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ACUTE PHARYNGITIS Definition of Acute pharyngitis :- Acute pharyngitis is a sudden painful inflammation or infection in the Pharynx. usually causing symptoms of a sore throat. 2

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Pathophysiology Most cases of acute pharyngitis are caused by viral infection. When group A beta-hemolytic streptococcus the most common bacterial organism, causes acute pharyngitis, the condition is known a strep throat. The body responds by triggering an inflammatory response in the pharynx. This results in pain, fever, vasodilation, edema, and tissue damage, manifested by redness and swelling in the tonsillar pillars, and soft palate. 4

Cont,,, Uncomplicated viral infections usually subside promptly within 3 to 10 days after the onset. However, pharyngitis caused by more virulent bacteria such as 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 adenitis. In rare cases the infection may lead to : bacteremia, pneumonia meningitis, rheumatic fever, or nephritis. 5

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 & tender cervical lymph nodes and Fever & malaise and sore throat also may be present. 6

Assessment and Diagnostic Findings Rapid strep test (RST) and strep culture require proper collection technique, because improper collection reduces the accuracy of the test. RST must be performed according to the manufacturer's guidelines. When the test is performed correctly, the swabs touch both the tonsillar pillars and the posterior pharyngeal wall; the tongue should not be included. If the RST result is negative, a second culture should be performed. Treatment is usually delayed until the culture results are available. 7

Medical Management Viral pharyngitis is treated with supportive measures since antibiotics will have no effect on the organism. Bacterial pharyngitis is treated with a variety of antimicrobial agents. 8

Cont,,, PHARMACOLOGIC THERAPY :- If a bacterial cause is suggested or demonstrated, penicillin is usually the treatment of choice. For patients who are allergic to penicillin or have organisms that are resistant to erythromycin cephalosporins and macrolides may be used. 9

Cont,,, Antibiotics are administered for at least 10 days to eradicate the infection from the oropharynx. Severe sore throats can also be relieved by analgesic medications, as prescribed. For example, aspirin or acetaminophen can be taken at 3- to 6-hour. 10

Cont,,, NUTRITIONAL THERAPY :- A liquid or soft diet is provided during the acute stage of the disease, depending on the patient’s appetite and the degree of discomfort that occurs with swallowing. Occasionally, the throat is so sore that liquids can not 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 possible at least 2 to 3 L per day. 11

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 tissues should be disposed of properly to prevent the spread of infection. Is important to examine the skin once or twice daily for possible rash, because acute pharyngitis may precede some other communicable diseases. 12

Cont,,, Warm saline 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 (40.5°C to 43.3°C) Irrigating the throat properly is an effective means of reducing spasm in the pharyngeal muscles and relieving soreness of the throat. 13

CHRONIC PHARYNGITIS Chronic pharyngitis is a persistent inflammation of the pharynx. 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. 14

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Cont,,, Three types of chronic pharyngitis are recognized :- 1) Hypertrophic: a general thickening and congestion of the pharyngeal mucous membrane. 2) Atrophic: a late stage of the type 1 ( the membrane is thin, whitish, glistening, and at times wrinkled ). 3) Chronic granular : characterized by numerous swollen, lymph follicles on the pharyngeal wall. 16

Clinical Manifestations Patients with chronic pharyngitis complain of : A constant sense of irritation or fullness in the throat. Mucus that collects in the throat and can be expelled by coughing. and Difficulty swallowing. 17

Medical Management Treatment of chronic pharyngitis is based on relieving symptoms avoiding exposure to irritants, and correcting any upper respiratory, pulmonary, or cardiac condition that might be responsible for a chronic cough. 18

Cont,,, Nasal congestion may be relieved by short-term use of nasal sprays or medications containing ephedrine sulfate If there is a history of allergy, one of the antihistamine decongestant medications, such as Drixoral or Dimetapp, is taken orally every 4 to 6 hours. Aspirin or acetaminophen is recommended for its anti inflammatory and analgesic properties. 19

Nursing Management TEACHING PATIENTS SELF-CARE :- To prevent the infection from spreading, the nurse instructs the patient to avoid contact with others until the fever subsides. Alcohol, tobacco, secondhand smoke, and exposure to cold are avoided, as are environmental or occupational pollutants if possible. The patient may minimize exposure to pollutants by wearing a disposable facemask. The nurse encourages the patient to drink plenty of fluids. Gargling with warm saline solutions may relieve throat discomfort. 20

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