RHINITIS
Acute and Chronic
Abuke, Jannah Niña T. BSN-3A
Buedron, Kevin Garnett M. BSN-3B
Table of contents
01 02 03
Definition Introduction Prevalence/
Incidence
04 05 06
Clinical signs Laboratory and Concept Map of
and symptoms Diagnostic Exam Pathophysiology
Table of contents
07 08 09
Treatment Medical/Surgical Nursing
Algorithm Management Management
10 06
Prognosis
01 Definition
o A group of disorders
characterized by
inflammation and
irritation of the mucous
or the lining of the nose.
o May be an acute viral
rhinitis or chronic rhinitis.
02 Introduction
o "inflammation of the nose,"
especially the mucous o Type 1 hypersensitivity reaction
membrane, 1829, medical Latin,
from rhino- "nose" + -itis o There are three distinct rhinitis
"inflammation.“ subgroups that are widely
accepted: allergic rhinitis (AR),
o Rhinitis is an entity that includes infectious rhinitis, and non-
many different subtypes and is allergic, non-infectious rhinitis
mainly used to describe a pattern (NAR)
of nasal symptoms that appear
as a result of inflammation
and/or dysfunction of the nasal
mucosa
Acute Rhinitis Chronic Rhinitis
o Short-lived inflammation o Is a condition
of the mucous characterized by long-
membrane of the nose lasting inflammation of
that is caused by a the nasal passages. Main
variety, usually common causes include allergies,
cold. Infections, Structural,
Medications, Hormonal
changes or Occupational
Factors.
Prevalence/Incidence o The over-all prevalence of allergic
03 rhinitis in Filipino adults in this
study is 20%
o It is also estimated that 10% to
20% of the U.S population has
allergic rhinitis
o The prevalence of non-allergic
rhinitis appears to be 19 million
and mixed rhinitis 26-million
people.
o In the UK, the prevalence reaches
26% in adults, with an observed
peak in the third and fourth
decades of age
o It affects between 10% and 30% of the o Rhinitis is considered one of the
population worldwide annually. most common medical conditions,
with significant impairment of
quality of life.
Clinical Signs and Symptoms 04
01 02
Rhinorrhea Nasal
excessive nasal drainage, Congestion
runny nose a feeling of fullness in the nose
or face
03 04
Nasal Discharge 05 Sneezing
purulent with bacterial make a sudden involuntary
rhinitis Pruritus expulsion of air from the nose
pruritus of the nose, roof of the and mouth due to irritation of
mouth, throat, eyes, and ears one's nostrils.
Laboratory and
05 Diagnostic Exam
• Medical History
• Physical Examination
• Allergy Testing
• Nasal Endoscopy
• Imaging
• Nasal Cytology
• Nasal Provocation Test
• Lung Function Tests
• Allergen Avoidance
Trials
06
1. Allergy Sensitization
Rhinitis
2. Primary Reaction Phase 3. Secondary Reaction Phase
(initiated within 5 minutes of antigen exposure (occurs 4-6 hours after the primary reaction
and maximum effect by 15 minutes) phase)
Antigen Exposure
Antigen Exposure Presence of mediators
APC (macrophages, HLA
class II) process antigen Antigen binds to IgE on Recruitment of inflammatory cells
into peptides mast cells and basophils (neutrophils, eosinophils,
macrophages, lymphocytes), bone
Mast cells & basophils release marrow proliferation of eosinophils
APC present peptides to mediators: performed (histamine,
Helper T cells serotonin, protease) & newly-
Second phase of
generated (leukotrienes, mediators released
protaglandins, TNF-a
Helper T cells release
Interleukins (IL-4 and IL- Allergic Rhinitis
3)
Vascular
IL-4 and IL-3 stimulate B-cell Mucous gland permeability
transformation to IgE producing stimulation increased
Plasma Cells Sensory nerve
stimulation Vasodilation Plasma
Increased Secretion
IgE Abs coat mast cells within exudation
nasal mucosa and basophils in
the plasma Sneezing and Congestion
Rhinorrhea Tissue edema
itching and pressure
07 Rhinitis
Symptoms: blocked nose, rhinorrhea, sneezing, itch
Signs: Allergic facies
Complications: sinusitis, chronic otitis media, obstructed breathing
Evaluation for Asthma Allergy testing Note co-morbidities
Treat asthma Skin-prick Selected • Sinusitis
if present test immunoCAP • Otitis media effusion
Profiles • Obstructed breathing
• Atopic dermatitis
No routine total IgE
Allergic rhinitis Non-Allergic rhinitis
Mild or Moderate to Infant Evaluation for cause –
seasonal Severe treat as for allergic rhinitis
(Uncommon (common in (Vasomotor) if no other
in South South Africa) All medications are off- cause found
Africa) label: urgent studies of
Avoidance Saline
efficacy and safety required
Non-sedating Intranasal
corticosteroid Allergens, irritants, dangerous medications (topical
vasoconstrictors for longer than 7-10 days, over-the-
counter preparations
Educate patients Follow-up regurarly
08 •
Medical Management
Antihistamines
• Decongestants
• Nasal corticosteroids
• Nasal antihistamines
• Leukotriene modifiers
• Cromolyn sodium nasal spray
• Nasal Ipratropium
Surgical Management
• Septoplasty
• Turbinate reduction
• Endoscopic Sinus surgery
• Nasal valve surgery
• Balloon sinuplasty
• Allergen-Specific Immunotherapy
Nursing Management
08 • Environment control at home.
• Instruct the patient in the proper use of and
technique for administering types of medications
such as Nasal sprays.
• Advise patient to drink plenty of fluids and
promote complete bed rest.
Prognosis
09 • Most symptoms of rhinitis especially allergic
rhinitis can be treated, it can occasionally
improve with time but this can take many months
or even years and it is unlikely that the condition
will disappear completely.
• In a long term process, some noticeable
improvement is often not observed for 6-12
months, and if helpful therapy should be
continued for 3-5 years.
• Mortality is not associated with allergic rhinitis
but significant morbidity occurs.
• If triggered with allergens, long term treatment
would be required.
