Pharyngitis
Pharyngitis: Excerpt from Handbook of Diseases
The most common throat disorder, pharyngitis is an acute or chronic inflammation of the pharynx. It’s widespread among adults who live or work in dusty or dry environments, use their voices excessively, habitually use tobacco or alcohol, or suffer from chronic sinusitis, persistent coughs, or allergies.
Causes
Pharyngitis is usually caused by a virus. The most common viral agents are rhinovirus, coronavirus, adenovirus, influenza, and parainfluenza. The most common bacterial cause is group A beta-hemolytic streptococci. Other common causes include Mycoplasma and Chlamydia.
Signs and symptoms
Pharyngitis produces a sore throat and slight difficulty in swallowing. Swallowing saliva is usually more painful than swallowing food. Pharyngitis may also cause the sensation of a lump in the throat as well as a constant, aggravating urge to swallow. Associated features include mild fever, headache, muscle and joint pain, coryza, and rhinorrhea. Uncomplicated pharyngitis usually subsides in 3 to 10 days. Some severe forms such as severe mononucleosis-pharyngitis may cause airway obstruction.
Diagnosis
Physical examination of the pharynx reveals generalized redness and inflammation of the posterior wall and red, edematous mucous membranes studded with white or yellow follicles. Exudate is usually confined to the lymphoid areas of the throat, sparing the tonsillar pillars. Bacterial pharyngitis usually produces a large amount of exudate.
A throat culture may be performed to identify bacterial organisms that may be the cause of the inflammation.
Treatment
The focus of treatment for acute and chronic pharyngitis varies.
Acute pharyngitis
With acute viral pharyngitis, treatment is usually symptomatic and consists mainly of rest, warm saline gargles, throat lozenges containing a mild anesthetic, at least 2 qt (2 L) of fluid daily, and analgesics as needed. If the patient can’t swallow fluids, hospitalization may be required for I.V. hydration.
Antibiotics are used to treat bacterial pharyngitis, which is diagnosed by a culture (or rapid strep test) that’s positive for group A beta-hemolytic streptococci. If bacterial infection is suspected despite negative culture results, antibiotic therapy may be indicated in select patients (those who are immunosuppressed or otherwise at high-risk) to prevent the sequelae of acute rheumatic fever, glomerulonephritis, bacteremia, or streptococcal shock syndrome.
Chronic pharyngitis
Treatment for chronic pharyngitis requires the same supportive measures as that for acute pharyngitis but with greater emphasis on eliminating the underlying cause such as an allergen. Preventive measures include humidying the air and avoiding excessive exposure to air conditioning. In addition, the patient should be urged to stop smoking, if appropriate.
Special considerations
❑ Administer analgesics and warm saline gargles as appropriate.
❑ Encourage the patient to drink at least 2 qt (2 L) of fluid daily. Monitor intake and output scrupulously, and watch for signs of dehydration. Assess skin turgor, mucous membranes and, in young children, tearing.
CLINICAL TIP: Encourage the intake of cool fluids to soothe the patient’s throat. Also have the patient take normal-size swallows, not sips.
❑ Provide meticulous mouth care to prevent dry lips and oral pyoderma, and maintain a restful environment.
❑ Elevate the patient’s head with three or four pillows.
❑ Obtain throat cultures, and administer antibiotics as required. If the patient has acute bacterial pharyngitis, emphasize the importance of completing the full course of antibiotic therapy.
❑ Teach the patient with chronic pharyngitis how to minimize sources of throat irritation in the environment, such as using a bedside humidifier.
❑ Refer the patient to a self-help group to stop smoking, if appropriate.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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Gag reflex abnormalities [Pharyngeal reflex abnormalities] (Nursing: Interpreting Signs and Symptoms)
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