STUDY - Technical - New Dacian's Medicine
Nasal
obstruction (Classical / Allopathic Medicine)
Nasal obstruction
may result from an inflammatory, neoplastic, endocrine, or
metabolic disorder or from a structural abnormality or
traumatic injury. It may cause discomfort, alter a person's
sense of taste and smell, and cause voice changes. Although a
frequent and typically benign symptom, a nasal obstruction may
herald certain life-threatening disorders, such as a basilar
skull fracture or malignant tumor.
HISTORY:
Ask the patient when he first noticed the nasal obstruction. Did it begin suddenly or gradually?
Ask the patient about the obstruction's characteristics, including its duration and frequency. Is it intermittent or persistent? Unilateral or bilateral?
Ask the patient about the presence and character of drainage.
Ask the patient if he has nasal or sinus pain or headaches.
Ask the patient about recent travel.
Review the patient's medical history, noting especially trauma and surgery.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient when he first noticed the nasal obstruction. Did it begin suddenly or gradually?
Ask the patient about the obstruction's characteristics, including its duration and frequency. Is it intermittent or persistent? Unilateral or bilateral?
Ask the patient about the presence and character of drainage.
Ask the patient if he has nasal or sinus pain or headaches.
Ask the patient about recent travel.
Review the patient's medical history, noting especially trauma and surgery.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Examine the nose; assess airflow and the condition of the turbinates and nasal septum.
Evaluate the orbits for evidence of dystopia, decreased vision, excess tearing, or abnormal appearance.
Palpate the frontal and maxillary sinuses for tenderness.
Examine the ears for signs of middle ear effusions.
Inspect the oral cavity, pharynx, nasopharynx, and larynx to detect inflammation, ulceration, excessive mucosal dryness, and neurologic deficits.
Palpate the neck for adenopathy.
Examine the nose; assess airflow and the condition of the turbinates and nasal septum.
Evaluate the orbits for evidence of dystopia, decreased vision, excess tearing, or abnormal appearance.
Palpate the frontal and maxillary sinuses for tenderness.
Examine the ears for signs of middle ear effusions.
Inspect the oral cavity, pharynx, nasopharynx, and larynx to detect inflammation, ulceration, excessive mucosal dryness, and neurologic deficits.
Palpate the neck for adenopathy.
SPECIAL
CONSIDERATIONS:
Topical nasal vasoconstrictors may cause rebound rhinorrhea and nasal obstruction if used longer than 5 days. Antihypertensives may cause nasal congestion as well.
Topical nasal vasoconstrictors may cause rebound rhinorrhea and nasal obstruction if used longer than 5 days. Antihypertensives may cause nasal congestion as well.
PEDIATRIC
POINTERS:
Acute nasal obstruction in children can result from the common cold.
In infants and children, especially between ages 3 and 6, chronic nasal obstruction typically results from large adenoids.
In neonates, choanal atresia is the most common congenital cause of nasal obstruction, and it may be unilateral or bilateral.
Cystic fibrosis may cause nasal polyps in children, resulting in nasal obstruction. However, if the child has unilateral nasal obstruction and rhinorrhea, you should assume a foreign body in the nose until proven otherwise.
Acute nasal obstruction in children can result from the common cold.
In infants and children, especially between ages 3 and 6, chronic nasal obstruction typically results from large adenoids.
In neonates, choanal atresia is the most common congenital cause of nasal obstruction, and it may be unilateral or bilateral.
Cystic fibrosis may cause nasal polyps in children, resulting in nasal obstruction. However, if the child has unilateral nasal obstruction and rhinorrhea, you should assume a foreign body in the nose until proven otherwise.
PATIENT
COUNSELING:
Advise the patient to increase his fluid intake, if appropriate, to thin secretions. Remind him to take an antihistamine, a decongestant, or an antipyretic, as directed.
Advise the patient to increase his fluid intake, if appropriate, to thin secretions. Remind him to take an antihistamine, a decongestant, or an antipyretic, as directed.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.