Acute Pharyngitis - Upper Airway Infections

ACUTE PHARYNGITIS

Acute pharyngitis is an inflammation or infection in the throat, usually causing symptoms of a sore throat.

Pathophysiology

Most cases of acute pharyngitis are caused by viral infection. When group A beta-hemolytic streptococcus, the most common bacte-rial organism, causes acute pharyngitis, the condition is known as strep throat (Bisno, 2001). The body responds by triggering an in-flammatory response in the pharynx. This results in pain, fever, vasodilation, edema, and tissue damage, manifested by redness and swelling in the tonsillar pillars, uvula, and soft palate. A creamy ex-udate may be present in the tonsillar pillars (Fig. 22-3).

Uncomplicated viral infections usually subside promptly, within 3 to 10 days after the onset. However, pharyngitis caused by more virulent bacteria such as group A beta-hemolytic strep-tococci is a more severe illness. If left untreated, the complications can be severe and life-threatening. Complications include sinusitis, otitis media, peritonsillar abscess, mastoiditis, and cervical adeni-tis. In rare cases the infection may lead to bacteremia, pneumonia, meningitis, rheumatic fever, or nephritis.

Clinical Manifestations

The signs and symptoms of acute pharyngitis include a fiery-red pharyngeal membrane and tonsils, lymphoid follicles that are swollen and flecked with white-purple exudate, and enlarged and tender cervical lymph nodes and no cough. Fever, malaise, and sore throat also may be present.

Assessment and Diagnostic Findings

Rapid screening tests for streptococcal antigens such as the latex agglutination (LA) antigen test and solid-phase enzyme immuno-assays (ELISA), optical immunoassay (OIA), streptolysin titers, and throat cultures are used to determine the causative organism, after which appropriate therapy is prescribed. Nasal swabs and blood cultures may also be necessary to identify the organism (Corneli, 2001).

Medical Management

Viral pharyngitis is treated with supportive measures since an-tibiotics will have no effect on the organism. Bacterial pharyngi-tis is treated with a variety of antimicrobial agents.

PHARMACOLOGIC THERAPY

If a bacterial cause is suggested or demonstrated, penicillin is usu-ally the treatment of choice. For patients who are allergic to peni-cillin or have organisms that are resistant to erythromycin (one fifth of group A beta-hemolytic streptococci and most S. aureus organisms are resistant to penicillin and erythromycin), cepha-losporins and macrolides (clarithromycin and azithromycin) may be used. Antibiotics are administered for at least 10 days to eradicate the infection from the oropharynx.

Severe sore throats can also be relieved by analgesic medica-tions, as prescribed. For example, aspirin or acetaminophen (Tylenol) can be taken at 3- to 6-hour intervals; if required, acet-aminophen with codeine can be taken three or four times daily. Antitussive medication, in the form of codeine, dextromethor-phan (Robitussin DM), or hydrocodone bitartrate (Hycodan), may be required to control the persistent and painful cough that often accompanies acute pharyngitis.

NUTRITIONAL THERAPY

A liquid or soft diet is provided during the acute stage of the dis-ease, depending on the patient’s appetite and the degree of dis-comfort that occurs with swallowing. Occasionally, the throat is so sore that liquids cannot be taken in adequate amounts by mouth. In severe situations, fluids are administered intravenously. Otherwise, the patient is encouraged to drink as much fluid as pos-sible (at least 2 to 3 L per day).

Nursing Management

The nurse instructs the patient to stay in bed during the febrile stage of illness and to rest frequently once up and about. Used tis-sues should be disposed of properly to prevent the spread of in-fection. It is important to examine the skin once or twice daily for possible rash, because acute pharyngitis may precede some other communicable diseases (ie, rubella).

Warm saline gargles or irrigations are used depending on the severity of the lesion and the degree of pain. The benefits of this treatment depend on the degree of heat that is applied. The nurse teaches the patient about the recommended temperature of the solution: high enough to be effective and as warm as the patient can tolerate, usually 105°F to 110°F (40.6°C to 43.3°C). Irri-gating the throat properly is an effective means of reducing spasm in the pharyngeal muscles and relieving soreness of the throat. Unless the purpose of the procedure and its technique are un-derstood clearly by the patient and family, the results may be less than satisfactory.

An ice collar also can relieve severe sore throats. Mouth care may add greatly to the patient’s comfort and prevent the development of fissures (cracking) of the lips and oral inflammation when bac-terial infection is present. The nurse instructs the patient to resume activity gradually. A full course of antibiotic therapy is indicated in patients with group A beta-hemolytic streptococcal infection in view of the possible development of complications such as nephri-tis and rheumatic fever, which may have their onset 2 or 3 weeks after the pharyngitis has subsided. The nurse instructs the patient and family about the importance of taking the full course of ther-apy and informs them about the symptoms to watch for that may indicate complications.