Absence Of Rhinorhea Research Paper

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Absence of itchy, stuffy nose and sneezing
Absence of nasal congestion
Absence of rhinorrhea
Absence of cough, post-nasal drip
Absence of mouth breathing
Absence of itchy, red, tearing eyes
Increased sleep quality and improved attention

Counseling on proper use of nasal spray- both technique and expectations for the product. Be sure to include that the intranasal steroid is not an immediate onset of action; she must consistently use the product to ensure maximum therapeutic action.
Change nasal spray from Flonase to Nasacort 2 sprays in each nostril daily to avoid bad taste and improve adherence. Since Flonase is alcohol based, if it is going down her throat, it could be contributing to irritating and drying the mucosa.2 Additionally,
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The patient can take the oxymetazoline in the evenings and the pseudoephedrine during the day to avoid insomnia.
Nasal strips can help make it easier to breathe nasally.
If patient prefers, counsel the patient on the use of a saline nasal spray to help keep the nasal passages and sinuses clear. Be sure to space out from the use of the intranasal corticosteroid.
If eye symptoms are not well controlled after switching to cetirizine, consider adding an opthalmic antihistamine, such as azelastine or olopatadine.
Recommend reduction of exposure to allergens such as:11
Use air conditioning and avoid opening windows and the use of indoor fans.
Eliminate outside activities during times of high pollen counts
Shower/shampoo, and change clothes following outdoor activity
Use dryer instead of clothesline
Use of HEPA filters. Vacuuming the house.
Refer patient to allergy specialist for allergy testing to determine the allergen(s) that most effect her and possibly immunotherapy if her financial situation allows.

Refer to patient to see if allergy symptoms improve.
Refer to patient to see if nasal congestion improves and mouth breathing is
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Control of allergic rhinitis symptoms, including nasal symptoms, rhinorrhea, ocular symptoms, sleep quality and daily attention.
No need to mouth breathe
No complaints of nasal congestion

Follow up in 4 weeks to monitor therapy changes. Nasacort maximum effects seen after 2-4 weeks.

Resolve chest tightness, shortness of breath (SOB), wheezing

Educate patient that montelukast should be taken consistently at bedtime every day, rather than as needed.
Refer to a primary care physician to assess the presence and severity of underlying asthma and make recommendations for further treatment.
Educate patient to avoid asthma triggers to include allergen and cold air.

Monitor frequency of chest tightness, SOB and wheezing

Decreased occurrence of chest tightness, SOB and wheezing

Discuss progress at follow up in 2-4 weeks

Absence of heartburn

Avoid big meals, spicy foods, fatty foods, and caffeine.
Advise patient to eat at least 2 hours before going to bed
Recommend calcium carbonate 1-4 tablets as needed for heart burn.
If symptoms continue or are unresolved by antacid, recommend the patient keep a journal of occurrence to find possible

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