allergies

Risk factors

Cystic fibrosis

Aspirin sensitivity Asthma

Allergic fungal sinusitis

Churg –Strauss Syndrome

Age- common in adult

Family history

Z z z z

Runny nose Mouth breathing

Snoring Shape of face may change

Clinical manifestations

Persistent stuffiness and facial discomfort

Decreased/ no sense ofsmell and taste

Nasal obstruction

Complications Obstructive sleep apnea

Altered facial structure

Bleeding

DIAGNOSTIC TESTs

CT Scan of Nasal cavityPhysical examination

Nasal endoscopic Test for cystic fibrosis

Manage allergies

and asthma

Avoid irritants

Practice good

hygiene

Clean and humidify

your home and surroundi

ng

Use nasal rinse or nasal

lavage

preventions

Medical/ surgical

management

Fluticasone (Flonase.Veramyst) Budesonide (Rhinocort)

Flunisolide(Nasarel)

Prednisone (either alone or with nasal spray)

NASAL CORTICOSTEROID

•To reduce inflammati

on

NASAL SPRAY

SurgicalmanagementPOLYPECTOMY

Removed using a small mechanical suction device or a microdebrider.

ENDOSCOPIC SINUS SURGERY

• Procedure to remove the nasal polyp

Endoscopic Sinus surgery/ Polypectomy

of the Nasal Polyp

nursing

management

Pre operative care of patient undergo Polypectomy.

Physical examination.

Taking vital signs as baseline data.

Inform or explain to patient and family members about the procedure.

Ensure the consent form is signed.

Make sure case note, blood result, and CT Scan film are ready.

Ask patient to change his/ her clothes to OT gown.

Shaving if necessary (moustache).

Tell patient to stop taking medicine that can lead to severe bleeding. E.g aspirin.

Ask patient to fasting 6-8 hours before procedure.

Ensure that patient has already past motion and urine.

Post operative care..Monitor patient’s vital signs properly.

Observe any complications such as bleeding and infections.

Administer analgesic drugs as prescribed by doctor.

Inform doctors if any abnormalities detect. Examples : inflammation

Assess patient’s conditions ~ take patient’s level of pain.

(pain scale)

Removing the polyps makes easier to breath through nose.

Nasal polyps can return

Treatment and surgery does not always improve lost sense of smell.

prognosis

nursing

Care plan

NURSING DIAGNOSIS

GOALSNURSING INTERVENTION

EVALUATION

Low self-esteem due to altered facial structure

Patient will improved his self-esteem slowly.

-Suggest patient to wear a mask.

-Explain to the patient that the polyps will shrink after the inflammation treated and polyps will removed by surgical management.

Patient’s self-esteem slowly improved.

NURSING DIAGNOSIS GOALS

NURSING INTERVENTION EVALUATION

Anxiety due to growth of the polyps

Patient will verbalize less anxiety

-Administer an anti-inflammatory drugs to reduce the polyps as prescribed by doctor.

-Provide patient an information about nasal polyps.

-Let patient express his feeling regarding the disease.

Patient verbalized less anxiety

NURSING DIAGNOSIS GOALS

NURSING INTERVENTION EVALUATION

Risk for bleeding related to patient nose care.

Prevent from bleeding.

-advise patient not to digging his nose or blowing too hard because it will cause trauma/ bleeding.

Bleeding prevented.

Nursing Diagnosis

Goals Nursing intervention

Evaluation

Pain related to the surgery.

Patient will verbalize less pain

-administer patient an analgesic drug such as tramadol and voltaren according to doctor’s order.

- Assess patient’s pain with pain scale

Patient verbalized less pain.

Health education

Advise patient to compliant with medication given and not to take herbs that are not recommended by doctor.

Follow up review~ condition of the nasal cavity after

surgery done.~detect any infection or

inflammation.

Avoid any irritants that can develop back the nasal polyps such as dust, infection, etc.

Advice patient not to injured to the surgery area such as..

~digging~blowing

Summary Nasal polyp is not a disease.

It caused by many triggering such as viral and bacterial infections, allergies, and fungus.

Nasal polyps are commonly developed in adult.

The common causes of nasal polyp are aspirin sensitivity, asthma, cystic fibrosis, and allergic fungal infection.

Nasal polyps can manifest complications such as chronic sinus infection, bleeding, altered facial structures and others.

Nasal polyps can return after surgery.

REFERENCES Bachert C, Van Cauwenberge p.Nasal Polyps and Sinusitis. In:

Adkinsaon NF, Yunginger JW, Busse ww,et,eds. Middleton’s Allergy, Principles and Practice, 6th ed Philadelphia, Morby; 2003:1421-1436

Lewis, Heitkemper, Dirksen, O’Brian, Bucher. Medical-surgical Nursing. Assessment and management of clinical problems. Page 541.International edition.

Mayo Clinic Staff, 1998-2010 Mayo Foundation for Medical Education & Research(MFMER)

(www.mayoclinic.com /health/nasal-polyps/ds00498) Pl Dhingra , Disease of ear,nose and throat. Fourth edition 2007.

Elsevier, A division of Reed Elsevier India private limited . Seth Schwartz, MD, MPH, Otolaryngologist, Bachert C, Gevaert P,

Van Cauwenberge P.Nasal polyps and rhinosinusitis. In:Adkinson NF Jr.,Bochner BS ,Busse WW, Holgate ST,Lemaske RF Jr.,eds.Middleton’s Allergy:Principles and Practice.7th edition.Philadelphia,Pa;Mosby Elsevier;2008:chap 56