NOSE Smell Assessment

-entrance and exit for air in and out respi sys  Smell and taste are affected by:
-sense organ for smell -viral infection, aging, head injury, local obstruction
-influences speech and sense of taste -medications (metro, local analgesics, some antibiotics, allopurinol,
-body image codeine, morphine, carbamazepine, lithium)
Structure of Nose and Sinuses  Other impairment
-nose lined with respiratory mucosa, except vestibule (lined with the Olfactory and Trigeminal Stimulants
skin containing nasal hairs/ vibrissae)  Olfactory
 Mucus -coffee (instant powder)
-secreted from respi mucosa is carried back into the nasopharynx by -phenylethyl alcohol
cilliary movements -almond oil
 Nasal mucosa -peppermint
-is normally redder than oral mucosa because the lining of the nasal -musk
cavities is very vascular  Trigeminal
-blood carries moisture and heat to the mucosa -ammonia
 Paranasal sinuses -acetone
-air-filled cavities, lined with mucous membrane surrounding nasal -menthol
cavities Dx
-sinuses drain into the nasal cavities through openings in the grooves  Nose and throat culture
between the turbinates  X-ray
 Maxillary sinuses (antra)  CT scan
-largest and most accessible  MRI
-located on the either side of the nose in the maxillary bones Common Nasal Interventions
 Frontal sinuses  Drops, spray, aerosol (neb)
-lower forehead bet and above the eyes  Most often instilled into the nose are vasoconstrictors
 Sphenoid sinuses (phenylephrine) used mainly to reduce nasal congestion
 Olfactory cells  Use only as prescribed to avoid rebound effect
-located in olfactory membrane covering the roof of the nose and the  Turbinate engorgement is controlled by ANS
floor of the anterior cranial fossa  Vasoconstrictors stimulate sympathetic nerves hence, compensatory
 Nasolacrimal duct relaxation of the turbinal vessels occur after the medication has
-small duct communicating indirectly with the lacrimal glands and the stopped
nose  Time relaxation is accompanied by nasal stiffness after a period of
Function of Nose as Sinuses temporary relief the nose becomes more stuffy
 Principal functions Nasal Medications
-olfaction (smelling)  Vasoconstrictors can be systematically absorbed
-air conditioning (ctrl air temp and humidity and removing particles - X hypertensive unless prescribed
before air contents enters the trachea bronchi and lungs)  Can cause distressing sym (restlessness, heart palpitations and
 Olfactory cells tension)
-neurons that divide into numerous hair like processes in the  Oil-based sol-not used, interfere with normal ciliary action and
olfactory membrane may cause pneumonitis if aspirated
 Axons from the cell bodies become the olfactory nerve which passes Nasal Irrigation
to the olfactory center in the brain  To clean nose
 Sinus fn is not definitely known  PNSS-not commonly used
 Lighten the weight of the skull  Self-administered for chronic nasal condition
 Give vocal resonance and timbre Nsg Intervention for Post-Nsal Sx pt
 Produce mucus for the nasal cavity  Remind pt:
Assessment of the Nose and Sinuses -breath through mouth (bec nasal packing)
 History -not blow nose
 Examination of Nose, nasopharynx and paranasal sinuses -spit out drainage accumulating in the nasopharynx
 Smell assessment  If GA given-turn pt onto side to prevent aspiration of bloody drainage
 Diagnostic procedures before consciousness returns
Examination of the nose  Ineffective airway clearance
 External nose: -breath through mouth
-symmetry, swelling, redness, lumps -periodically assess nasal packing
 Nasal chambers -elevate head
-anteriorly: using nasal speculum -don’t blow nose
-posteriorly: using nasopharyngeal mirror -pt’s mouth may become dry and develop ubpleasant taste and odor
Examination of the Nasopharynx due to mouth breathing, blood and postnasal discharges
 Best examined with tongue depressed with tongue blade or gauze  Alterations in nutrition, less than body requirements due to difficulty
 Nasopharyngoiscope swallowing
Examination of the Paranasal Sinuses -give fluids as prescribed (usually liq diet)
 Inspecting and palpating the soft overlying tissues -be sure gag reflex has returned b4 giving oral fluids
 Observing any nasal secretions -oral hygiene b4 meals to improve appetite
 Transillumination of the maxillary and frontal sinuses -encourage fluid intake
 X-ray may be used