PHARYNGITIS

ICD-9: 462

Description

Pharyngitis, inflammation of the pharynx, is the most common throat disorder and may be acute or chronic. On the average, children experience sore throats about five times a year, adults twice a year.

Etiology

Acute pharyngitis can be caused by any of a number of bacterial or viral infections, with viral infections being the most common. Streptococcus pyogenes (causing strep throat) is the most common of many possible bacterial pathogens; influenza virus and common cold viruses are the most common viral pathogens causing the condition. Acute pharyngitis also may arise secondary to systemic viral infections, such as measles or chickenpox. Noninfectious causes of the disease include trauma to the mucosa of the pharynx from heat, sharp objects, or chemical irritants. Chronic pharyngitis is more likely to have a noninfectious origin and is often associated with persistent cough or allergy.

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Signs and Symptoms

The hallmark of acute pharyngitis is sore throat. The pain may be mild or of such severity that swallowing becomes difficult. Accompanying symptoms may include malaise, fever, headache, muscle and joint pain, coryza or cold, and rhinorrhea.

Diagnostic Procedures

Physical examination of the pharynx typically reveals red, swollen mucous membranes. In severe cases, pustular ulcerations of the pharyngeal wall may be evident. See Figure 13.3 for an example of strep throat. A throat culture is usually performed to identify the infecting organism. This culture generally takes up to 24 hours for results, but a 15-minute in-clinic rapid test (not quite as reliable) can be obtained also.

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Inflammation of the oropharynx and petechiae

FIGURE. Inflammation of the oropharynx and petechiae, or small red spots on the soft palate caused by strep throat. (Hardin MD. University of Iowa and the Centers for Disease Control and Prevention. http://www.lib.uiowa.edu/hardin/Md/cdc/3185.html.)

Treatment

Antibiotics are generally prescribed if the source of the infection is determined to be bacterial. Otherwise, treatment is symptomatic and may typically include the use of warm saline gargles, analgesics, and drugs to relieve fever or antipyretics. Bed rest and adequate fluid intake may be advised.

Complementary Therapy

Gargling with warm water and one-quarter teaspoon of turmeric powder and a pinch of salt may help. Aromatherapy that includes inhalation with lavender, thyme, eucalyptus, and sandalwood is often used. The client should drink herbal teas, diluted fruit juices, and broth.

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CLIENT COMMUNICATION

A sore throat caused by a streptococcal infection must be identified and treated to prevent such complications as rheumatic fever, tonsil abscess, or acute glomerulonephritis.

Prognosis

The prognosis for most forms of pharyngitis is generally good. Uncomplicated pharyngitis usually subsides in 3 to 10 days. Serious complications may result from untreated streptococcal acute pharyngitis; these include rheumatic fever and glomerulonephritis. Therefore, antibiotic therapy must be continued until the medication is gone.

Prevention

There are no specific preventive measures for pharyngitis. Some of the common ways to protect against strep throat are to cover the mouth when sneezing or coughing and remind clients to avoid contracting upper respiratory tract infections by maintaining strict hand-washing habits and avoiding those with a cold. Irritating substances, such as cigarette smoke and any known allergens, should be avoided.

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Croup ICD-9: 464.4 Description Croup, a common childhood ailment, is acute and severe inflammation and obstruction of the upper respiratory tract, occurring most frequently from 3 months to 3 years of age. It is more common in male infants and children, usually occurring in winter. Etiology The condition may be caused by parainfluenza virus, adenoviruses, respiratory syncytial viruses, and influenza and measles viruses. Croup generally follows an upper respiratory tract infection. Signs and Symptoms Common symptoms include hoarseness; fever; a distinctive harsh, brassy, barklike cough; respiratory distress; and persistent stridor during inspiration. Stridor is a harsh, high-pitched sound during respiration due to obstruction of the air passages. The infant or child may be anxious and frightened by the respiratory distress. The symptoms may last a few hours or persist for a day or two. Diagnostic Procedures The clinical picture is very characteristic, so a diagnosis is m...
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EPIGLOTTITIS ICD-9: 464.31 Description Epiglottitis occurs when the epiglottis covering the windpipe swells and blocks the flow of air into the lungs. It is life-threatening. Etiology Infection with Haemophilus influenzae type b (Hib) is the most common cause, followed by burns from hot liquids and direct injury to the throat. Other bacteria and viruses that cause epiglottitis are pneumococcus; streptococcus A, B, and C; Candida albicans; and varicella zoster. Swallowing a foreign object and smoking crack cocaine and heroin may also cause epiglottitis. Signs and Symptoms Onset of symptoms is sudden. Likely symptoms include sore throat, painful swallowing, fever, drooling, hoarseness, dyspnea, and cyanosis. Diagnostic Procedures Once the airway is open and the condition is stable, the throat is examined with a flexible fiberoptic tube. A blood test and throat culture are likely taken to establish the cause of any infection. Treatment The first priority is to establish a c...