NR 576 Week 7 Assignment; Clinical Practice Guidelines Presentation on Allergic Rhinitis

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Contributor

Katherine Harrington

Category

Nursing

Course

NR 576 Differential Diagnosis in Adult-Gerontology Primary Care Practicum

Institute

Chamberlain

Pages

15

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Allergic Rhinitis Allergic Rhinitis Student Name Chamberlain University College of Nursing NR 576 – Differential Diagnosis in Adult – Gerontology Primary Care Dr. Kendra Brady August 2024 Disease and Background What is allergic rhinitis? airway inflammation caused by an allergic reaction The most prevalent chronic diseases among adults Other terms for this condition include hay fever or nasal allergies IgE is activated by the presence of certain antigens, leading to the production of antibody immunoglobulin E. Sneezing, itchy and watery eyes, eyelid edema, swelling of the nasal passages, and post nasal drip are the symptoms being described Excessive production and flow of mucus (rhinorrhea) Otitis media with effusion Disease and Background Classification of Allergic Rhinitis: Categorization based on the specific patterns of exposure to allergens that produce the allergic reaction. Types of seasons: Perennial (lasting throughout the year) Occupational (related to one's job or occupation) Frequency of symptoms (how often symptoms occur) Intensity of symptoms Disease and Background Prevalence of allergic rhinitis in the United States population Approximately 10-20% of the population in the United States 40% of the population consists of children The average age range is between 8 and 12 years 30-60% of the patients have nasal symptoms throughout their presentation Disease and Background •The burden of incidence include factors such as cost, quality of life, and productivity. •The pathophysiology of this condition involves the following steps: The individual is exposed to allergens. • • • This exposure triggers the production of a particular kind of immunoglobulin called IgE. The IgE molecules then bind to the allergen with the help of antigen presentation cells. This binding leads to the formation of allergen-specific IgE. These allergen-specific IgE molecules are present in the nasal mucosa. Publication and Applicability in Primary Care Authors: numerous The writer chair of the guideline is Seidman, and the assistant chair is Gurgel. The guideline was developed by the AAO/HNSF organization in 2015. It is intended to be applied in primary care settings, with a focus on quality improvement. The guideline aims to address the management of conditions that are commonly encountered in primary care. Its goals include promoting effective diagnosis and therapy, reducing harmful and unnecessary variations in care, and optimizing patient care. The guideline is intended for both pediatric and adult patients. Guideline definitions for evidence based statements •Outline for the Key action statement and body of evidence for the following 4 slides: •Strong recommendation: Grade A or B, indicating high-quality evidence. •Recommendation: Grade B or C, indicating lower evidence of good quality. •Options- Grade D- indicates a low quality of evidence available. •No recommendation- Grade D indicates a lack of relevant evidence. Key action statements and body of Evidence Guideline Action Statements Clinicians should diagnose Allergic Rhinitis based on the patient's medical history and physical examination. 1.The strengths of the advice are graded as C. 2.The recommendation is only based on observations. 3.The level of confidence in the evidence is high. Guideline Action Statements Statement outlining recommended actions to follow as a guideline. Persistent medical conditions and the presence of many health conditions simultaneously. (Medical professionals should evaluate individuals who have received a clinical diagnosis of Allergic Rhinitis and who have comorbidities.) 1.The strengths of the suggestion are graded as B. 2.The recommendation is based on a randomized trial with considerable heterogeneity. 3.The level of confidence in the evidence is high. Guideline Action Statements Statement outlining recommended actions to be followed as a guideline. In cases of Allergic Rhinitis, clinicians should suggest the use of intranasal steroids as a treatment option. Advantages: suggestion Excellent According to randomized controlled studies with minimal constraints The level of confidence in the evidence is substantial. Guideline Action Statements Statement outlining recommended actions based on guidelines. Clinicians should advise patients with Allergic Rhinitis to take oral second-generation antihistamines. Advantages: suggestion Achieved the highest level of performance. Derived from randomized controlled trials with minimal constraints The level of confidence in the evidence is substantial. Guideline Action Statements Other suitable options for a primary care context include environmental intranasal antihistamines. An oral leukotriene receptor antagonist is a kind of medication that works by blocking the action of leukotrienes, which are substances in the body that cause inflammation and constriction of the airways. Combination treatment refers to the use of many medications together to treat a certain condition. Application in Clinical Rotation Medical Diagnosis: Allergic Rhinitis A 77-year-old female presents with a painful throat that started three days ago. She has the need to clean her throat often and has clear postnasal discharge. She also has a cough, cobblestone-like look on her tonsils, nasal congestion, watery eyes, and a history of seasonal allergies. Diagnosis: Allergic rhinitis determined solely based on the patient's medical history and physical examination. Prescribed medications: Zyrtec and Flonase Application in Clinical Rotation • • • • • • Comparing the advice for the treatment of allergic rhinitis to those provided at a clinic. Recommended by clinical practice guidelines Discharged with guidelines for over-the-counter Flonase Discharged with guidelines for over-the-counter Zyrtec. Diagnostic testing was not conducted; the diagnosis was solely based on the patient's medical history and physical examination. Additionally recommended is an oral decongestant to alleviate nasal congestion. References •Akhouri S, House SA. Allergic Rhinitis. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538186/ •Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2022). Primary Care: The Art and Science of Advanced Practice Nursing - and Interprofessional Approach (6th ed.). F. A. Davis Company. https://bookshelf.vitalsource.com/books/9781719649469 •Seidman, M.D., Gurgel, R.K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., et al. (2015). Clinical Practice Guideline: Allergic Rhinitis. Otolaryngology-Head and Neck Surgery, 125(1S) S1-S43.

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