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