PHARYNGITIS
• PRESENTED BY:
• POOJA ARYAL
• PRANISHA MAGAR
• BSC.NURSING 2ND YEAR
(15TH BATCH)
GENERAL OBJECTIVES
• At the end of the session, BSc Nursing 2nd year students
will be able to explain about pharyngitis.
ANATOMY OF PHARYNX
• The pharynx is divided into
three parts.
• Nasopharynx
• Oropharynx
• laryngopharynx
• What is Pharyngitis?
Pharyngitis is the inflammation of the pharynx,
the portion of the throat that lies just beyond of
roof the mouth.
Types
Acute Pharyngitis
Chronic Pharyngitis
ACUTE PHARYNGITIS
• Acute pharyngitis, commonly referred to as a “sore
throat”,is a sudden painful inflammation of the pharynx,
caused mostly by viral infections, with bacterial
infections .
• The inflammatory response results in pain, fever,
vasodilation, Edema, and tissue damage, manifested by
redness and swelling in the tonsillar pillars, uvula, and soft
palate .
• It usually subside within 3 to 10 days .
• In rare cases, the infection may lead to bacteraemia,
pneumonia, meningitis, rheumatic fever, and nephritis .
Etiology
Viral : Bacterial :
• Rhinoviruses • Streptococcus ( group A , beta-
• Influenza haemolytic )
• Diphtheria
• Parainfluenza
• Gonococcus
• Measles and
chickenpox
Fungal :
• Coxsackie virus • Candida albicans
• Herpes simplex
• Infectious Miscellaneous :
mononucleosis • Toxoplasmosis ( parasitic,
• Cytomegalovirus rare )
• Chlamydia trachomatics
CHRONIC PHARYNGITIS
• Chronic Pharyngitis is a persistent inflammation of the
pharynx.
• It is characterised by multiple, white elongated
keratinized epithelial out growths project from the
surface of the tonsil , base of tongue or posterior
pharyngeal wall.
• It is common in adults who work or live in dusty
surroundings , use their voice to excess, suffer from
chronic cough, and habitually use alcohol and tobacco.
• Chronic pharyngitis lasts longer more than 10 days.
Types of Chronic Pharyngitis
1. Hypertrophic : characterised by a general thickening
and congestion of the pharyngeal mucous
membranes.
2. Atrophic : probably a late stage of the first type ( the
membrane is thin, whitish, glistening, and at times
wrinkled).
3. Chronic granular : characterised by numerous
swollen lymph follicles of the pharyngeal wall.
2. Atrophic 3. Chronic Granular
1.
Hypertrophic
Etiolo
gy
Bacterial : Viral :
• Streptococcus • Rhinoviruses
( group A , beta- • Influenza
haemolytic ) • Parainfluenza
1. Persistent infection in the neighbourhood :
• Diphtheria • Measles and chickenpox
• Gonococcus
• Chronic rhinitis and sinusitis
2. Chronic irritants : excessive smoking, chewing of
• Tonsillitis and dental sepsis
tobacco,
3.Environmental pollution : smoky or dusty
betel leaves and heavy drinking, highly spiced foods
environment or
Pathophysiology
• Due to etiology (persistent infection )
• Invasion of causative microorganisms (streptococcus) into the
pharyngeal mucosa
• Antigen antibody reaction occurs
• Histamines , prostaglandins releases
• Inflammation of pharynx
Clinical Features
1. Milder infection :
• Discomfort in throat , some malaise and low grade fever,
• pharynx in this case is congested but there is no lymphadenopathy
2. Moderate and severe infection :
• pain in throat, dysphasia, headache, malaise and high fever,
• pharynx in this case shows erythema, exudate and enlargement of
tonsils and lymphoid follicles on the posterior pharyngeal wall
3. Very severe infection :
• Edema of soft palate and uvula with enlargement of cervical lymph
nodes.
• Viral infections are generally mild and accompanied by rhinorrhoea
and hoarseness .
Complication
Pharyngitis caused by group A beta haemolytic
streptococci is a severe illness. If left untreated, it can
cause :-
• Sinusitis
• Otitis media
• Peritonsillar abscess
• Mastoiditis
• Acute rheumatic fever
Diagnostic procedure
• History taking
• Physical examination
• Culture of throat swab for bacterial pharyngitis.
• Nasal swab and blood culture may also be done to
identify the organism .
TREATMENT
• Gargle
• Bedrest
• More drink
• Antiviral
• Antibiotics
Medical Management
• Treatment of chronic pharyngitis is based on relieving symptoms.
• Avoiding exposure to irritants.
• Correcting upper respiratory, pulmonary, gastrointestinal or cardiac
conditions that might be responsible for chronic cough .
• Nasal spray or medication containing ephedrine sulfate or
phenylephrine hydrochloride are used – to relieve nasal congestion.
• Aspirin ( for patients older than 20 years ) or acetaminophen may be
recommended to control inflammation and relieve discomfort.
• For streptococcal pharyngitis :Penicillin V 250mg QID orally for 0
days .
• Eryhtromycin and cephalosporin for patient who is allergic to
penicillin.
Surgical Management
• Tonsillectomy : In case of severe chronic pharyngitis
followed by tonsilitis .
Nursing Management
• Advise patient to avoid contact with others until fever has
subsided completely to prevent infection from spreading.
• Recommends avoidance of alcohol, tobacco, second hand
smoke.
• Recommends to avoid the exposure to cold or to
environmental or occupational pollutants.
• Encourage patient to wear a disposable facemask .
• Encourages the patient to drink plenty of fluids .
• Gargling with warm saline solution in morning may relive
throat discomfort.
• Voice rest.
• Lozenges keep the throat moistened .
• An ice collar also can relieve severe sore throat .
• Mouth care may promote the patients comfort and
prevent the development of fissures of the lips and oral
inflammation when bacterial infections is present.
• The nurse instructs the patient and family about the
importance of taking the full course of therapy and
inform them about the symptoms to watch for
complications.
• Instruct the patient about the preventive measures such
as not sharing the infected persons utensils, glasses,
napkins, food or towels, cleaning telephones after use ,
use a tissue to cough or sneeze , replace his or her
toothbrush with a new one
References;
• Janice L . Hinkle , Kerry H . Cheever “Brunner and
Siddharth’s Textbook of Medical- Surgical Nursing ”,13th
edition, Wolters Kulwer Publication.
• Mandal , G.N (2012) Textbook of Medical- Surgical
Nursing (5th edition) , Kathmandu ; Makalu publication .
• Black ,J.M and Hawaks , J.H (2003) , Medical- Surgical
Nursing (8th edition) , New Delhi ; Elsevier’s publications.
