PHARYNGITIS

DEFINITION:
 Pharyngitis－commonly known as sore throat －is inflammation of
the mucous membranes that line the back of the throat, or pharynx.
This inflammation can cause discomfort, dryness, and difficulty of
swallowing.
 Pharyngitis can involve some or all of these parts of the throat:
 The back third of the tongue
 The soft palate
 The tonsils
Incidence
 With regards to age, pharyngitis occurs with much greater frequency
in the pediatric population. Approximately 15-30% of pharyngitis
cases among school-aged children in the cooler months are due to
GAS. Only 10% of adult cases of pharyngitis are due to GAS.
 The peak incidence of bacterial and viral pharyngitis occurs in the
school-aged child aged 4-7 years.

Risk Factors
Risk factors for pharyngitis include the following:
 Cold and flu seasons
 Having close contact with someone who has a sore throat or cold
 Smoking or exposure to secondhand smoke
 Frequent sinus infections
 Allergies

Manifestations
 Fever. Fever is common, especially in young children; older children
have low-grade fevers, which appear early and suddenly.
 Dyspnea. The onset of dyspnea is abrupt, sometimes preceded by a
cough or nasal discharge.
 Cough. Symptoms include a dry and persistent cough.
 Nasal inflammation. Nasal inflammation may lead to obstruction of
passages, and continual wiping away of secretions causes skin
irritation to nares.
 Retractions. Suprasternal and substernal retractions are present.
 Barrel-shaped chest. The chest becomes barrel-shaped from the
trapped air.
 Shallow respirations. Respirations are 60 to 80 breaths per minute.
 Viral pharyngitis is usually associated with sneezing, rhinorrhea, and
cough

Laboratory and Diagnostic procedure

Diagnosis is made from clinical findings and can be confirmed by
laboratory testing of the mucus.

 Throat culture. A throat culture remains the standard for diagnosis,

though results can take as long as 48 hours; throat culture results are
highly sensitive and specific for group A beta-hemolytic streptococci
(GABHS), but results can vary according to technique, sampling, and
culture media.
 Rapid testing. Most institutions and clinics have rapid testing, which
is useful when immediate therapy is desired; rapid testing can be highly
reliable when used in conjunction with throat cultures; several rapid
diagnostic tests are available; compared with throat culture, such tests
are 70-90% sensitive and 95-100% specific.
 Testing for viral causes. If Epstein-Barr virus (EBV) is considered,
obtain a complete blood count (CBC) to detect atypical cells in the white
blood cell (WBC) differential, along with a Monospot test (or another
rapid heterophile antibody test).
 Radiography. Imaging studies are usually not necessary unless a
retropharyngeal, parapharyngeal, or peritonsillar abscess is suspected;
in such cases, a plain lateral neck film can be used as an initial screening
tool.

Treatment
Non-pharmacologic
If a virus is causing pharyngitis, these can help relieve symptoms.
 drinking plenty of fluids to prevent dehydration
 eating warm broth
 gargling with warm salt water (1 teaspoon of salt per 8 ounces of
water)
 using a humidifier
 resting until you feel better

Pharmacologic
The appropriate treatment for pharyngitis varies depending on its
underlying cause.
 For bacterial infections, a doctor may prescribe a person a course of
oral antibiotics, such as amoxicillin or penicillin. The antibiotics aim
to prevent complications, such as rheumatic fever or kidney disease,
not to treat the sore throat. It is essential to complete the entire
course of antibiotics to ensure the infection has cleared and to
prevent reinfection.
 Viral pharyngitis does not respond to antibiotics, but will typically
clear up on its own. However, over-the-counter medications, such as
acetaminophen or ibuprofen, can help reduce pain and fever.

Nursing Responsibilities
Assess vital signs
 Get a baseline to determine if interventions are effective. Assess for
fever which can lead to tachycardia, tachypnea, and elevated blood
pressure
Assess mouth and throat
 Look for erythema, pustules, or petechiae that may indicate
infection. Assess for adequate airway. Note any post-nasal drip that
could cause throat pain.
Assess for signs of dehydration
 Throat pain in children often causes them to refuse food and drink
because swallowing is painful. Note mucous membranes.
Assess for pain using appropriate pain scale for age (FLACC / FACES) and
provide non-pharmacological pain relief methods
 Throat pain is the most common symptom of tonsillitis, but patients
may not be able to verbalize complaints. Note nonverbal cues such
as crying, mouth breathing, irritability, or refusal to eat or drink.
Administer medications as appropriate

Nursing Care Plan

Nursing Diagnosis
Ineffective airway clearance related to mechanical obstruction of the
airway secretions and increased production of secretions as manifested
by stuffy nose, Nasal inflammation and Shallow respirations.

Nursing Goal
After 3-8 hours of providing appropriate interventions, the patient will
be able to maintain patent airway.

Nursing Interventions:
 Positioning. Place the child in a semi-Fowlers position using pillows
to facilitate lung expansion.
 Increase fluid intake. Encourage increased fluid intake to decrease
the viscosity of secretions.
 Increase room humidity. Increase the humidity by using cool mist
vaporizers to relieve stuffiness of the nose.
 Administer medications. Administer antibiotics as prescribed after a
positive culture result.

Nursing outcomes
After 5 hours of providing appropriate interventions, the patient was
able to maintain patent airway.