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  • Subject Name : Nursing

Allergic Rhinitis

Questions to be asked

  1. The patient will be asked about her diet or routine.
  2. She will be asked for her and her family’s medical history.
  3. She will be asked about how long and how often the issue occurs.
  4. She will be asked about her smoking habits if any.
  5. She will be asked about her environment and the symptoms that are most bothersome.

Physical examination on the patient

  1. Examination for nasal crease: Presence of horizontal crease on the lower bridge of the nose and deviated or perforated nasal septum.
  2. The physical examination of ear, nose, chest, outer signs, skin: There can be rubbing of the nose, allergic shiners, throat clearing or frequent sniffling, and persistent mouth breathing (Wahn et al., 2019).
  3. Sinus exam: It helps in identifying the signs such as wheezing, palpation, and mucus accumulation at the back of the throat and nose (Wahn et al., 2019). It can be conducted by using a computerized tomography scan.

Differential diagnosis

The differential diagnoses (from highest priority range to lowest priority) that are considered for this case study are as follows: checking for tumors – patient with allergies are at high risk of developing blood cancers, enlarged adenoid glands due to infection or allergy, nasal polyps, presence of the foreign body, non-allergic rhinitis – due to changes in weather, prolonged use of topical nasal decongestants leads to rhinitis medicamentosa, viral illness - such as common cold and associated upper respiratory symptoms (Wahn et al., 2019).

Laboratory tests

  1. Allergic skin testing: it is a very sensitive and quick testing exam that is conducted by the administration of a small amount of allergen into the body of the patient, if a reaction occurs it means that the patient is allergic (Small et al., 2018). If no allergy occurs means the patient is not allergic.
  2. Radio allergo sorbent test: It is a sensitive blood test that detected the serum allergen-specific IgE levels. It tests for molds, pollens, and dust mites. If the results are positive it means it is allergic rhinitis (Small et al., 2018).

As the patient shows nasal challenge with other symptoms of allergic so, she will show positive Allergic skin test with high IgE levels, that might also be because of her history of allergy due to pollination. Moreover, her respiratory rate is 20 breaths per minute that are higher than the normal range of 12 – 16 breaths per minute (Liu et al., 2020). All these indicate that she might be having allergic rhinitis.

Treatment options

The patient will be provided with first-generation anti-histamines with a dosage of taking 25-50 mg every 4-6 hours. Its side effects are constipation, dizziness, blurred vision, and sedation. The second-generation anti-histamines will also be prescribed with a dosage of Dosed between 2.5-5 mg orally every day. It is taken at night only. Its side effects are a bloody nose, fatigue, sore throat, sedation, and dry mouth (). The other alternatives that can be prescribed are as follows: nasal saline, nasal sprays, nasal corticoids, or others.

The patient will be asked to take her medication as prescribed and on the scheduled time only without skipping any of the doses. She will be educated about her lifestyle interventions like an allergen-free environment, no smoking, removal of feather blankets, or pillows. To prevent the history of allergy, the patient should be encouraged for self-care as well. She should be asked to avoid the allergy triggering items and environments. She should be educated about the risk factors such as pollens, dust mites, feathers, weeds, certain foods, spices, textile dust, smoking, and a few others. If the patient and her family members are educated and informed about these factors then it will help in health promotion and prevention as well.

Patient Follow-Up

The patient follow-ups will be conducted weekly for tests and frequent follow-up visits.

According to Church et al. (2020), there should be referrals to pulmonologists – for treating the respiratory tract disease, otolaryngologist – for treating the nose, ear, or throat disorders, allergy and immunology doctor – for immune system and treatment of allergy, and primary care practitioner – to prevent, treat and diagnose the disease. A follow-up visit to these specialists frequently will help in the prevention of the disease. There should be the education of the patient and the family members about the health complications in allergy rhinitis, its associated signs, and symptoms so that the patient can immediately inform the nurse or doctor if any unexpected symptoms occur. Before delivering the nursing care of the patient, the documentation guidelines should include – plan of care, long-term care, environmental assessment of the patient, timely updating and modification of the plan of care as per the health evaluation, and teaching plan as per the cultural beliefs of the patient.

Reflection

From this assignment, it is learned that allergy can be due to many triggering factors but the physical and laboratory exams will indicate the exact reason with clinical data. The issues can be resolved with the help of medication, these might also show side effects, in some cases. It is learned that frequent monitoring, patient education, and follow-ups are essential for health promotion and prevention.

References for Real‐world Benefits of Allergen Immunotherapy

Church, M. K., Tiongco-Recto, M., Ridolo, E., & Novák, Z. (2020). Bilastine: A lifetime companion for the treatment of allergies. Current Medical Research and Opinion36(3), 445-454. https://doi.org/10.1080/03007995.2019.1681134

Liu, C., Zheng, K., Liu, X., Zheng, M., Liu, Z., Wang, X., & Zhang, L. (2020). Use of nasal nitric oxide in the diagnosis of allergic rhinitis and nonallergic rhinitis in patients with and without sinus inflammation. The Journal of Allergy and Clinical Immunology: In Practice8(5), 1574-1581. https://doi.org/10.1016/j.jaip.2019.12.017

Small, P., Keith, P. K., & Kim, H. (2018). Allergic rhinitis. Allergy, Asthma & Clinical Immunology14(2), 51. https://doi.org/10.1186/s13223-018-0280-7

Wahn, U., Bachert, C., Heinrich, J., Richter, H., & Zielen, S. (2019). Real‐world benefits of allergen immunotherapy for birch pollen‐associated allergic rhinitis and asthma. Allergy74(3), 594-604. https://doi.org/10.1111/all.13598

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