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7 Cards in this Set

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Describe the first step in controlling epistaxis. How should the patient sit while waiting for the bleeding to stop?
Apply direct pressure to the anterior portion of the nose for 10 minutes (most common source of epistaxis is the anterior part of the septum where Kiesselbach’s plexus is located), and sit in an upright position as this reduces venous pressure. The patient can also lean forward to decrease swallowing of blood.
What are the indications for referral for the patient with epistaxis
If the site of bleeding is inaccessible for direct control or if attempts to control bleeding are unsuccessful, referral may be needed for anterior and posterior nasal packing (this needs to be placed in an OR or specialist’s office since the patient could become hypoxic). posterior packing applied first in the posterior pharynx (choanae posterior nares) then the anterior packing is placed. if these measures are not successful, internal maxillary or ethmoid artery ligation is done by a specialist.
What are the key components of education for the patient with epistaxis
To avoid vigorous exercise and aspirin containing medications for several days or weeks. To call their PCP if bleeding reoccurs especially if packing is still in place. F/U in 48-72 h to ensure healing of the lesion. Avoid tobacco, hot, spicy foods because they cause vasodilation. avoid nasal trauma, lubricate MM with petroleum jelly or bacitracin to reduce nasal discomfort. Instruct how to treat nose bleeds at home by applying pressure for 10-30 minutes. Use a humidifier to prevent nasal irritation from dry environment.
What physical findings will confirm your preliminary diagnosis of allergic rhinitis
Boggy, swollen nasal turbinates with pale, bluish mucosa associated bleeding, mucus, crusting and inflammation. Enlarged tonsils, a crease across the nose from manipulating the nose (allergic salute)
Clinical Presentation of Allergic Rhinitis
clinical presentation: sneezing, taste or smell disturbances, nasal congestion, dry mouth, postnasal discharge, fatigue, thin clear nasal discharge, nasal obstruction, facial discomfort, watery itchy and puffy eyes. NO fever or chills.
What additional history do you need in order to properly treat a patient with allergic rhinitis Be sure to rule out the historical factors that would indicate an alternate cause for his rhinitis
Determine any medications he is on, in addition to aspirin sensitivity, any nasal problems in the past (nasal blockages, polyps, deviated septum) or a HX of hypothyroidism. Any known existing allergies (Reserpine, methyldopa, NSAIDS and beta blockers may all cause rhinitis)
Personal or family HX asthma, eczema, atopic disease. Environmental exposure: dust mites, animal dander, indoor allergens (especially in winter R/T heating systems dissemination of dust particles)
Symptoms R/T allergic rhinitis cause itching in nose and URI (pattern of ssx important for DX)
When are you symptomatic? Where and when do symptoms occur? Is there any associated itching? What medications have you been using?
What are some things a patietn can do to decrease doggy allergens?
Keep the dog out of the bedroom at all times, leave him outdoors as much as possible. Wash pet/bedding weekly, ventilate home frequently, have a friend whose not allergic clean regularly with a HEPA double bag vacuum, minimize carpets, drapes, and upholstered furniture. Get washable rugs, remove old loose rugs. Furniture and curtains should be cleaned and wiped regularly acaricide powder every other month on carpets to kill dust mites. carpet needs to be synthetic and short napped. cotton curtains are preferable avoid dust catching blinds.