Additional subjective and objective data are required to increase the patient’s understanding of the diagnosis. First, the client would inquire about any factors that help relieve the cough and nasal congestion. Second, the nurse practitioner should ask about any medications that the patient has used to treat the pain and the time when the cough is more pronounced. Third, the nurse should ask for information about any history of shortness of breath, wheezing, sore throat, or earaches. Also, personal information comprises a history of other symptoms associated with facial infections, as well as headache, which worsens while bending over, unpleasant smell of the mouth, and pain of the teeth. Further assessment involves seek to know about any history of smoking by the patient. Several studies have found that respiratory conditions take a more extended time to show smokers’ symptoms (Ignatavicius et al., 2018). The culture and sensitivity of the sputum may also be used to detect the offending organism.
Differential Diagnosis
The differential diagnoses according to the symptoms presented by the patient include viral upper respiratory tract infection, allergic rhinitis, common cold, and facial pain syndromes. Viral upper respiratory tract infections like viral sinusitis whose symptoms tend to resolve within five days after symptomatic management. Allergic rhinitis causes inflammation of the facial sinuses without a related disease. This condition is caused by the body’s hypersensitive reactions to ordinarily harmless substances leading to mucopurulent discharge, reddened and itchy eyes (Ignatavicius et al., 2018). In allergic rhinitis, the nasal discharge is clear in appearance as the sinuses works to get rid of allergens. Facial pain syndromes are characterized by facial pain and headaches but may not necessarily have other symptoms like coughing. The common cold is caused by viruses and presents as sore throat, nasal obstruction, rhinorrhea, and fevers. However, these symptoms may also self-limit within seven days without pharmacologic therapy. Other infections with various pathogens may cause prolonged illness.
Likely Diagnosis
The likely diagnosis of these assessment findings is acute rhinosinusitis. This disease is marked with postnasal mucus discharge, which is greenish for more than ten days. Patients with this condition also do present with a low-grade fever and frontal headache. Isolated headaches are not indicative of acute rhinosinusitis except frontal headaches or facial fullness. Other symptoms of acute bacterial rhinosinusitis are cough, dental or ear pain, which may indicate advanced disease. The signs of this bacterial infection tend to persist for more than ten days.
Desired Treatment Outcomes
The desired treatment outcomes for the management of acute rhinosinusitis are aimed at eradicating the infectious agent to reduce the burden of its undesirable symptoms. The patient is supposed to have relief of cough and comfort of the mucopurulent discharge following the treatment plan’s completion (Long et al., 2019). Moreover, the patient needs relief from the frontal headache. Promoting the patient’s comfort and relaxation is the key to all interventions. Furthermore, the achievement of stable body temperatures is critical. Fevers are due to the body’s mechanism to fight the bacterial infection. Management strategies are aimed at decreasing the anxiety of the patient about the pathophysiology of the disease. The healthcare provider should aspire to improve the patient’s knowledge about the disease process and the ways of promoting his health.
Suspected Pathogens
Viruses, bacteria, or fungi are the pathogens implicated in the etiology of acute rhinosinusitis. Viruses involved in this disease’s etiology include influenza virus, rhinovirus, adenovirus, and parainfluenza virus. Viral infections usually heal on their own after five days or with symptomatic management (Feleszko et al., 2019). The bacteria involved in acute rhinosinusitis are Haemophilus Influenza, Streptococcus Pneumonia, and Moraxella Catarrhalis. Fungal infections involved in the etiology of this condition include Aspergillus, Rhizopus, Rhizomucor, and Mucor. Bacterial infections take a more extended period to heal without antibiotic therapy (O’Connor et al., 2019). However, fungal infections are commonly found in immunocompromised states, for instance, in patients with human immunodeficiency virus (HIV), as well as those who have undergone splenectomy or organ transplants. Patients taking corticosteroids may also be at risk of acute fungal rhinosinusitis.
Non-Pharmacologic Therapy
Non-pharmacologic treatment options are one of the integral elements recommended in the management of respiratory conditions. First, the client is required to drink warm water, which helps open the airways and thin the mucous secretions to relieve the nasal congestion. Second, the patient needs to consume fruits, including lemons, which are useful in improving the body’s immunity to fight respiratory infections. A balanced diet promotes an effective immune response to acute rhinosinusitis (Ignatavicius et al., 2018). Moreover, saline nasal sprays are needed several times per day to rinse the nasal pathways from mucous. Humidifiers are essential in dry weather to keep the nasal and para-nasal sinuses moistened.
Considerations in the Pharmacologic Plan
Antibiotic therapy is recommended for the treatment of acute rhinosinusitis which persists for more than ten days. However, the healthcare personnel have to observe the child for an additional three days before commencing treatment, which should be initiated sooner with the occurrence of adverse symptoms. Children are treated with amoxicillin with or without clavulanate for 10 to 14 days, with an additional seven days after resolving symptoms. However, the use of amoxicillin in pediatric influences the selection of the antibiotic of choice (O’Connor et al., 2019). In adults and geriatrics, therapy with amoxicillin is supposed to run for 5 to 7 days. Management failure is suspected after seven days of medications with no resolution of symptoms. The use of antihistamines is only indicated for suspected allergic reactions. Doxycycline and fluoroquinolones should be used with caution in children and pregnant women. Penicillin, including amoxicillin and cephalosporins, is safe to use during pregnancy to manage acute rhinosinusitis.
Medications and Patient Monitoring
The pharmacotherapeutic plan for acute rhinosinusitis includes the use of antibiotics and analgesics. The first line antibiotic of choice is amoxicillin with or without clavulanic acid for 5-10 days in adults. The dosage of amoxicillin is 500mg per os, three times a day for 5-10 days. Amoxicillin works by impairing the integrity of the bacterial cell wall causing bacterial death. It is essential to monitor for symptoms of allergic reactions during therapy, including fever, rashes, shortness of breath, and runny nose (Ignatavicius et al., 2018). Analgesics including non-steroidal anti-inflammatory drugs (NSAID) can be used to manage pain. Ibuprofen 400mg per os three times a day for five days. This NSAID non-selectively inhibits cyclooxygenase enzymes 1 and 2, leading to a reduction in pain. Ibuprofen can cause gastrointestinal bleeding with prolonged use; therefore, monitoring for gastrointestinal discomforts is crucial for early detection of this complication.
Decongestants, including phenylephedrine, may be inhaled three times a day. Phenylephedrine activates adrenoceptors in the nasal arterioles causing their vasoconstriction resulting in drainage of the sinus cavities. It is crucial to observe the heart rate during treatment with phenylephedrine due to the risk of bradycardia. The success of therapy can be measured by evaluating body temperatures, relief of coughing, reducing mucous production, and resolving the frontal headache. The nurse practitioner should counsel the client to adhere to the prescription by taking the medications on the specified timelines (Smith et al., 2016). Also, they should avoid taking the antibiotics when they feel better before finishing the amoxicillin dose prescribed. Failure to complete the dosage of antibiotics may result in antibiotic resistance.
References
Feleszko, W., Marengo, R., Vieira, A. S., Ratajczak, K., & Mayorga Butrón, J. L. (2019). Immunity-targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children. Clinical Otolaryngology 44(4), 502–510. Web.
Ignatavicius, D.D., Workman, M.L., & Rebar, C.R. (2018) Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.). Wolters Kluwer.
Long, J. C., Williams, H. M., Jani, S., Arnolda, G., Ting, H. P., Molloy, C. J., Hibbert, P. D., Churruca, K., Ellis, L. A., & Braithwaite, J. (2019). Assessing the appropriateness of upper respiratory tract infection management in Australian children: A population-based sample survey.BMJ Open, 9(5). Web.
O’Connor, R., O’Doherty, J., O’Regan, A., O’Neill, A., McMahon, C., & Dunne, C. P. (2019). Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: Cross-sectional study of patient presentations and expectations.BMJ Open, 9(2). Web.
Smith, K. L., Tran, D., & Westra, B. L. (2016). Sinusitis treatment guideline adherence in the e-visit setting: A performance improvement project. Applied Clinical Informatics, 7(2), 299–307. Web.