CASE STUDY

AGNUS ELSA FRANCIS

INTRODUCTION
A 24 year old female patient was admitted on
12.1.15 with complaints of nasal obstruction,
recurrent nasal discharge, sneezing and
recurrent headache, more over forehead since
4 years.
DEMOGRAPHIC DETAILS
NAME: SUREMYA.K.
AGE: 24 YRS
DOA:12.1.15
DOD:15.1.15
DEPT: ENT
 SUBJECTIVE
Presenting Complaints:
Nasal obstruction, recurrent nasal discharge,
sneezing, recurrent headache, more over forhead.
Allergic History:
Allergic to dust
Dietic History:
Mixed diet
Sleep ,appetite-Normal
Bowel and bladder habits-normal
 OBJECTIVE
GENERAL EXAMINATION
• PULSE:72/min
• R.R: 20/min
• BP: 120/80mmHg
ENT EXAMINATION
NOSE AND PNS
• External framework-NORMAL
• Vestibule columella-NORMAL
FUNCTIONAL TEST
• Cold spatula test- Decreased fogging on right
side
• Cotton wool test- Decreased movement on
right side
• Cottle test- negative
• Septum: DNS to right
• B/L ITH (more on left)
• Nasal mucosa-congested
• Dental caries -positive
 EAR
RIGHT LEFT
PREAURICULAR AREA NORMAL NORMAL

PINNA NORMAL NORMAL

POSTAURICULAR AREA NORMAL NORMAL

EXTERNAL AUDITORY NORMAL NORMAL

CANAL
TYMPANIC MEMBRANE INTACT RETRACTED,DULL

RINNES TEST 256Hz POSITIVE POSITIVE

512Hz POSITIVE POSITIVE

ABC-ABSOLUTE BONE DECREASED DECREASED
CONDUCTION TEST
• WEBBERS TEST- central

• Facial nerve- normal

PARAMETER VALUE REFERENCE INFERENCE
Hb gm% HAEMATOLOGY
12.1 12-16 Normal
PCV 36.5 38-44 Normal
Platelets/cumm 2.9 1.5 -3.5 Normal
ESR 11 <20 Normal
WBC 9000 5000-11000 Normal
DC NEUTR 56 54-62 Normal

LYMPH 37 25-33 HIGH

EOS 10 1-3 HIGH

MONOS 8 0-9 Normal

PT 16 1-18sec Normal

APTT 33.7 30-40SEC Normal

INR 1.1 0.8-1.1 Normal
 BIOCHEMISTRY
PARAMETER VALUE REFERENCE VALUE INFERENCE
BLOOD SUGAR 71 <120 NORMAL

BLOOD UREA 21 <40 NORMAL

SERUM CREATININE 0.7 0.5-1.4 NORMAL

Na 138 130-145 NORMAL

K 3.7 3.5-4.5 NORMAL
 CT SCAN-BRAIN

Mucosal thickening of Right

frontal and B/L Maxillary sinus
 ASSESSMENT

DEVIATED NASAL SEPTUM TO

RIGHT WITH SINUSITIS

PROCEDURE DONE:
SEPTOPLASTY UNDER GA
 SINUSITIS
Sinusitis is an inflammation, or swelling, of the
tissue lining the sinuses. Normally, sinuses are
filled with air, but when sinuses become blocked
and filled with fluid, germs (bacteria, viruses, and
fungi) can grow and cause an infection.
 CAUSES
• INFECTIONS
• cold and flu infections.
• If a secondary bacterial infection develops.
• An infected tooth

• INCREASED RISKS
• irritants – air pollution, smoke and chemicals, such as pesticides,
disinfectants and household detergents
• allergies –such as allergic rhinitis, asthma and hayfever
• narrow nasal passages –facial injury ,nasal polyps (growths) ,Deviated
nasal septum-these often leads to chronic sinusitis
• cystic fibrosis – a genetic condition where thick, sticky mucus builds up
within the body, increasing the risk of infection

•
 DEVIATED NASAL SEPTUM
It is a condition in which the nasal septum is significantly
off center or crooked making breathing difficult.
 SIGNS AND SYMPTOMS
CHRONIC SINUSITIS
1. Facial congestion/fullness

2. A nasal obstruction/blockage

3. Pus in the nasal cavity

4. Fever

5. Nasal discharge

6. Headaches

7. Bad breath

8. Dental pain
 DIAGNOSIS
• Physical examination
The exam may include the doctor feeling and pressing
your sinuses for tenderness.
• Mucus culture
• X-rays
• Allergy testing
• CT scan of the sinuses
• Nasal Endoscopy
• A nasal endoscope is a special tube-like instrument
equipped with tiny lights and cameras used to examine
the interior of the nose and sinus drainage areas.
 TREATMENT
• Antibiotics

• Nasal decongestant sprays

• Antihistamines

• Topical nasal corticosteroids

• Nasal saline washes

• Oral or injected corticosteroids

• Over-the-counter pain relievers

• Surgery
BRAND GENERIC CLASS INDICATION ADR DRUG INT
NAME NAME
Inj.Monocef Ceftriaxone 3rd gen Meningitis,U Nausea
cephalospor RTI,LRTI ,vomiting,dia
in rrhoea,super
infection
Inj.TT Tetanus vaccine Against Mild
toxoid tetanus fever,joint
infection pain,muscle
aches
Inj.Xylocaine Lidocaine LA Prior to Confusion
surgical ,dizziness,bra
procedures dycardia,hyp
otension
T.Rantac Ranitidine H2 Gastric Nausea
antagonist distress,stom ,vomiting
ach ulcers ,diarrhea
T.Perinorm Metoclopromi Antiemetics Post Tremors,anxi
de operative ety,unusual
vomiting,GE musle
RD,migraine movements
T.Alprax Alprazolam Benzodiazepi antianxiety Drowsiness,ti
ne redness,slurre
d speech

Inj.Augmed Amoxicillin penicillin antimicrobial Nausea,vomiti

clavulanate ng,diarrhea

Inj.Tranexa Tranexamic Antifibrinolyti Haemophilia, Nausea

acid inj c agent dental ,vomiting,dizzi
surgery,nose ness
bleeds

Inj.P’mol Paracetamol Acetaminoph Analgesic,anti Nausea

en pyretic ,vomiting,hep
atotoxicity

T.Dolo Paracetamol Acetaminoph Analgesic,anti Nausea

en pyretic ,vomiting,hep
atotoxicity
T.Lykast Montelukas Leukotriene Allergic Asthenia,fat
t+levocetiriz recep rhinitis igue,fever
ine antagonist+
antihistamin
e

T.Pantop pantoprazol PPI Gastric Flatulence,d

e distress,pep iarrhea,dizzi
tic ulcer ness
BRAND NAME DOSE FREQUENCY 12 13 14 15
Inj.Monocef 1gm BD *
Inj.TT 0.5ml *
Inj.Xylocaine *
T.Rantac 150mg HS *
T.Perinorm 10mg *
T.Alprax 0.25mg *
Inj.Augmed 1.2g Q8H ON 13 * * *
thn BD
Inj.Rantac 50mg BD *
Inj.Tranexa 1amp Q8H *
Inj.P’mol 1amp IM STAT& *
SOS
T.Dolo 650mg 1-1-1 * SOS SOS
T.Lykast 1-0-1 ON 13 * * *
THEN 1-0-0
T.Pantop 40mg BD * *
 DISCHARGE MEDICATION
• T.DOLO 650mg 1-0-1
• T.LYKAST 1-0-1
• T.AUGMATE 625mg 1-0-1
• T.SIBELIUM 10mg 1H.S 1WEEK
• NASIVION 3 DROPS T.D.S
• NASAL DOUCHING 1-1-1

• REVIEW AFTER 1 WEEK IN ENT OPD ON 22.1.15

 PLAN
• Follow therapeutic regimen properly
• Aviod exposure to dust,smoke ,pollen .
• Avoid alcohol and tobacco since it prolongs
healing and swelling.
• Adequate rest and sleep.
• Intake of plenty of fluids.
• Steam inhalations
• The patient should be adviced to avoid
aspirin,NSAID(Ibuprofen,naproxen) for 3 weeks
following surgery
• Rinse out your nasal passages. Use a specially designed squeeze bottle
(Sinus Rinse, others), saline canister or neti pot to rinse your nasal
passages, called nasal lavage, can help clear your sinuses

• Sleep with your head elevated to avoid nose bleeding after surgery
and also increases the nasal discharge

• Swelling of the face is common,ice packs can be used

• If there is an icrease in nose bleeding,a fever greater than 101.5F,

persistent sharp pain, or increased swelling after surgery,they should
contact surgeon
 PHARMACIST INTERVENTION
• The use of nasal decongestants for more than
3-4 days causes a rebound phenomenon
worsening the nasal mucosal swelling.
• The use of antihistamines for longer periods
can cause drying due to anticholinergic
effects, thickening the mucus and reducing
the nasal discharge.
 REFERENCE
• www.drugs.com
• www.webmd.com
• Pharmacotherapy ,Joseph .T.Dipiro
• www.mayoclinic.com