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NURSING 812 Soap Plan | Sinusitis Management, Intervention, Plan

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Monroe College NURSING 812 Soap Plan: Sinusitis Management/Intervention/Plan: Ø Pharmacological: 1. Steroid injection: (Decadron) dexamethasone 4-8 mg (Systemic corticosteroid) (Caution if Diabetic) 2. (Rocephin) ceftriaxone injection 1 g (3rd gen cephalosporin) 3. Antibiotic prescription –start tomorrow 1st Line: Amoxicillin § Adult: 1000 mg orally twice daily § Child: 90 mg/kg/day divided bid to tid (high dose) 2nd Line 1. Amoxicillin-Clavulanate (Augmentin) a. Adult: 875 mg PO bid or 500 mg PO tid Child:TID: 40 mg/kg/day divided q8 hours, OR BID: 45 mg/kg/day divided q12 Hr Cefuroxime (Zinacef, Ceftin) Adult: 250 to 500 mg PO bid Child: 30 mg/kg/day divided bid Cefpodoxime (Vantin) a. Adult: 200 mg PO bid Child: 10 mg/kg/day once daily Cefdinir (Omnicef) Adult: 300 mg PO bid or 600 mg PO qd b. Child: 14 mg/kg/day divided qd-bid Avoid Cefixime Poor Gram Positive Bacteria coverage 3rd Line Consider adding Metronidazole (Flagyl) to 2-line agents Consider 2-line agent for longer course (4 wk) Fluoroquinolones (avoid if < age 16 yr) Levofloxacin (Levaquin) 500 mg daily Moxifloxacin (Avelox) 400 mg daily 4. Mucolytic: Guaifenesin (e.g. Mucinex) 600 -1200 mg PO BID till clear 5. Topical Decongestants (Max of 3 day use) (Oxymetazoline (Afrin) or Phenylephrine (Neo-Synephrine) 6. Intranasal Steroids (treat for 3-6 weeks minimum if indicated) OTC Flonase 7. Cough Med: Promethazine 6.25mg/Dextromethorphan 15mg. 5 ML PO Q 4-6 Hr (Take at night, makes you sleepy) 8. OTC: Tylenol for symptom relief Ø Non-pharmacological: Symptomatic relief 1. Hydration-Drink plenty of water, it helps lubricate the mucous membranes 2. Chicken soup helps congestion & aches. Spicy foods containing hot peppers or horseradish may help clear sinuses 3. Warm, moist compresses over sinuses 4. Nasal saline (salt) washes or (Neti Pot-with sterile water) help remove mucus and relieving congestion 5. Inhaling steam 2-4 X a day is extremely helpful. A Humidifier helps prevent sinus drying & in turn sinusitis

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