Nasal Instillations Show
Answer & Explanation Solved by verified expert What are the most common reasons for nasal instillations? Allergies, nasal congestion, and sinus infections are treated with nasal medicines. Although the nose is not a sterile chamber, its relationship to the sinuses necessitates medical asepsis. Why is chronic use of nasal decongestants contraindicated? Patients with heart problems should avoid both oral and topical nasal decongestants. They increase the heart's workload; hypertension raises blood pressure, thyroid condition raises the chance of adverse responses, diabetes, or, in males, urination trouble caused by an enlarged prostate. What is a safer non-medicated type of decongestant that the nurse can recommend to the client? A nasal saline spray is a safer non-medicated decongestant that the nurse might offer to a client. A nasal spray is the saver option for minor congestion caused by allergies or colds. A saline nasal spray contains no drugs and is usually considered harmless. Why is positioning very important when administering nasal drops. Positioning is important because the drug may now flow back into the nasal cavity due to the positioning. Describe the two positions for nasal drop insertion and the areas accessed. The patient is seated or kept lying down with their head inclined back over a cushion underneath the neck. If the patient suffers a cervical spine injury, do not tilt the head back. Position the patient with their head inclined backwards and facing upwards when sitting or reclining supine. The nurse should place the spray bottle or nasal dropper tip in one nare while occluding the other, then activate the spray when the patient inhales. Step-by-step explanation References Terrie, Y. C. (2018). A Guide to the Proper Use of Nonprescription Decongestant Products. Trabut, S., Friedrich, H., Caversaccio, M., & Negoias, S. (2020). Challenges in topical therapy of chronic rhinosinusitis: The case of nasal drops application-A systematic review. Auris Nasus Larynx, 47(4), 536-543. Zeng, X. H., Yang, G., Liu, J. Q., Geng, X. R., Cheng, B. H., Liu, Z. Q., & Yang, P. C. (2019). Nasal instillation of probiotic extracts inhibits experimental allergic rhinitis. Immunotherapy, 11(15), 1315-1323. Nearly 33% of adults in the United States have the typically symptomless disease known as hypertension. Nearly 33% of adults in the United States have the typically symptomless disease known as “hypertension.”1 When health care providers treat ailments in these individuals, caution should be exercised, as several medications are contraindicated. For example, because decongestants, which are frequently used to manage nasal congestion, can increase blood pressure (BP), their use is a concern in patients with hypertension. Nasal congestion, often referred to as a “stuffy nose,” is a typical symptom of the common cold, occurring when nasal and adjacent tissues and blood vessels become swollen with excess fluid.2 This symptom has been described as the most bothersome by adults with allergies.2,3 Individuals with nasal congestion are encouraged to drink plenty of fluids to thin mucus and promote nasal drainage. Getting plenty of rest and limiting activities are also warranted for affected patients.4 In addition, OTC medications are often used to manage symptoms; however, they do not shorten the duration of illness and only offer temporary relief. Individuals with hypertension should be made aware that decongestants can elevate their BP. Various medical guidelines characterize hypertension in adults as a systolic BP of 140 mm Hg or higher or a diastolic BP of 90 mm Hg or higher.5 Hypertension is treated by using various methods to decrease BP to a predetermined target. The American Heart Association warns all individuals with hypertension, including those being treated for it, to read the labels on all OTC medications prior to use.6 Decongestants Nasal decongestants are vasoconstrictors that belong to the pharmacologic class sympathomimetic amines. They exert their primary action by activating alpha-adrenergic receptors on blood vessels of the nasal mucosa. This results in vasoconstriction, which decreases blood flow through the nasal mucosa and shrinks tissue.7 Decongestants are available in multiple formulations with varying degrees of systemic effects, including potential elevation of BP. Oral Decongestants The decongestants pseudoephedrine and phenylephrine may offer mild relief from nasal congestion associated with the common cold.8 These medications are administered alone or in combination with antihistamines, which minimize other symptoms associated with the common cold. Pseudoephedrine is a common ingredient in more than 135 medications and has proved effective in treating nasal congestion. The drug was found to elevate BP in a 2005 meta-analysis that showed it significantly increased systolic BP (0.99 mm Hg) and heart rate (2.83 beats/min). However, the results revealed no effect on diastolic BP. Higher BP increases were associated with higher doses and immediate-release formulations of pseudoephedrine.9 Studies comparing phenylephrine with placebo showed no significant improvement in measures of nasal congestion. There is a lack of data on phenylephrine’s effect on BP. Phenylephrine and pseudoephedrine have been described as safe and effective for treating nasal congestion.9 However, as a result of the Combat Methamphetamine Epidemic Act of 2005, pseudoephedrine products are kept “behind the counter” and have certain restrictions regarding their purchase. Topical Decongestants Naphazoline, oxymetazoline, and phenylephrine are commonly used topical decongestants. Although these agents are expected to promote local activity, the FDA requires their instructions to contain a warning for individuals with high BP; however, the data on the connection between their use and hypertension are sparse. Unlike other topical decongestants, propylhexedrine is a topical OTC decongestant that is not required to carry a warning against unsupervised use in patients with hypertension.10 The use of topical nasal decongestants for more than 5 days is associated with the development of rhinitis medicamentosa, also known as “rebound rhinitis,” which can lead to user dependency.11 Alternatives A 2003 Cochrane review concluded that monotherapy with antihistamines does not alleviate nasal congestion to a clinically significant degree. In that review, first-generation antihistamines were found to have greater adverse effects than placebo, with neither first- nor second-generation antihistamines increasing BP. Antihistamines can be used in combination with decongestants; however, they should not be used in small children.8 Saline has been used to relieve congestion and is thought to thin mucus in the sinus cavities. Increasing humidity in the environment of patients with nasal congestion may also provide relief; therefore, the use of humidifiers is recommended. A third solution, nasal strips may help open the nostrils and, therefore, improve breathing in patients with congestion.11 The Pharmacist’s Role With their training in OTC medications, pharmacists can play a major role in managing decongestion in their patients. No product can be recommended to provide safe and effective relief of congestion in all patients with hypertension. Therefore, pharmacists’ medication knowledge, coupled with their keen ability to obtain valuable information from patients, can ensure optimal drug selection for individuals with hypertension. Clarence D. Moore, PharmD, BCPS, BCOP, is Assistant Professor at Bernard J. Dunn School of Pharmacy, Shenandoah University, in Ashburn, Virginia. References
Which condition would contraindicate the use of or Oxymetazoline?closed angle glaucoma. high blood pressure. coronary artery disease. hardening of the arteries due to plaque buildup.
Who should not take decongestants?They should not be used by the following groups of people without getting advice from a pharmacist or GP first:. people taking other medicines.. people with diabetes.. people with high blood pressure.. people with an overactive thyroid gland (hyperthyroidism). men with an enlarged prostate.. What is an adverse reaction commonly experienced by people taking nasal decongestants?Some people have reported nasal burning, irritation and dryness after using decongestant nasal sprays and nose drops. Other side-effects that have been reported with nasal decongestants include feeling sick (nausea) and headache.
What is a safer non medicated type of decongestant that the nurse can recommend to the client?A nasal saline spray is a safer non-medicated decongestant that the nurse might offer to a client. A nasal spray is the saver option for minor congestion caused by allergies or colds.
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