Pharyngitis: Nursing

Pharyngitis, more commonly known as sore throat, is an inflammatory disease of the pharynx, or the back of the throat, and it’s most often caused by an invading pathogen like a virus or bacteria, and rarely by fungi.Now, let’s quickly review a bit of anatomy and physiology of the respiratory tract.

When we breathe in, air enters the respiratory tract through the nose or mouth, respectively into the nasal and oral cavities, and then into the pharynx.

At each side of the back of the throat, there is a pair of structures called adenoids and tonsils, which are small clumps of lymphoid tissue that act as the body's first line of defense that swallow harmful foreign particles and pathogens that enter through the nose or mouth.

The lower part of the pharynx is continuous with the larynx or the voice box. Now, the pharynx also connects the oral cavity to the esophagus.

So, at the top of the larynx sits a spoon-shaped flap of cartilage called the epiglottis, which acts like a lid that seals the airway off while eating or drinking, so that anything we consume can only go one way, down the esophagus and towards the stomach.

In contrast, during breathing, the epiglottis stays open, so that air can make its way into the larynx, and then continue its journey through the trachea, or windpipe, towards the lungs.Zooming in, the epithelium lining respiratory tract consists of goblet cells that release mucus, which is sticky and contains enzymes to help trap and destroy harmful foreign particles and pathogens; as well as columnar epithelial cells that have hair-like projections called cilia, which work to sweep the harmful particles up and out of the airways.

In addition, the epithelial layer that lines the pharynx is actually thicker than elsewhere in the respiratory tract, as it has to protect the tissues from any harmful particles from the air we breathe in, as well as from anything we consume.

Okay, so pharyngitis is caused by any harmful particle that manages to breach these defense mechanisms and irritates the epithelial layer that covers the pharynx.

In most cases, the cause is infectious. Typically, the pathogen is transmitted from person to person via respiratory droplets or aerosolized particles expelled from an infected individual when talking, coughing, or sneezing.

Most often, these droplets land in the eyes, nose, or mouths of people nearby, infecting them; less frequently, the pathogen is transmitted indirectly when an individual touches a contaminated surface and then, prior to washing their hands, they touch their eyes, nose, or mouth.In most cases, pharyngitis is caused by a virus, such as rhinovirus, influenza, adenovirus, coronaviruses, and parainfluenza.

Less frequent viruses include coxsackievirus, herpes simplex virus, Epstein-Barr virus, and HIV. Pharyngitis can also be caused by bacteria, such as Streptococcus pyogenes, which is often referred to as group A beta hemolytic streptococcus or GAS for short; this infection is commonly known as strep throat.

Other less frequent bacteria include other streptococci, as well as Chlamydia pneumoniae, Mycoplasma pneumoniae, Haemophilus influenzae, Neisseria spp, and Corynebacterium diphtheriae.

Pharyngitis can also be rarely caused by fungi, such as Candida albicans. Risk factors for infectious pharyngitis include being between 5 to 15 years of age, having frequent contact with children, close contact with infected individuals, or being in small spaces with large groups of people, as well as prolonged or inappropriate use of antibiotics, inhaled corticosteroids, or clients who are immunosuppressed, such as those who have HIV.

Finally, pharyngitis can also be caused by non-infectious foreign particles like allergens or cigarette smoke, as well as irritation from acid reflux, dry and cold air, or intubation.

Now, regardless of the cause, pharyngitis occurs when there’s irritation or damage to the pharynx. In response to this, the immune system launches an inflammatory response, which results in visible pharyngeal redness and edema, as well as increased mucus discharge, as these cells start to produce more mucus that can help trap and eventually expel any pathogens.

The inflammatory response can be local, or it can spread to nearby areas of the respiratory tract, such as the nasal cavity, as well as the adenoids and tonsils.

Viral infections tend to also involve the mucosa lining the nasal cavity, causing rhinopharyngitis or the common cold. On the other hand, strep throat can spread to the tonsils, causing tonsillitis and even a peritonsillar abscess, which is a potentially life threatening complication.

Additionally, clients with untreated strep throat may develop rheumatic fever, a delayed systemic complication that typically occurs two to four weeks after the original infection.

Rheumatic fever arises because Streptococcus pyogenes has a bacterial protein that mimics the structure of some human proteins.

So, when the immune system produces antibodies against the bacterial protein, these antibodies also end up attacking the client’s own tissues.

This can ultimately result in fever and tissue destruction, especially involving the heart, joints, skin, and brain. Now, the most common symptom of pharyngitis is a sore throat, which can be associated with dysphagia, hoarseness and pain when talking, and even dyspnea.

On physical assessment, the pharynx looks red and swollen, and the tonsils may have patchy exudates on the surface. Clients often can also experience malaise, ear pain, and enlarged cervical lymph nodes.

Additionally, viral infections tend to be more gradual, and can present with symptoms like cough, rhinorrhea, and conjunctivitis, as well as fever typically around 100.4° F or 38° C.

On the other hand, bacterial infections tend to be acute, and are often associated with high grade fever above 103°F or 39.4°C.

Bacterial infections can also result in suppurative complications like a peritonsillar abscess, causing additional symptoms like drooling, as well as a muffled or “hot potato” voice, neck swelling, and even upper airway obstruction causing extreme difficulty breathing.

Pharyngitis is generally diagnosed based on the client’s history and physical assessment, guided by The Centor Score. The score evaluates for tonsillar exudate, anterior cervical node enlargement, fever, and absence of a cough.

For each one present, one point is added. For clients who score 0 and 1, the cause is likely to be viral.

In contrast, for scores of 2, 3, and 4, the cause is likely to be bacterial, which can be confirmed by performing a rapid antigen detection test or a throat culture.Treatment of pharyngitis depends on the cause.

Usually, treatment for viral pharyngitis involves supportive care to reduce the symptoms; this includes rest and hydration, as well as medications like analgesics, antipyretics, and antihistamines.

On the other hand, bacterial pharyngitis requires oral antibiotics for 10 days with penicillin; while clients with a penicillin allergy can be treated with erythromycin or clindamycin.

Finally, fungal pharyngitis is treated with antifungal medications, such as nystatin.Alright, let’s look at the nursing care you’ll be providing for a client with pharyngitis.

Your priority goals of care are promoting client comfort, prevention of complications, and infection control. Start by assessing your client’s vital signs, respiratory status, pain, and your client’s general presentation.

Immediately report to the healthcare provider if your client is experiencing difficulty handling secretions, dyspnea, stridor, cyanosis, or oxygen saturation of less than 92%, and be sure to administer supplemental oxygen.

Also provide additional interventions as ordered, including the prescribed antibiotic, as well as an antipyretic for fever, an analgesic for their pain, and provide fluids to prevent dehydration.

Alright, moving on to client and family teaching for care at home. First, instruct them to take their prescribed antibiotic as directed, and stress the importance of completing their entire course of the medication.

Then, let them know they can ease their throat pain by taking the prescribed analgesic, gargling with warm salt water made with ¼ teaspoon of salt per 1 cup or 250 mL of warm water, or drinking warm fluids like soup and tea.

Let them know that they can also soothe their throat by consuming cool bland liquids, gelatin, ice cream, popsicles, or sucking on lozenges.

Be sure to emphasize the importance of staying well hydrated by drinking plenty of fluids, and let them know to avoid citrus juices as well as cranberry and pineapple juice, as these can irritate their throat.

Also, encourage a soft diet, including foods such as mashed potatoes, plain pasta, eggs, applesauce, bananas, and cooked vegetables.

If your client has access to a humidifier, encourage them to use it while sleeping to help prevent their throat from drying out overnight.

Next, stress the importance of preventing the spread of germs to others. Instruct your client to practice good hand hygiene by washing their hands frequently and using alcohol-based hand rubs, as well as practicing cough etiquette.

Also remind them to stay home from work or school until they have been on their antibiotic for at least 24 hours. Lastly, instruct your client to seek medical attention right away if they experience new or worsening ear or sinus pain; a persistent temperature greater than 100.4 F or 38 C; if they develop a rash; or have difficulty swallowing or breathing.Alright, as a quick recap… Pharyngitis is an inflammatory disease involving the back of the throat, usually caused by an invading virus, bacteria, or less commonly a fungus.

Symptoms of pharyngitis include a sore throat, dysphagia, hoarseness, dyspnea, and fever, as well as cervical lymph