MODULE 2A: Nursing Care to Patients with Problems in Oxygenation-Ventilation
Acute Pharyngitis
DESCRIPTION: Sudden painful inflammation of the pharynx, the back portion of the throat that
includes the posterior third of the tongue, soft palate, and tonsils. In layman’s term it is called
sore throat.
ETIOLOGY: adenovirus, influenza virus, Epstein-Barr virus, herpes simplex virus, beta-hemolytic
streptococcus (GABHS) or group A streptococcus (GAS). Mycoplasma Pneumoniae, Neisseria
gonorrhaea and H influenza type B.
PATHOPHYSIOLOGY: When GAS causes acute pharyngitis, the body responds by triggering an
inflammatory response in the pharynx. This results in pain, fever, vasodilation, edema, and
tissue damage, manifested by redness and swelling and tonsillar pillars, uvula and soft palate. A
creamy exudate may be present in the tonsillar pillars. Uncomplicated viral infections subside
within 3 to 10 days after onset. However, if it is caused by more virulent bacteria (GAS) causes a
more severe illness and if left untreated, complications can be severe and life-threatening.
COMPLICATIONS: sinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adenitis.
In rare cases, the infection may lead to bacteremia, pneumonia, meningitis, rheumatic fever
and nephritis.
CLINICAL MANIFESTATIONS: fiery-red pharyngeal membrane and tonsils, lymphoid follicles that
are swollen and flecked with white – purple exudate, enlarged and tender cervical lymph
nodes, and no cough. Fever (higher than 38.3C), malaise and sore throat. Those with GAS
exhibits vomiting, anorexia, and a scarlatina-form rash with urticaria known as scarlet fever.
ASSESSMENT AND DIAGNOSTIC FINDINGS: swab specimens obtained from posterior pharynx
and tonsils (Fox, Morcon & Bonsu, 2006). Culture and sensitivity exams in 24 hours. Rapid
streptococcal antigen test (RSAT),
MEDICAL MANAGEMENT:
Pharmacologic: Penicillin V potassium for 5 days. Cephalosporins and macrolides
(clarithromycin and azithromycin) may be used if allergic with penicillin and erythromycin.
Gargle with benzocaine may relieve symptoms.
Nutritional: liquid or soft diet during acute stage of disease, depending of appetite and the
degree of discomfort that occurs with swallowing. Cool beverages, warm liquids, and flavored
frozen desserts such as Popsicles are often soothing. If the sore throat is so sore that liquids
cannot be taken in adequate amounts by mouth, intravenous fluids may be needed. Encourage
more fluids at least 2 to 3L per day.
NURSING MANAGEMENT:
Focus the care on symptomatic management’
Instruct the patient about signs and symptoms and correct administration of prescribed
antibiotic therapy
Instruct the patient to stay in bed during the febrile stage of illness and to rest frequently
once up and about.
Teach about proper disposal of soiled tissue to prevent the spread of infection.
Examine the skin once or twice daily for possible rash, since acute pharyngitis may precede
some other communicable diseases like rubella.
Encourage warm saline gargle or throat irrigations (recommended temperature depend on
what the patient can tolerate: 40.6C to 43.3C). This may reduce spasm in pharyngeal
muscles and relieve soreness of the throat.
Ice collar can relieve severe sore throats.
Encourage mouth care to promote oral comfort and prevent development of fissures
(cracking) of the lips and oral inflammation when bacterial infection is present.
Instruct patient to resume activity gradually and delay returning to work or school until
after 24 hours of antibiotic therapy.
Instruct the importance of taking the full course of therapy and inform them to watch out
about the symptoms that may indicate complications.
PREVENTION:
Instruct about preventive measure that include not sharing of eating utensils, glasses,
napkins, food or towels; cleaning telephones after use; using tissue to cough or sneeze;
disposing of used tissues appropriately; and avoiding exposure to tobacco and secondhand
smoke; replace toothbrush with the new one.
Reference:
Smeltzer S, Bare B, Hinkle J, Cheever K. (2010). Brunner and Suddarth’s Texbook of Medical-
Surgical Nursing. Wolters Kluwer, Lippincott Williams & Wilkins.12 th Edition.
