2018

SINPMS, BADAL

Submitted to :
Mr. Satish Chand
Bansal
Assistant professor
Department of
Medical Surgical
Nursing

Submitted by :
Kiranbir Kaur
M.Sc. Nursing 1st
year

[PRACTICE
TEACHING ]
RHINITIS – ALLERGIC & NON- ALLERGIC
 LESSON PLAN ON RHINITIS

 Name of the student- Kiranbir kaur

 Class- M.Sc. Nursing 1st year
 Subject- Medical surgical Nursing
 Topic- Rhinitis
 Venue- B.Sc. 3rd year class room, SINPMS , Badal
 Language- English
 Time duration- 45- 50 min.
 Name of Evaluator- Mr Satish Bansal (Assistant professor)
 Previous Knowledge: Students are aware about Infection control protocol
 Method of Teaching: Lecture cum Discussion
 Media of Instruction: Blackboard, Flashcards and chart, power point presentation
 General objectives :
At the end of teaching the group is able are aware about Rhinitis, its causes and treatment

 Specific objectives: At the end of teaching the group is able to:-

 Definition of Rhinitis
 Classification of Rhinitis
 Causes of Rhinitis
 Allergic rhinitis
 Non allergic rhinitis
 Pathophysiology of Rhinitis
 Diagnostic evaluation of Rhinitis
 Management of Rhinitis
 Nursing management of Rhinitis
 Complications of Rhinitis

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Sr. Objectives Time Content-matter Teaching and AV Aids Evaluation
no. Learning
Activities
1. To establish 1 min I am Kiranbir kaur, student of M.sc Student teacher
Rapport (Nsg) 1st year, standing before you introduced
with to present my topic. about herself.
the students
2. To 1min Today we will discuss about Student teacher
announce announced the
Infection control protocol
the topic to topic.
the group
3. To 2 Rhinitis is a group of disorders Student teacher Lecture What do you
introduce minute introduce the cum understand by
characterized by inflammation and
topic to the s topic discussion Rhinitis ?
students irritation of the mucous membranes
of the nose. The inflammation is
caused by viruses, bacteria, irritants
or allergens. Common symptoms
are a stuffy nose, runny nose,
sneezing, and post-nasal drip.
4. To explain 4-5 The causes of rhinitis include the Student teacher Lecture What do you
causes of minute following: explains causes cum understand by
Rhinitis s of Rhinitis discussion causes of
Irritation of nose by smoke, Rhinitis ?
strong smells, fumes, chemicals,
changes in temperature or
humidity.

Hormonal changes during

pregnancy and puberty, which can
sometimes cause nasal symptoms.

Overactive thyroid gland : this

can also sometimes lead to rhinitis.

Food and drink - mainly hot,

spicy food, or alcohol. Sensitivity
to certain food colourings or
preservatives may be a cause.

Emotion such as stress or sexual

arousal can sometimes affect your
nose.

Medication - a side-effect from

certain medicines is a rare cause.
These include beta-blocker

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 medicines, aspirin and other anti-
inflammatory medicines,
angiotensin-converting enzyme
(ACE) inhibitors, the contraceptive
pill and chlorpromazine.

Rhinitis medicamentosa is the

name given to rhinitis that can
occur due to the overuse of nasal
decongestant sprays. These sprays
are used to help a blocked nose and
they reduce swelling of blood
vessels in your nose. However, if
they are used for more than seven
days, the swelling can come back.

5. To describe 5-6 The classification of Rhinitis are : Student teacher Power What do you
classificatio minute (i) Infectious rhinitis includes explains point know about
n of Rhinitis s acute and chronic bacterial classification presentatio classification
infections; Rhinitis is commonly of Rhinitis n of Rhinitis ?
caused by a viral or bacterial
infection, including the common
cold, which is caused by
Rhinoviruses, Coronaviruses, and
influenza viruses, others caused by
adenoviruses, human para influenza
viruses, human respiratory
syncytial virus, entero viruses .
(ii) Non allergic (vasomotor)
rhinitis The category was formerly
referred to as vasomotor rhinitis, as
the first cause discovered was
vasodilation due to an overactive
parasympathetic nerve response.
includes idiopathic, hormonal,
atrophic, occupational, and
gustatory rhinitis, as well as rhinitis
medicamentosa (drug-induced);
(iii) Allergic rhinitis : triggered by
pollen, mold, animal dander, dust,
Balsam of Peru, and other inhaled
allergens. Allergic rhinitis or hay
fever may follow when an allergen
such as pollen, dust, or Balsam of
Peru is inhaled by an individual
with a sensitized immune system,
triggering antibody production.
These antibodies mostly bind to
mast cells, which contain
histamine. When the mast cells are
stimulated by an allergen,

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 histamine (and other chemicals) are
released. This causes itching,
swelling, and mucus production.
6. To explain 5-6 Allergic rhinitis, or hay The student Power What do you
allergic minute fever, is an allergic response to teacher point know about
rhinitis s specific allergens. Pollen is the explains about presentatio allergic
most common allergen in allergic rhinitis n rhinitis ?
seasonal allergic rhinitis. These
are allergy symptoms that occur
with the change of seasons.

Symptoms of allergic
rhinitis

Common symptoms of allergic

rhinitis include:

 sneezing
 a runny nose
 a stuffy nose
 an itchy nose
 coughing
 a sore or scratchy throat
 itchy eyes
 watery eyes
 dark circles under the eyes
 frequent headaches
 eczema-type symptoms,
such as having extremely
dry, itchy skin that can
blister and weep
 hives
 excessive fatigue

What causes allergic rhinitis?

When your body comes into

contact with an allergen, it
releases histamine, which is a
natural chemical that defends
your body from the allergen.
This chemical can cause allergic
rhinitis and its symptoms,
including a runny nose,
sneezing, and itchy eyes.

What are the types of

allergic rhinitis ?
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The two types of allergic rhinitis
are seasonal and perennial.
Seasonal allergies usually occur
during the spring and fall season
and are typically in response to
outdoor allergens like pollen.
Perennial allergies can occur
year round, or at any time
during the year in response to
indoor substances, like dust
mites and pet dander.

Risk factors for allergic

rhinitis

 cigarette smoke
 chemicals
 cold temperatures
 humidity
 wind
 air pollution
 hairspray
 perfumes
 colognes
 wood smoke
 fumes

Tips to prevent allergies

1. Stay indoors when pollen

counts are high.
2. Avoid exercising outdoors
early in the morning.
3. Take showers immediately
after being outside.
4. Keep your windows and
doors shut as frequently as
possible during allergy
season.
5. Keep your mouth and nose
covered while performing
yard work.
6. Try not to rake leaves or
mow the lawn.
7. Bathe your dog at least
twice per week to minimize
dander.
8. Remove carpeting from

5
 your bedroom if you’re
concerned about dust
mites.

7. To explain 5-6 Nonallergic rhinitis The student Power What do you

about non minute (vasomotor rhinitis) is a nurse explain point know about
allergic s condition that causes chronic about non – presentatio non allergic
rhinitis sneezing, congestion, or runny allergic rhinitis n rhinitis ?
nose. While these symptoms are
similar to those of allergic
rhinitis (hay fever), nonallergic
rhinitis is different because,
unlike an allergy, it doesn’t
involve the immune system. An
allergic reaction occurs when
the immune system overreacts to
an otherwise harmless substance
known as an allergen.

Symptoms
Airborne pollutants or odors,
certain foods or beverages, some
medications, changes in the
weather or underlying chronic
health problems can all trigger
symptoms of non allergic
rhinitis. These symptoms can
come and go, or be constant.

The most common symptoms of

non allergic rhinitis are:

 Stuffy nose
 Runny nose
 Sneezing
 Postnasal drip

Unlike the allergic form, non

allergic rhinitis rarely causes
itchy nose, eyes or throat.

Diagnosis and Treatment

Non allergic rhinitis cannot be
cured, but many people find
relief by avoiding triggers, using
a saline rinse solution or by
taking over-the-counter or
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 prescription medications.
8. To explain 2-3 The pathophysiology of Rhinitis is Student teacher Power What do you
pathophysio minute as : Predisposing factors such explains point understand
logy of s as allergens , food, emotions, pathophysiolog Presentatio about
Rhinitis pollution , medications etc. y of Rhinitis n pathophysiolo
gy of Rhinitis
It leads to edematous conchae; ?
polyps may develop

It turns into occluded sinus

openings , enlarged nasal mucosa

It results into discharging mucus

at last .

9. To describe 3-4 The clinical features are Student teacher Power What do you
clinical minute explains point know about
features of s  Rhinorrhea. This clinical features Presentatio clinical
Rhinitis condition is of Rhinitis n features of
commonly called Rhinitis ?
“runny nose”.

 Nasal congestion. The

child may complain of
stuffiness in the nose.
 Postnasal drainage. This
occurs when excessive
mucus is produced by the
nasal mucosa.
 Repetitive sneezing.
Sneezing repeatedly is a
sign that there is irritation.
 Itchiness. There is itching
of the palate, ears, nose, or
eyes.
 Allergic salute. The
allergic salute is when the
child pushes his or her nose
upward and backward to
relieve itching and open the
air passages in the nose.

10. To describe 2-3 It includes following Student teacher Power What do you
diagnostic minute evaluations : describes point know about
evaluation s diagnosis of presentatio diagnosis of
of Rhinitis  Skin-prick testing. This Rhinitis n Rhinitis ?
test is highly sensitive and
specific for aeroallergens;

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 however, a false positive
reaction can occur without
corresponding clinical
features, especially when
skin mast cells are easily
activated by pressure or
other physical stimuli.
 Serum allergen-specific
IgE testing. The main
limitations are that patients
may be sensitive on a
molecular level before IgE
response is clinically seen
on standard skin testing;
this may lead to positive
results on laboratory tests
that are not triggering
clinical symptoms.
 Nasal smear. Eosinophils
usually indicate allergy.
 CBC count with
differential. A CBC count
may reveal an increased
number of eosinophils; an
eosinophil count within the
reference range does not
exclude AR; however, an
elevated eosinophil count
is suggestive of the
diagnosis.

11. To explain 3-4 The management of Rhinitis Student teacher Power What do you
management min includes describes point understand by
of Rhinitis utes management of presentatio management
Environment control. Use Rhinitis n of Rhinitis ?
of environmental controls
is not adequately explored
in most patients; for many
patients, the removal of the
trigger can have a dramatic
effect; difficulty arises
when the trigger needs to
be identified and
eliminated; eliminating the
trigger may be simple if
removal of a feather pillow
or blanket is involved;
however, it can be very
difficult if a family pet

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 needs to be removed.

Pharmacologic Management

Many groups of medications are

used for allergic rhinitis (AR),
including antihistamines,
corticosteroids, decongestants,
saline, sodium cromolyn, and
leukotriene receptor antagonists.

 2nd generation
antihistamines.
Antihistamines are
classified in several ways,
including sedating and
nonsedating, newer and
older, and first- and
second-generation
antihistamines (most
widely accepted
classification); first-
generation antihistamines
are primarily over-the-
counter OTC) and are
included in many
combination products for
cough, colds, and allergies.
 Intranasal
antihistamines. These
agents are an alternative to
oral antihistamines to treat
allergic rhinitis; currently,
azelastine and olopatadine
are the only agents
available in the United
States.
 Intranasal
corticosteroids. This class
of medications is most
effective; intranasal
corticosteroids are potent
anti-inflammatory agents
shown to decrease allergic
rhinitis symptoms in more
than 90% of patients.
 Intranasal antihistamine
and corticosteroids.
Combination products are
emerging on the market for

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 patients who require an
intranasal antihistamine
and corticosteroids.
 Intranasal decongestants.
Decongestants are effective
for short-term symptom
control; they decrease nasal
discharge and congestion
and are available without a
prescription.
 Leukotriene receptor
agonists. Montelukast has
been approved as
monotherapy for allergic
rhinitis; it has been shown
to be most effective in
patients in whom
significant congestion is a
primary complaint.
 Allergen immunotherapy.
Immunotherapy with daily
sublingual (SL) tablets may
be able to replace weekly
injections in some
individuals, depending on
the offending allergens;
depending on the particular
SL tablet, therapy must be
initiated at least 3-4 months
before the allergen season
that is being treated.
 Intranasal mast cell
stabilizers. These are
effective therapy for AR in
approximately 70-80% of
patients; they produce mast
cell stabilization and
antiallergic effects by
inhibiting mast cell
degranulation.

12. To explain 4-5 Nursing management of the client The student Power What do you
nursing minute with allergic rhinitis includes: teacher point know about
management s explains presentatio nursing
of Rhinitis Nursing Assessment nursing n management
management of of Rhinitis?
Assessment of the client include: Rhinitis

History. Nurses should try to

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identify seasonal variations,
provocative elements in the
environment, and the timing of
events that lead to symptoms; for
example, if the patient only has
issues during the week, this may
lead to investigating the
environment of the client .

Nursing Diagnoses

Based on the assessment data, the

major nursing diagnoses are:

 Ineffective airway
clearance related to
obstruction or presence of
thickened secretions.
 Disturbed sleep pattern
related to obstruction of the
nose.
 Self-concept disturbance
related to the condition.
 Anxiety related to lack of
knowledge about the
disease and medical action
procedure.

Nursing Care Planning and

Goals

The major goals for a client with

allergic rhinitis are:

 client will no longer

breathe through the mouth.
 Airway will be back to
normal, especially the
nose.
 client will sleep 6-8 hours a
day.
 client and parents will
describe the level of
anxiety and coping
patterns.
 client and parents will
know and understand about
the disease and treatment.

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Nursing Interventions

Nursing interventions for the child

include:

 Identification of the
allergen. Identification and
elimination is easiest for
dust mite allergens; pollen
is more difficult to avoid
because daily activities
must be altered to do so; an
easy intervention is to keep
the windows closed, which
is easily accomplished in
air-conditioned homes and
must be done throughout
the year.
 Use of nasal sprays. Teach
the patient and parents on
how to use nasal sprays by
blowing the nose first then
administering the
medication.
 Encourage thorough
cleaning of the house.
Encourage a routine
cleaning of the house,
furniture, and
equipment which may
house dust and other
pollens.
 Encourage medication
compliance. Administer
pharmacologic treatment as
ordered by the physician.

Evaluation

Goals are met as evidenced by:

 client no longer breathes

through the mouth.
 Airway is back to normal,
especially the nose.
 client sleeps 6-8 hours a
day.
 client and parents describe
the level of anxiety and
coping patterns.

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  client and parents know
and understand about the
disease and treatment.

13. To explain 2 The complications of Rhinitis are : The student Power What do you
complicatio minute Sinusitis: If allergic rhinitis is not teacher point know about its
ns of s treated or treated improperly, explains presentatio complications
Rhinitis infection from the nose can proceed complications n ?
into the sinuses surrounding the of Rhinitis
noses causing sinusitis.

Bronchial Asthma: Allergic

Rhinitis is a disease characterized
by hypersensitivity to certain
factors. This can also trigger a
similar hypersensitivity (allergy) in
the airways of the lungs and trigger
breathlessness, cough and
wheezing leading to Bronchial
Asthma.

Otitis Media: Infection from the

nose may also spread to the middle
ear through a connecting tube
called Eustachian tube and cause
infection called otitis media.

14. To 2 Definition of Rhinitis

recaptualize minute Causes of Rhinitis
the topic s Pathophysiology of Rhinitis
Classification of Rhinitis
Clinical features of Rhinitis
Diagnostic evaluation of Rhinitis
Management of Rhinitis
Complications of Rhinitis
15. To 2 What is definition of Rhinitis ?
summarize minute What is causes of Rhinitis ?
the topic s What is pathophysiology of
Rhinitis ?
What is classification of Rhinitis?
What is clinical features of Rhinitis
?
What is diagnostic evaluation of
Rhinitis ?
What is management of Rhinitis ?
What is complications of Rhinitis ?

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References :

“Textbook of medical surgical nursing” ; Brunner & Suddarth ; lippinkot publishers ; 9th edition

www.google.com

www.slideshare.com

www.wikipedia.com

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