STUDY - Technical - New Dacian's Medicine
Rhinorrhea
(Classical / Allopathic Medicine)
Common
but rarely serious, rhinorrhea is the free discharge of
thin nasal mucus. It can be self-limiting or chronic,
resulting from a nasal, sinus, or systemic disorder or
from a basilar skull fracture. Rhinorrhea can also result
from sinus or cranial surgery, excessive use of
vasoconstricting nose drops or sprays, or inhalation of an
irritant, such as tobacco smoke, dust, and fumes.
Depending on the cause, the discharge may be clear,
purulent, bloody, or serosanguineous.
HISTORY:
Ask the patient if the discharge runs from both nostrils, is intermittent or persistent, and if it began suddenly or gradually. Does the position of the patient's head affect the discharge?
Ask the patient to characterize the discharge. Is it copious or scanty? Does it worsen or improve with the time of the day?
Ask the patient if he's using medications, especially nose drops or sprays.
Ask the patient if he has been exposed to nasal irritants at home or at work or had a recent head injury.
Ask the patient if the discharge runs from both nostrils, is intermittent or persistent, and if it began suddenly or gradually. Does the position of the patient's head affect the discharge?
Ask the patient to characterize the discharge. Is it copious or scanty? Does it worsen or improve with the time of the day?
Ask the patient if he's using medications, especially nose drops or sprays.
Ask the patient if he has been exposed to nasal irritants at home or at work or had a recent head injury.
Using
a nasal speculum
To visualize the interior of the nares, you'll need a nasal speculum and a good light source such as a penlight. Hold the speculum in the palm of one hand and the penlight in the other hand. Have the patient tilt his head back slightly and rest it against a wall or other firm support, if possible. Insert the speculum blades about ½″ (1.3 cm) into the nasal vestibule.
Place your index finger on the tip of the patient's nose for stability. Carefully open the speculum blades. Shine the light source in the direction of the nares. Now, inspect the nares. The mucosa should be deep pink. Note discharge, masses, lesions, or mucosal swellings, if present. Check the nasal septum for perforation, bleeding, or crusting. Bluish turbinates suggest allergy. A rounded, elongated projection suggests a polyp.
To visualize the interior of the nares, you'll need a nasal speculum and a good light source such as a penlight. Hold the speculum in the palm of one hand and the penlight in the other hand. Have the patient tilt his head back slightly and rest it against a wall or other firm support, if possible. Insert the speculum blades about ½″ (1.3 cm) into the nasal vestibule.
Place your index finger on the tip of the patient's nose for stability. Carefully open the speculum blades. Shine the light source in the direction of the nares. Now, inspect the nares. The mucosa should be deep pink. Note discharge, masses, lesions, or mucosal swellings, if present. Check the nasal septum for perforation, bleeding, or crusting. Bluish turbinates suggest allergy. A rounded, elongated projection suggests a polyp.
PHYSICAL
ASSESSMENT:
Examine the patient's nose, checking airflow from each nostril.
Evaluate the size, color, and condition of the turbinate mucosa (normally pale pink). Note if the mucosa is red, unusually pale, blue, or gray. Then examine the area beneath each turbinate. (See Using a nasal speculum.)
Palpate over the frontal, ethmoid, and maxillary sinuses for tenderness.
To differentiate nasal mucus from cerebrospinal fluid (CSF), collect a small amount of drainage on a glucose test strip. If CSF (which contains glucose) is present, the test result will be abnormal.
Use a nonirritating substance to test for anosmia.
Examine the patient's nose, checking airflow from each nostril.
Evaluate the size, color, and condition of the turbinate mucosa (normally pale pink). Note if the mucosa is red, unusually pale, blue, or gray. Then examine the area beneath each turbinate. (See Using a nasal speculum.)
Palpate over the frontal, ethmoid, and maxillary sinuses for tenderness.
To differentiate nasal mucus from cerebrospinal fluid (CSF), collect a small amount of drainage on a glucose test strip. If CSF (which contains glucose) is present, the test result will be abnormal.
Use a nonirritating substance to test for anosmia.
SPECIAL
CONSIDERATIONS:
Pregnancy causes physiologic changes that may aggravate rhinorrhea, resulting in eosinophilia and chronic irritable airways.
Pregnancy causes physiologic changes that may aggravate rhinorrhea, resulting in eosinophilia and chronic irritable airways.
PEDIATRIC
POINTERS:
Be aware that rhinorrhea in children may stem from choanal atresia, allergic or chronic rhinitis, acute ethmoiditis, or congenital syphilis.
Assume that unilateral rhinorrhea and nasal obstruction is caused by a foreign body in the nose until this is proven otherwise.
Be aware that rhinorrhea in children may stem from choanal atresia, allergic or chronic rhinitis, acute ethmoiditis, or congenital syphilis.
Assume that unilateral rhinorrhea and nasal obstruction is caused by a foreign body in the nose until this is proven otherwise.
AGING
ISSUES:
Elderly patients may suffer increased adverse reactions to medications used to treat rhinorrhea.
Elderly patients may suffer increased adverse reactions to medications used to treat rhinorrhea.
PATIENT
COUNSELING:
Warn the patient to avoid using over-the-counter nasal sprays for longer than 5 days.
Warn the patient to avoid using over-the-counter nasal sprays for longer than 5 days.
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.