What technique should the nurse use to examine the sinuses of a client with a sinus infection?
How is the diagnosis of sinusitis made?The symptoms of sinusitis are not unique to the disease itself. Other disease processes can mimic sinusitis including the common cold, allergies, migraine headache, chronic daily headache, myofascial pain, temporomandibular joint or jaw pain, rhinitis medicamentosa, and even sleep apnea. Therefore an accurate diagnosis requires a thorough history and physical examination. This will document the timing, duration, severity of the symptoms, what interventions have previously been performed and the success of each. Show
“Nasal endoscopy” is also used to make the diagnosis of sinusitis. This procedure involves passing a fiber-optic telescope, or "endoscope," into the nose and examining the interior of the nasal cavity. It is performed in the clinic setting with mild topical nasal anesthetic. The endoscope provides excellent lighting, magnification, and visualization of the mucosal lining around the sinus openings into the nasal cavity. This allows the Otolaryngologist to more precisely identify anatomic abnormalities that may be contributing to sinus infections, or monitor a patient’s response to therapy. While nasal endoscopy plays a major role in the diagnosis of sinusitis, this procedure can only give information about the openings of the sinuses (unless the patient has had previous surgery to widen the natural openings). Therefore another tool, called computerized tomography or a CT scan, is used to visualize the sinus interior. The CT scan provides information about swelling within the sinuses and also provides a road map of sinus anatomy should surgery be necessary. Each of these modalities (i.e., history and physical examination, nasal endoscopy, and CT scan) plays an important role in the diagnosis of sinusitis. Any single study in isolation is of much less value, while the use of all four modalities is most effective in making an accurate diagnosis and treatment plan. OverviewWhat is chronic sinusitis?Chronic sinusitis is a long-lasting sinus inflammation (swelling) and infection. It can linger over a period of time, typically longer than 12 weeks. The sinuses are four paired cavities (spaces) in the head. These spaces are connected by narrow channels. The four spaces are named for the bones they are near: ethmoidal, sphenoidal, frontal and maxillary. The sinuses make thin mucus that drains out of the channels of the nose. This drainage works as a filtration system, keeping the nose clean and free of bacteria. The sinuses can become infected when they are blocked and filled with fluid. This is called sinusitis. There are several kinds of sinusitis: acute, subacute, chronic and recurrent. Unlike chronic sinusitis, acute sinusitis typically lasts only a few days, but can last up to four weeks, before going away with minimal or no treatment. Chronic sinusitis may require different types of treatment. Surgery is sometimes needed in severe cases of chronic sinusitis that do not respond to other methods. Chronic sinusitis is different than recurrent sinusitis because chronic sinusitis symptoms never really go away for long periods of time. In recurrent sinusitis, you have 4 or more bouts of sinusitis in one year, but you also have symptom-free periods in between. What is the difference between sinusitis and rhinitis?The “-itis” means that we are talking about inflammation, swollen tissue. Sinusitis is swelling in the sinuses. Rhinitis is swelling in the nose. In reality, these usually happen at the same time, so chronic sinusitis is pretty much the same as chronic rhinosinusitis. Symptoms and CausesWhat causes chronic sinusitis?Chronic sinusitis can be caused by several factors. These include:
What are the symptoms of chronic sinusitis?Symptoms of chronic sinusitis may include:
The combination of symptoms and the fact that they last for such a long period of time can make you miserable. You'll probably have trouble sleeping through the night and may have dark circles under your eyes. Diagnosis and TestsHow is chronic sinusitis diagnosed?Chronic sinusitis is diagnosed when symptoms of a sinus infection have continued for more than 12 weeks. In some cases, your doctor may use an endoscope (a small and flexible tool that allows the doctor to see inside your nose and sinuses). A CT scan or MRI could also be used to look for structural issues. Structural problems usually include a deviated nasal septum (the nose is shifted to the side) or polyps (growths). In very few cases, your provider might order a biopsy to see if the infection has spread. Biopsies involve taking tissue or bone samples to example under the microscope. How can you tell the difference between chronic sinusitis and other issues, like migraine headaches?You probably can’t tell the difference between all of these things. So, in cases where you have a constant headache, or facial pain, or tooth pain, you should call your healthcare provider to get a diagnosis. This is especially true if you have tried different therapies and have not been able to find relief. Your primary healthcare provider might even find it difficult to diagnose you properly and might suggest you see a specialist. This would be an otolaryngologist, commonly called an ear, nose and throat (ENT) doctor. Management and TreatmentHow is chronic sinusitis treated?Chronic sinusitis is not usually caused by a bacterial infection, but it can be. If your healthcare provider really thinks that you have a bacterial infection, they might give you a prescription for something like amoxicillin. Antibiotics only help for bacterial infections. Other ways to treat non-bacterial chronic sinusitis include:
Can chronic sinusitis be cured?Chronic sinusitis symptoms can be cured. However, you will probably have to use more than one therapy. Is chronic sinusitis dangerous?This condition is rarely life-threatening, but it can be dangerous at times. Infections can spread beyond the sinuses into your bones, brain or spine. PreventionHow do I prevent chronic sinusitis?You may be able to prevent infections and chronic sinusitis if you:
Living WithWhen should I call my healthcare provider about chronic sinusitis?Call your doctor if your symptoms last for a long period of time (several weeks) despite treatment or if you are in pain. You should also call if you have a stiff neck, swollen eyes, and a problem with your vision or mental changes. Remember, your health is your business. You do not have to put up with feeling ill for long periods of time. Pay attention to how long you have sinus symptoms because this is something that your care provider will ask you. Keep track of things that you have done to make yourself feel better. If medications are prescribed, make sure you store them and take them as instructed. Which technique should the nurse use to examine the sinuses of a client?What technique should the nurse use to examine the sinuses of a client with a sinus infection? Press up on the brow on each side of the nose to palpate the frontal sinus. An elderly client diagnosed with sinusitis undergoes a transillumination test to detect the presence of fluid or pus in the maxillary sinus.
How do you examine a sinus infection?You'll get a spray that numbs your nose. The doctor will then insert a thin flexible device called an endoscope inside your nose. The instrument has a tiny lens at one end, which shows a detailed look at your sinuses. Sometimes, you may need to get a CT scan to look for more serious inflammation deep in your sinuses.
What technique is best for viewing maxillary sinuses?CT scanning is painless, noninvasive and accurate. It's also the most reliable imaging technique for determining if the sinuses are obstructed and the best imaging modality for sinusitis.
Why do you palpate sinuses?Physical assessment of the paranasal sinuses, along with the patient's signs and symptoms, can help you to identify certain conditions such as acute sinusitis involving the frontal or maxillary sinuses.
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