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1 Students will be able to :

ANATOMY OF NOSE

Nose, the prominent structure between the eyes that serves as the entrance to the respiratory tract and contains the olfactory organ. It provides air for respiration, serves the sense of smell, conditions the air by filtering, warming, and moistening it, and cleans itself of foreign debris extracted from inhalations.

The nose has two cavities, separated from one another by a wall of cartilage called the septum. The external openings are known as nares or nostrils. The roof of the mouth and the floor of the nose are formed by the palatine bone, the mouth part of which is commonly called the hard palate; a flap of tissue, the soft palate, extends back into the nasopharynx, the nasal portion of the throat,

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and during swallowing is pressed upward, thus closing off the nasopharynx so that food is not lodged in the back of the

The shape of the nasal cavity is complex. The forward section, within and above each nostril, is called the vestibule. Behind the vestibule and along each outer wall are three elevations, running generally from front to rear. Each elevation, called a nasal concha or turbinate, hangs over an air passage. Beside and above the uppermost concha is the olfactory region of the nasal cavity. The rest of the cavity is the respiratory portion. The respiratory area is lined with a moist mucous membrane with fine hairlike projections known as cilia, which serve to collect debris. Mucus from cells in the membrane wall also helps to trap particles of dust, carbon, soot, and bacteria. Sinus cavities are located in the bony skull on both sides of the nose.

In the olfactory (smelling) portion of the nose, most of the lining is mucous membrane. A small segment of the lining contains the nerve cells that are the actual sensory organs. Fibres, called dendrites, which project from the nerve cells into the nasal cavity, are covered only by a thin layer of moisture. The moisture dissolves microscopic particles that the air has carried into the nose from odour-emitting substances,

Define Deviated Nasal Septum

and the particles dissolved in the fluid stimulate the olfactory nerve cells chemically.

DEVIATED NASAL SEPTUMDEFINITION :A deviated nasal septum refers to a deformity of the partition in the nose that separates the two nostrils. Composed of bone and cartilage, this partition (nasal septum) is covered with a mucous membrane. The nasal septum usually is straight and reasonably centered, dividing the nasal passage into two equal halves.In some individuals, however, the septum is bent (deviated), a condition either present at birth (congenital) or, more commonly, the result of injury to the nose. The bending or deviation may be shifted severely from the midline so as to partially or completely block the nasal passage

Generally there are two main types of deviation. The first occurs because the lower end of the septum becomes dislocated i. e. pulled from its attachment at the bottom of the nose. It becomes pushed to one side

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What is deviated nasal septum?

Enlist the causes of Deviated Nasal Septum

therefore narrowing one of the nostrils. The other type of deviation happens because the septum becomes deformed either in a bow shape or an 'S' shape. This can cause partial or complete blockage of both nostrils.

CAUSES :

A deviated septum can be caused by:

A condition present at birth. In some cases, a deviated septumoccurs during fetal development and is apparent at birth.

Injury to the nose. A deviated septum can also be the result of an injury that causes the nasal septum to be knocked out of position. In infants, such an injury may occur during childbirth. In children and adults, a wide array of accidents may lead to a nose injury and deviated septum — from tripping on a step to colliding with another person on the sidewalk. Trauma to the nose most commonly occurs during contact sports, active play or roughhousing, or automobile accidents.

Individuals who play contact sports such as karate or football without

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Enumerate causes of DNS

List out the signs and symptoms of Deviated Nasal Septum

protective headgear are at higher risk. Not wearing a seatbelt increases risk of

injury to the face or nose in the event of a high impact automobile accident

Normal aging may also cause nasal tip cartilage to deteriorate, aggravating a deviated septum over time.

SIGNS & SYMPTOMS:

The most common symptom of a deviated septum is nasal congestion, with one side of the nose being more congested than the other, along with difficulty breathing. Recurrent or repeated sinus infections can also be a sign of a deviated septum. Other symptoms include frequent:

Most septal deformities result in no symptoms, and one may not even know they have a deviated septum. Some septal deformities, however, may cause the following signs andsymptoms:

Obstruction of one or both nostrils. This obstruction can make it difficult to breathe through the nostril or nostrils. This may be more noticeable when you have a cold (upper respiratory tract infection) or allergies that can

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Enlist signs and symptoms of DNS

Differentiate the diagnostic tests performed for Deviated Nasal Septum

cause your nasal passages to swell and narrow.

Nosebleeds. The surface of your nasal septum may become dry, increasing your risk of nosebleeds.

Facial pain. You may experience pain if your nasal septum is coming into contact with the outside wall of your nose.

Frequent or recurring sinus infections. Sinus infections can result from blocked mucus and are often marked by facial pain, nasal obstruction and a foul discharge.

Noisy breathing during sleep. This is more common in infants and young children with a deviated septum.

DIAGNOSTIC TESTS :

History taking : The individual may report a history of injury to the nose or face. The most common symptom associated with a deviated septum is difficulty breathing. Depending on the severity of the obstruction, the individual may report chronic nasal congestion, sinusitis, repeated ear infections, headache, or nosebleeds. Scuba divers with a deviated septum may have difficulty equalizing the

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What are diagnostic tests used for DNS?

pressure in their ears when they dive.

Physical examination : Visual inspection may reveal an inequality in the size of the nostrils and/or a deformity in the septum. A deformity of the external nose sometimes is apparent. When there is a history of injury, the septal bending is usually toward the injured side. Examination of the nasal cavity may reveal blockage of one or both nostrils. Noisy breathing may be noted. Signs of chronic sinusitis or allergic rhinitis may be present, such as post-nasal drip, nasal inflammation, and swelling of nasal cavity walls. If irritation and swelling of the nasal mucosa are present, the physician may ascertain whether the individual has used nasal decongestant spray for a long period, has used cocaine, or has taken certain medications (e.g., beta-blockers, sympatholytics, hormone replacement therapy) (Watson). Food allergies may be addressed as well.

Tests: X-rays of the face and sinuses may be taken to confirm the nasal septal deviation and to evaluate for sinus infection.

Explain about treatment for Deviated Nasal Septum

TREATMENT :

Managing symptoms Initial treatment of deviated septum may be directed at managing the symptoms of the condition, such as nasal congestion and postnasal drip. Your doctor may prescribe:

Decongestants. Decongestants are medications that reduce nasalcongestion, helping to keep the airways on both sides of your nose open. Decongestants are available as a pill or as a nasal spray. Use nasal sprays with caution, however. Frequent use can create dependency and cause symptoms to be worse (rebound) after you stop using them. Decongestants have a stimulant effect and may cause you to be jittery as well as elevate your blood pressure and heart rate.

Antihistamines. Antihistamines are medications that help prevent many cold and allergy symptoms, including runny nose. Some antihistamines cause drowsiness and can affect your ability to perform tasks that require

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Explain surgical management for DNS

physical coordination, such as driving.

Nasal steroid sprays. Prescription nasal corticosteroid sprays can reduce inflammation in your nasal passage and help prevent a runny nose. Common side effects of nasal steroid spray include throat irritation and burning, dryness or other irritation inside your nose.

SURGICAL REPAIR

Submucous resection (SMR): This operation is usually done under general anaesthetic and involves peeling back the lining of the nose from the septum and removing the cartilage and bone from the deviated area. The lining is then replaced. The nose is gently packed for about 24 hours to maintain the correct position and usually the patient is allowed home after a day or two. Septoplasty: A septoplasty is performed under local or general anesthesia with an endoscope, surgeon makes an incision inside the nose, lifts up the lining of the septum, and realigns and/or removes the deviated portions of the septal bone and cartilage. Sometimes the septum is held in place after the operation with splints which are placed inside the nostrils. Patients are sometimes instructed not to blow their nose for a week or two to allow the septum to heal

up in the correct position.

Nursing Management :1) Ineffective airway clearance related to excessive mucus production secondary to retained secretion and inflammationGoal : after providing nursing intervention client will maintain normal respiratory statusIntervention :

- Assess the respiratory status of the client i.e. the respiratory rate, rhythm, depth, partial pressure of O2 and CO2 in the blood etc.

- Provide semi-fowlers or fowlers position to the client

- Provide oxygen to the client and monitor the PaO2 level on the monitor

- Restrict the clients activity and provide complete rest to the client

- Provide suctioning as per the clients requirements

- Maintain patent airway and provide medication as per the physicians order e.g. Inj deriphylin etc. Provide nebulization as per the orders of the doctor

- Maintain adequate nutrition and hydration status for the client

- Enhance coughing and deep breathing

exercises of the client- Provide chest physiotherapy to aid

removal of secretions and thick mucus due to infection

2) Impaired gas exchange related to dyspnoea Goal: client will verbalize no dyspnoea

- Assess the respiratory status of the client i.e. is the respiratory rate, rhythm, depth, partial pressure of O2 and CO2 in the blood etc.

- Provide adequate rest and a semifowlers position

- Provide medications as ordered to relieve laryngeal edema e.g. inj lasix , torsemide etc to the client

- Provide nebulisation as per the orders of the doctor

- Maintain adequate nutrition and hydration status for the client

- Enhance coughing and deep breathing exercises of the client

- Provide chest physiotherapy to aid removal of secretions and thick mucus due to infection

3)Altered Nutrition: Less then Body Requirements related to related to anorexia, altered absorption and metabolism evidenced

by vomiting ,nausea, not able to tolerate heavy meals, reduced weightGoal : client will maintain adequate nutritional status after providing diet plan

Intervention:- Provide a nutritious breakfast. Because

anorexia usually worsens during the day. - Encourage the client to avoid fatty foods, which can induce nausea.

- Include the optimal amount of protein and carbohydrates to allow recovery of injured lever cells without overfeeding

- Suggest multiple small meals. This approach allows the client with anorexia to ingest a diet of 2500 to 3000 calories more comfortably.

- Also candy, juice, sweetened tea and carbonated drinks can supply calories when nausea is a problem.

- Avoid Alcohol remind the client to ;avoid alcohol, which is an extremely hepatotoxic agent.

- Relieve Nausea and Vomiting and Clients who experience severe nausea and vomiting may obtain relief with antiemetics.

4) Acute pain related to disease condition

Goal : client will verbalize reduction In painIntervention : - Assess the pain level using the Visual

analogue scale- Provide adequate rest and diet as

required for the client- Provide and maintain proper hydration

process- Give the medications as ordered by the

physician eg. Avil- Provide pain reliving lozenges to give

smoothening effect to the throat5) Knowledge deficit related to therapeautic regieme evidenced by continous questioning on the recovery,duration of the medications and period of hospitilisation, rehabilitation of the clientGoal : client will show the expression of understanding about disease conditionIntervention:- Assess the present knowledge of the

client regarding laryngitis- Allow the client to verbalize the

questions he has about his illness and the fears associated along with the recovery

- Provide health education and use maximum pictures to demonstrate the

Give health education related to deviated nasal septum

condition of the illness, the pathology of the illness, different rehabilitation techniques

- Also explain about his present condition and the reason of the medications and treatment given to him

- Allow the client to verbalize his improvement in knowledge by asking various questions regarding diseased condition and client answering adequately to it.

HEALTH EDUCATION Rest. This will help the body fight

inflammation and speed recovery. Drink fluids, such as water or juice. This

will help dilute mucous secretions and promote drainage. Avoid beverages that contain caffeine or alcohol, as they can be dehydrating. Drinking alcohol can also worsen the swelling of the lining of the sinuses and nose.

Moisturize sinus cavities. Drape a towel over head as you breathe in the vapor from a bowl of medium-hot water. Keep the vapor directed toward the face. Or take a hot shower, breathing in the warm, moist air. This

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Summarize the topic

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will help ease pain and help mucus drain.

Apply warm compresses to face. Place warm, damp towels around nose, cheeks and eyes to ease facial pain.

Rinse out nasal passages. Use a specially designed squeeze bottle (Sinus Rinse, others), bulb syringe or neti pot to rinse your nasal passages. This home remedy, called nasal lavage, can help clear your sinuses.

Sleep with head elevated. This will help sinuses drain, reducing congestion.

SUMMARYDefinition, causes, clinical manifestation, diagnostic tests, medical and surgical management of Deviated nasal septumEVALUATION: Define Deviated nasal septum?State the causes of Deviated nasal septum?Enlist the clinical manifestation of Deviated nasal septum?What are the surgical management for Deviated nasal septum?

LESSON PLAN :

SUBJECT : Medical surgical nursing

UNIT :

GROUP: B Sc (N) IInd Year

TOPIC: Deviated Nasal Septum

METHOD F TEACHING: Lecture cum discussion

TEACHING MATERIAL: Black board, PPT

NO OF STUDENTS: 100

NAME OF THE TEACHER: Mrs Siddhi Parmar

CENTRAL OBJECTIVE: Students will gain in depth knowledge about Deviated nasal septum

SPECIFIC OBJECTIVE: At the end of the class students will be able :

o To define deviated nasal septumo Enlist the causes of Deviated Nasal Septumo List out the signs and symptoms of Deviated Nasal Septumo Differentiate the diagnostic tests performed for Deviated Nasal Septumo Explain about treatment for Deviated Nasal Septumo Give health education related to deviated nasal septum

LN NURSING COLLEGE

“LESSON PLANON

DEVIATED NASAL SEPTUM”

- Mrs Siddhi Parmar