l ln18CuuC1lCn

Sinusitis is defined as inflammation within the sinus cavities. Acute sinusitis often
occurs in the common cold and in the first ten days of symptoms there is reason to wait
since things often improve on their own. A recent study suggests that treatment with a
nasal steroid spray is as good as antibiotics in acute sinusitis. Beyond 10 days, it's likely
that things have evolved into a bacterial sinusitis. Anyone can get a bacterial sinusitis
but it's more likely if you have allergies, smoke cigarettes have some certain anatomic
variances within your or if you have an immune deficiency. Bacterial sinusitis can
relapse and require more than one round of antibiotics.
Chronic sinusitis is potentially much more complicated than acute sinusitis depending
upon the cause. Some patients with chronic sinusitis have localized areas of infection
due to their sinus anatomy that might respond well to surgery alone. For others there is
widespread swelling of the sinus membranes and though surgery may help some of
these patients, they also need careful close monitoring and medications to keep the
sinus swelling in check.

S1A1lS1lCS
l lnLernaLlonal
ll Local


ll C8!LC1lvLS
CLnL8AL C8!LC1lvL
AL Lhe end of Lhls case sLudy l wlll be able Lo uLlllze approprlaLe nurslng process perform
proper nurslng managemenL and enhance my ablllLy Lo lnLeracL wlLh Lhe cllenL

SLClllC C8!LC1lvLS
CognlLlve
1 1o be able Lo deflne chronlc slnuslLls
2 1o be able Lo deLermlne Lhe facLors LhaL may lead Lo chronlc slnuslLls
3 1o ldenLlfy Lhe organ LhaL may be affecLed ln chronlc slnuslLls
4 1o be aware of Lhe dlfferenL speclal nurslng conslderaLlon for Lhe dlsease
sychomoLor
1 1o be able Lo assess slgns and sympLoms LhaL my paLlenL wlll manlfesL
2 1o be able Lo perform Lhe dlfferenL speclal managemenLs for Lhe dlsease
3 1o perform Lhe speclal managemenL Lo Lhe cllenL genLly
AffecLlve
1 1o develop a good ouLlook ln llfe
2 1o be undersLandlng Lo Lhe cllenLs condlLlon and Lo be advocaLe of Lhe cllenL's well
belng
3 1o conslder Lhe behavlor of Lhe cllenL be able Lo ad[usL and Lo esLabllsh a worklng
relaLlonshlp wlLh her and Lhe folks

lll AnA1CM? Anu P?SlCLCC?

1he nasal cavlLy ls dlvlded by Lhe medlan sepLum lnLo rlghL and lefL halves Lach half of Lhe nasal
cavlLy opens Lo Lhe exLerlor Lhrough Lhe exLernal nares and posLerlorly lL opens lnLo Lhe
nasopharynx 1he half of Lhe cavlLy ls Lrlangular lL has a verLlcal medlal wall formed by Lhe nasal
sepLum a sloplng laLeral wall a relaLlvely broad floor formed by Lhe palaLe and a narrow roof
whlch lles aL Lhe [uncLlon of Lhe medlal and laLeral walls

1hese walls have a skeleLal basls LhaL ls made up of predomlnanLly of bone buL ls carLllaglnous
aL some places 1he skeleLal basls ls covered by mucosa ls molsL and hlghly vascular lL serves Lo
warm lnsplred alr and also helps Lo remove dusL lor Lhls reasons Lhe mucosa ls reffered Lo as
resplraLory 1he mucosa llnlng Lhe upper mosL parL of Lhe sepLum and Lhe ad[olnlng parL of Lhe
laLeral wall dlffers from LhaL presenL elsewhere ln Lhe nasal cavlLy lL ls characLerlsed by Lhe
presence of recepLor cella LhaL are senslLlve Lo smell Lhe mucosa ln Lhls reglon ls Lherefore
called Lhe olfacLory mucosa ClfacLory nerves arlse from Lhls mucosa A small area of Lhe nasal
cavlLy ls llned noL by mucous membrane buL by skln ?he skln bears halr whlch serve Lo Lrap
dusL presenL ln lnsplred alr
1he nasal sepLum ls falrly ofLen deflecLed Lo one slde so LhaL one half of Lhe nasal cavlLy may be
larger Lhan Lha oLher
1here are Lhree anLeroposLerlor eelevaLlons on Lhe laLeral wall 1hese are Lhe superlor mlddle
and lnferlor nasal conchae Lach concha has an upper border aLLached Lo Lhe resL of Lhe laLeral
wall and a free lower margln 1he spaces deep Lo Lhe superlor mlddle and lnferlor conchae are
called Lhe superlor mlddle and lnferlor meaLuses
1he parL of Lhe nasal cavlLy [usL above Lhe anLerlor nares ls called Lhe vesLlbule lL llned by Lhe
skln

1he aranasa| S|nuses
1hese are spaces presenL ln Lhe subsLance of Lhe bones relaLed Lo Lhe nasal cavlLles Lach slnus
opens lnLo Lhe nasal cavlLy and ls llned by mucous membrane conLlnous wlLh LhaL of Lhe laLer
8ecause of Lhls communlcaLlon each slnus ls normally fllled wlLh alr

1he rlghL and lefL fronLal slnuses are
presenL ln Lhe parL of Lhe fronLal bone
Lach slnus opens lnLo Lhe mlddle
meaLus
1he rlghL and lefL sphenoldal slnuses
are presenL ln Lhe body of Lhe sphenold
bone Lach opens lnLo Lhe
correspondlng sphenoeLhmoldal recess
Lach maxlllary slnus lles wlLhln Lhe
maxllla 1he slnus opens lnLo Lhe mlddle
of Lhe nasal cavlLy
1he eLhmoldal alr slnuse are locaLed
wlLhln Lhe eLhmoldal bone 1hey can be
dlvlded lnLo anLerlor mlddle and
posLerlor groups



lv vl1AL lnlC8MA1lCn

name GD
Age 86 yo
Sex Iema|e
Address ob I|awod Maayon Cap|z
Clvll SLaLus Marr|ed
8ellglon koman Catho||c
CccupaLlon nouse W|fe
uaLe 1lme admlLLed Iu|y 92011 Q 300 pm
Ward 8lessed 8osalle kendu Ward
Chlef complalnL D|zz|ness
lmpresslon/AdmlLLlng ulagnosls nypertens|on Urgency DM type II
llnal ulagnosls Chron|c S|nus|t|s nACVD DM type II
ALLendlng hyslclan Dr ID Dr I1

V CLINICAL ASSLSSMLN1
A Nurs|ng n|story
SaLurday mornlng(7/9/11) paLlenL was complalnlng of dlzzlness and her 8 was checked by her
granddaughLer and lL was 130/90 and Lhey declded Lo soughL medlcal advlce and admlLLed ln
SACP
8 ast nea|th rob|em]Status
Aprll 2006 she undergone appendecLomy
She has an allergy on sea foods poulLry producLs and drled foods
She was hosplLallzed several Llmes because of hyperLenslon
She was Laklng Cardlpres Zarc uuxarll CulvasmeL rogrel and Zanldlp
as her malnLenance for her hyperLenslon and uM

C Iam||y n|story of I||ness
Per husband has a hlsLory of asLhma and hyperLenslon Per 6
Lh
chlld acqulred Lhe dysLonla LhaL
was came from Lhe moLher slde of Cu

vl nu8SlnC ASSLSSMLn1 Cl lunC1lCnAL PLAL1P A11L8nS

PLAL1P L8CL1lCn Anu PLAL1P MAnACLMLn1 A11L8n
1 PlsLory
a Pow has general healLh been?
8efore her hosplLallzaLlon she was flne and was able Lo do her dally acLlvlLy

b Any colds ln pasL year? When approprlaLe absences from work?
She experlenced colds every Llme lL ls ralny season

c MosL lmporLanL Lhlngs you do Lo keep healLhy? 1hlnk Lhese Lhlngs make a dlfference
Lo healLh? (lnclude famlly folk remedles when approprlaLe) use of clgareLLes
alcohol drugs? 8reasL selfexamlnaLlon?
She doesn'L have hlsLory of clgareLLes smoklng nor drlnklng llquor She doesn'L do
self examlnaLlon

d AccldenLs (home work drlvlng)?
nCnL

e ln pasL been easy Lo flnd ways Lo follow suggesLlons from physlclans or nurses?
?LS

f When approprlaLe whaL do you Lhlnk caused Lhls lllness? AcLlons Laken when
sympLoms percelved? 8esulLs of acLlon?
8ecoose of my oqe ooJ my llfestyle
g When approprlaLe Lhlngs lmporLanL Lo you ln your healLh care?
h Pow can we be mosL helpful?
PeaLh Leachlng

2 LxamlnaLlon general healLh appearance
She ls really prone Lo dlseases because of her age

nu18l1lCnALMA1A8CLlC A11L8n
1 PlsLory
a 1yplcal dally food lnLake? (uescrlbe)
SupplemenLs (vlLamlns Lype of snacks)?
e osoolly eots Jx o Joy e mostly eot soft Jlet llke oot meols ooJ loqow e olso eot
veqetobles ooJ ftolts elJom eots meot ooJ clckeo
b 1yplcal dally fluld lnLake? (uescrlbe)
She drlnks 79 glasses of waLer and 2 glasses of mllk SomeLlmes she ls drlnklng sofL
drlnks
c WelghL loss or galn? (amounL)
PelghL loss or galn? (amounL)
She losses welghL of 3 kg
d AppeLlLe?
She has a good appeLlLe
e lood or eaLlng ulscomforL? Swallowlng?
uleL resLrlcLlons?
She ls prohlblLed of eaLlng sea foods and poulLry producLs and drled foods

f Peal well of poorly?
Peal poorly
g Skln problems leslons? uryness?
e os o Jty sklo ooJ os o tos below et tlqt bteost
h uenLal problems?
She don'L have permanenL LeeLh and she uses denLure for boLh gums

2 LxamlnaLlon
a Skln 8ony promlnences? Leslons? Color changes? MolsLness?
1here ls no color changes Leslon below her rlghL breasL

b Cral mucous membranes Color? MolsLness? Leslons?
no leslon noLed
c 1eeLh Ceneral appearance and allgnmenL? uenLures? CavlLles? Mlsslng LeeLh?
She mlsses all of her LeeLh and uses denLures for Lhe boLh gums
d AcLual welghL helghL
Per welghL ls 40 kg
Per helghL ls 3"

e 1emperaLure
Per LemperaLure ranges from 36372
o
C

f lnLravenous feedlngparenLeral feedlng (speclfy)? nSS 1L x 40 cc/
o


LLIMINA1ICN A11LkN
1 Pl sLory
a 8owel ellmlnaLlon paLLern? (uescrlbe) lrequency? CharacLer? ulscomforL? roblem
ln conLrol? LaxaLlves?
She has a regular bowel ellmlnaLlon lf consLlpaLlon occurs she drlnks MlLamosll

b urlnary ellmlnaLlon paLLern? (uescrlbe) lrequency? roblem ln conLrol?
volds 68x a day

c Lxcesslve persplraLlon? Cdor problems?
SomeLlmes lf she ls dolng her gardenlng
d 8ody cavlLy dralnage sucLlon and so on? (Speclfy)

2 LxamlnaLlonwhen lndlcaLed examlne excreLa or dralnage color and conslsLency
nCnL

AC1IVI1LkLkCISL A11LkN
1 Pl sLory
a SufflclenL energy for deslred or requlred acLlvlLles?
?es
b Lxerclse paLLern? 1ype? 8egularlLy?
She ls walklng every mornlng lf Lhe weaLher ls good
c SpareLlme (lelsure) acLlvlLles? Chlld play acLlvlLles?
WaLchlng Lelevlslon and someLlmes go Lo mall


d ercelved ablllLy (code for level) for
l e e d l n g | e v e | 0
u r e s s l n g | e v e | 0
C o o k l n g | e v e | I I
8 a L h l n g | e v e | I I
C r o o m l n g | e v e | C
S h o p p l n g | e v e | I I
1 o l l e L l n g | e v e | I I
C e n e r a l m o b l l l L y | e v e | I
8 e d m o b l l l L y | e v e | I
P o m e m a l n L e n a n c e | e v e | I V

luncLlonal Level Codes
Level 0 full selfcare

Level l requl res use of equl pmenL or devl ce

Level ll requlres asslsLance or supervlslon from anoLher person

Level lll requlres asslsLance or supervlslon from anoLher person and equlpmenL or
devlce

Level lv ls dependenL and does noL parLlclpaLe

2 LxamlnaLlon
a uemonsLraLed ablllLy (code llsLed above) for
4 l e e d l n g | e v e | I I
4 u r e s s l n g | e v e | I I
4 C o o k l n g | e v e | I V
4 8 a L h l n g | e v e | I I I
4 C r o o m l n g | e v e | I I
4 S h o p p l n g | e v e | I V
4 1 o l l e L l n g | e v e | I I I
4 C e n e r a l m o b l l l L y | e v e | I I I

b
4 C a l L c a n n o t a m b u | a t e a | o n e
4 o s L u r e h a s a p o o r p o s t u r e
4 A b s e n L b o d y p a r L ? (Speclfy) NCNL

c
4 8 a n g e o f m o L l o n ( [ o l n L s ) C a n m o v e h a n d u n t | |
e x t e n d e d
4 M u s c l e rmness musc|e |s not f|rm

d
4 P a n d g r l p w e a k h a n d g r | p
4 C a n p l c k u p a p e n c l l ? N C

e
4 u l s e ( r a L e )
4 ( r h y L h m )
4 8 r e a L h sounds no breath sound

f
4 8 e s p l r a L l o n s ( r a L e ) ( r h y L h m )
4 8 r e a L h sounds


g
4 8l ood pressure

h
4 Ceneral appearance (groomlng hyglene and energy level)



SLLLkLS1 A11LkN
1 Pl sLory
a Ceneral l y resLed and ready for dal l y acLl vl Ll es afLer sleep?

b Sleep onseL problems? Alds? ureams (nlghLmares)? Larly awakenlng?

c 8esLrelaxaLlon perlods?

2 LxamlnaLlon
a When approprlaLe Cbserve sleep paLLern

CCGNI1IVLLkCL1UAL A11LkN
1 Pl sLory
a Pearlng dlfflculLy? Pearlng ald?

b vl sl on? Wear gl asses? LasL checked? When l asLchanged?

c Any change l n memory l aLel y?
d lmporLanL decl sl on easy or dl ffl cul L Lo make?

e Lasl esL way for you Lo l earn Lhl ngs? Any dl ffl cul Ly?

f Any dl scomforL? al n? When approprl aLe Pow do you manage lL?

2 LxamlnaLlon
a CrlenLaLlon

b Pears whl sper?

c 8eads newsprl nL?

d Crasps ldeas and quesLlons (absLracL concreLe)?

e Language spoken

f vocabulary level ALLenLlon span







vll CLINICAL INSLC1ICN
A V|ta| s|gns




V|ta| s|gns upon my care




8 ne|ght S " we|ght 4S kg 8MI

C nSICAL ASSLSSMLN1 (CLnALCCAUDAL)
a Ceneral assessmenL

Cu was handled lasL !uly 92011 wearlng hosplLal gown and place ln a suplne poslLlon
She was awake and orlenLed Lo place person and Llme She responses Lo every
quesLlons asked as long as she can sLlll remember and hears lL

a Sk|n
Color wh|te
ury? MolsL? Dry
oor skln Lurgor? no
Warm? Cold? Warm
b na|r
Color comblnaLlon of black and whlLe halr
CuallLy
ShorL or long? ShorL
ury? ?es
1hlck? 1hln? 1hln
c Na||s
nall beds are acyanoLlc plnklsk ln color and clean flngernalls

d nead
Pead ls proporLlonal Lo Lhe slze of Lhe body
no leslons and flakes noLed
Can Lurn head from lefL Lo rlghL slde
e Iace
SymmeLrlcal
moles and freckles are noLed
wrlnkled face

V|ta|s s|gns upon adm|ss|on (7]9]11 Q 300 pm)
1 k Ck 8 kk S]U
36
o
C 76 bpm 80 bpm 170/80
130/70
23 bpm 0/0
V|ta|s s|gns upon adm|ss|on (7]9]11 Q 300 pm)
1 k Ck 8 kk S]U
36
o
C 76 bpm 80 bpm 170/80
130/70
23 bpm 0/0
f |ymphat|c system
no palpable mass noLed
g Lyes


h Lars
arallel and proporLlonal Lo Lhe slze of Lhe head
no dlrL noLed
no palpable mass
Looks symmeLrlcal and Lop of Lhe ear ls ln Lhe llne wlLh Lhe ouLer corner
of Lhe eye
l nose
Swelllng of Lhe slnuses
no nasal dlscharges
Color ls Lhe same as Lhe face
no deformlLy noLed
[ MouLh
Llps are dry
lncompleLe LeeLh
uses false LeeLh
k 1hroaL
no dlfflculLy when swallowlng

l neck
roporLlonal
no palpable mass
CaroLld pulse can easlly be palpaLed
Move enLlre range of moLlon
m upper exLremlLles
Warm
llve flngers ln boLh hands
unable Lo ambulaLe alone
Wrlnkled noLed
nalls are clean
n ChesL
very sLrong hearL beaL sound
Color ls Lhe same as of Lhe body parLs
no halr

o 8reasL
ury
WhlLe ln color
nlpple aL Lhe cenLer
8ash below Lhe rlghL breasL
p Axllla
8ashes and plgmenLaLlon noL noLed
ury
no halr
q 8esplraLory sysLem

88 ls 2030 bpm
r Cardlovascular sysLem
C8 ls
8lood pressure ls
s CasLrolnLesLlnal sysLem
(+) bowel sound
(+) flaLulence
noL waLery sLool
1 Llme ln 3 days
8rown and black ln color
Cdorous smell

L CenlLorurlnary sysLem
SLraw
ln dlaper

u MusculoskeleLal sysLem
Weakness noLed
no fracLure


b Ceneral appralsal
a Speaks ln moderaLe volce Can answer quesLlon LhaL was belng ask
b knows 3 languages speclflcally Lngllsh Lagalong and Plllgaynon
c CannoL hear well 8epeaLlng quesLlon Lwlce or Lrlce
d CrlenLed and consclous Lo Llme person and place
e Pappy and smlles Lo people around her

vlll LA8CkA1Ck AND DIAGNCS1IC DA1A
A CnLMIS1k
NAML AND DA1L
CI LkAMINA1ICN
(7]9]11)
kLSUL1S NCkMAL
VALULS
SIGNIIICAN1 CI
1nL A8NCkMAL
kLSUL1S
CLuCCSL 630 P mmol/L 4139 81
Mll1u
CPCLLS1L8CL 31 mmol/L 032 Wl1Pln nC8MAL
LlMl1S
18lCL?CL8luLS 061 mmol/L 0170 Wl1Pln nC8MAL
LlMl1S
PuL 164 mmol/L 090133 81
Mll1u
LuL 12 mmol/L 039 Wl1Pln nC8MAL
LlMl1
vLuL 028 mmol/L 0103 Wl1Pln nC8MAL
LlMl1
CPCLLS1L8CL 8lSk
lAC1C8S
19 mmol/L 040 Wl1Pln nC8MAL
LlMl1






















NAML AND DA1L
CI
LkAMINA1ICN
(7]9]11)
kLSUL1S NCkMAL VALULS SIGNIIICAN1 CI
1nL A8NCkMAL
kLSUL1S
PLMA18CC8l1 036 vCLl8 036040 Wl1Pln nC8MAL
LlMl1S
PLMCCLC8ln 120 gms?L M 140173
l 123133
AnLMlA
8Lu CLLL CCun1 42 x 1012/L 4331 CL?C?1PLMlA
WPl1L CLLL
CCun1
138 x109/L 4411 lnlLC1lCn
SLCMLn1L8S 089 3063 lnlLC1lCn
L?MPCC?1LS 26 2330 Zn8 Wl1Pln nC8MAL
LlMl1S
MCnCC?1LS 003 23 ACu1L lnlLC1lCn
LA1LLL1 334 x 109/L Wl1Pln nC8MAL
LlMl1S



SkuLL WA1L8S
x8A? llnulnCS
1he fronLal eLhmold and maxlllary slnuses are hazy
1he nasal sepLum ls aL Lhe mldllne
1here ls bllaLeral nasal fullness
1he osseous sLrucLures are lnLacL
lM8LSSlCn
olyslnuslLls
8llaLeral nasal fullness mosL llkely due Lo congesLed LurblnaLes

X . PATHOPHYSOLOGY



NAML AND DA1L
CI LkAMINA1ICN
(7]9]11)
kLSUL1S NCkMAL
VALULS
SIGNIIICAN1 CI
1nL A8NCkMAL
kLSUL1S
C8LA1lnln 323 L umol/L 33113 lONC1kM
cOk1cO1kO
1nk9
SCuluM 111 umol/L 136143 81c
k1OcO
C1ASSluM 36 uumol/L 3331 Wl1Pln nC8MAL
LlMl1S
AL1 34 u/L 3063 Wl1Pln nC8MAL
LlMl1S
u8lC AClu 7401 u/L 039 lCLlC AClu
uLllClLnC?
NAML AND DA1L
CI LkAMINA1ICN
(7]9]11)
kLSUL1S NCkMAL
VALULS
SIGNIIICAN1 CI
1nL A8NCkMAL
kLSUL1S

PATHOPHYSOLOGY OF CHRONC SNUSTES

















































L1ICLCG
9NuMON
nNlluN2
9lOcOccu
STRUCTI I THE STIA
THE RTAL, MAXILLARY A
ATERIR ETHMI SIUSES.
PREVETI AEQUATE
RAIAE T THE ASAL
PASSAES
8LCCkAGL 1nA1 LkSIS1S
ICk GkLA1Lk 1nAN 3
WLLkS
STAAT
SECRETIS
ICREASE RISK R
EVELPI UAL
SIUSITIS
O INILC1ICN
O ALLLkG
O S1kUC1Uk
AL
A8NCkMA
LI1
8LCll1A1lnC
lAC1C8
O 8LvlCuS
vl8AL
lnlLC1lCn
8LulSCSlnC lAC1C8
O WLA1PL8
O ACL (MCS1
CCMMCn ln
AuuL1)
O S1ull?
nCSL
CLnL8AL
MALAlSL
O 1CxlCl1?
L8SlS1Ln1
CCuCP
O CS1 nASAL
u8l
PLAuACPL
SLlCP1L? C8
nC8MAL
1LML8A1u8L
O MlLu
LLukCLnlA
C1 SCAn
An1l8lC
1lC
uLCCn
CLS1An
1 ln
SPC81
CCu8SL
nASAL
SALlnL
HEALTH
TEAHNG

-PROMOTE SNUS
DRANAGE
-NCREASE FLUD
NTAKE
-APPLYNG
LOCAL HEAT