Care of Clients With Nose and Throat Disorders

8/8/2019 Care of Clients With Nose and Throat Disorders

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CARE OF CLIENTS WITH NOSECARE OF CLIENTS WITH NOSE

AND THROAT DISORDERSAND THROAT DISORDERS

BY:BY:

SOFIA IRENE M. BRIONES, RN, MANSOFIA IRENE M. BRIONES, RN, MAN


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ANATOMY OF THE NOSEANATOMY OF THE NOSE The nose is the organ of smell, with receptors fromThe nose is the organ of smell, with receptors from

cranial nerve I (olfactory) located in the upper areas.cranial nerve I (olfactory) located in the upper areas.

SEPTUMSEPTUM

The upper one third of the nose is composed of bone;The upper one third of the nose is composed of bone;

the lower two thirds are composed of cartilage,the lower two thirds are composed of cartilage,allowing limited movement.allowing limited movement.

TheThe ANTERIOR NARES (nostrils or externalANTERIOR NARES (nostrils or externalopenings into the nasal cavities)openings into the nasal cavities) are lined with skinare lined with skin

and hair.and hair. TheThe POSTERIOR NARESPOSTERIOR NARES are openings from the nasalare openings from the nasal

cavity into the nasopharynx.cavity into the nasopharynx.

TURBINATESTURBINATES

CILIA (hair like projections)CILIA (hair like projections)


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SINUSESSINUSES

The PARANASAL SINUSES are airThe PARANASAL SINUSES are air--filledfilledcavities within the bones that surround thecavities within the bones that surround thenasal passages.nasal passages.

Lined with ciliated membrane, the purposesLined with ciliated membrane, the purposesof the sinuses are to provide resonanceof the sinuses are to provide resonanceduring the speech and to decrease theduring the speech and to decrease theweight of the skull.weight of the skull.

These are located in the frontal, ethmoid,These are located in the frontal, ethmoid,maxillary and sphenoid bones.maxillary and sphenoid bones.


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PHARYNXPHARYNX

Or THROAT, is a passageway for bothOr THROAT, is a passageway for boththe respiratory and digestive tracts. Itthe respiratory and digestive tracts. It

is located behind the oral and nasalis located behind the oral and nasalcavities.cavities.


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3 DIVISIONS OF PHARYNX3 DIVISIONS OF PHARYNX

1. NASOPHARYNX1. NASOPHARYNX located behindthenose, abovethelocated behindthenose, abovethesoft palate. Itcontainstheadenoidsandtheopeningofthesoft palate. ItcontainstheadenoidsandtheopeningoftheEustachiantube.Eustachiantube. ADENOIDS (pharyngealtonsils)ADENOIDS (pharyngealtonsils)

EUSTACHIAN TUBEEUSTACHIAN TUBE

2. OROPHARYNX2. OROPHARYNX located behindthe mouth, belowthelocated behindthe mouth, belowthenasopharynx. Itextendsfrom thesoft palatetothe baseofnasopharynx. Itextendsfrom thesoft palatetothe baseofthetongueandis usedforbreathingandswallowing.thetongueandis usedforbreathingandswallowing. PALATINE TONSILSPALATINE TONSILS

3. LARYNGOPHARYNX3. LARYNGOPHARYNX located behindthelarynxandlocated behindthelarynxandextendsfrom the baseofthetonguetotheesophagus. Atextendsfrom the baseofthetonguetotheesophagus. Atthis point, the passagewaydividesintothelarynxandthethis point, the passagewaydividesintothelarynxandtheesophagus.esophagus.


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LARYNXLARYNX

Located above the trachea, just below the throat at the base ofLocated above the trachea, just below the throat at the base ofthe tongue.the tongue.

Composedofseveralcartilages:Composedofseveralcartilages:

THYROID CARTILAGE isthelargestiscommonlycalledtheTHYROID CARTILAGE isthelargestiscommonlycalledtheAdamsapple.Adamsapple.

CRICOID CARTILAGE whichcontainsthevocalcordslies belowtheCRICOID CARTILAGE whichcontainsthevocalcordslies belowthethyroidcartilage. The CRICOTHYROID MEMBRANE islocatedthyroidcartilage. The CRICOTHYROID MEMBRANE islocatedbelowthelevelofthevocalcordsand joinsthethyroidandcricoidbelowthelevelofthevocalcordsand joinsthethyroidandcricoidcartilage.cartilage.

CRICOTHYROIDECTOMY (orcricothyrotomy), anopeningis madeCRICOTHYROIDECTOMY (orcricothyrotomy), anopeningis madebetweenthethyroidandcricoidcartilage, andresultsintracheostomy.betweenthethyroidandcricoidcartilage, andresultsintracheostomy.

Insidethelarynxaretwo pairsofvocalcords:Insidethelarynxaretwo pairsofvocalcords: FALSE VOCAL CORDSFALSE VOCAL CORDS

TRUE VOCAL CORDSTRUE VOCAL CORDS

GLOTTISGLOTTIS

EPIGLOTTISEPIGLOTTIS


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ASSESSMENT OF THE NOSE AND SINUSESASSESSMENT OF THE NOSE AND SINUSES

PHYSICAL ASSESSMENTPHYSICAL ASSESSMENT

1.1. Inspecttheclientsexternalnosefordeformitiesortumors,Inspecttheclientsexternalnosefordeformitiesortumors,andinspectthenostrilsforsymmetryofsizeandshape.andinspectthenostrilsforsymmetryofsizeandshape.

2. Toobservetheinteriornose, asktheclienttotilthead backfor2. Toobservetheinteriornose, asktheclienttotilthead backfor

a penlightexamination.a penlightexamination.3. Inspectforcolor, swelling, drainageand bleeding.3. Inspectforcolor, swelling, drainageand bleeding.

4. Checkfornasalseptum forbleeding, perforationordeviation.4. Checkfornasalseptum forbleeding, perforationordeviation.

5. Occludeonenaresatatimetocheckwhetherairmoves5. Occludeonenaresatatimetocheckwhetherairmovesthroughthenonthroughthenon--occludedsideeasily.occludedsideeasily.

6. Palpatethenoseand paranasalsinusestodetecttendernessor6. Palpatethenoseand paranasalsinusestodetecttendernessorswelling.swelling.

7. Transillumination (passageofstronglight)ofthesinuses may7. Transillumination (passageofstronglight)ofthesinuses maybe usedtodetectsinusitis.be usedtodetectsinusitis.


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ASSESSMENT OF THE PHARYNX, TRACHEAASSESSMENT OF THE PHARYNX, TRACHEA

AND LARYNXAND LARYNX

1. Assessmentofthe pharynx beginswithinspectionoftheexternalstructure1. Assessmentofthe pharynx beginswithinspectionoftheexternalstructureofthe mouth.ofthe mouth.

2. Toexaminethe posteriorpharynx, useatonguedepressorto pressdownone2. Toexaminethe posteriorpharynx, useatonguedepressorto pressdownonesideofthetongueatatime (toavoidstimulatingthegagreflex).sideofthetongueatatime (toavoidstimulatingthegagreflex).

3. Astheclientsays ah, observetheriseandfallofthesoft palateand uvula3. Astheclientsays ah, observetheriseandfallofthesoft palateand uvulaandinspectforcolorandsymmetry, evidenceofdischarge (postnasalandinspectforcolorandsymmetry, evidenceofdischarge (postnasaldrainage), edema, orulcerationandtonsillarenlargementorinflammation.drainage), edema, orulcerationandtonsillarenlargementorinflammation.

4. Inspecttheneckforsymmetry, alignment, masses, swelling, bruisesandthe4. Inspecttheneckforsymmetry, alignment, masses, swelling, bruisesandtheuseofaccessoryneckmusclesin breathing.useofaccessoryneckmusclesin breathing.

5. Palpatelymphnodesforsize, shape, mobility, consistency, andtenderness.5. Palpatelymphnodesforsize, shape, mobility, consistency, andtenderness.

TendernodesTendernodes

MalignantnodesMalignantnodes

6. Gently palpatethetracheaforposition, mobility, tendernessand masses.6. Gently palpatethetracheaforposition, mobility, tendernessand masses.

7. Manylungdisorderscausethetracheatodeviatefrom theastinal massand7. Manylungdisorderscausethetracheatodeviatefrom theastinal massandnecktumors pushthetracheaawayfrom theaffectedarea.necktumors pushthetracheaawayfrom theaffectedarea.

8. Thelarynxis usuallyexamined byaspecialistwithalaryngoscope.8. Thelarynxis usuallyexamined byaspecialistwithalaryngoscope.

Anabnormalvoice, especiallyhoarsenessAnabnormalvoice, especiallyhoarseness


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DISORDERS OF THE NOSE AND PARANASAL SINUSESDISORDERS OF THE NOSE AND PARANASAL SINUSES

EPISTAXISEPISTAXIS

Nosebleed is a common problemNosebleed is a common problem

Nosebleeds may occur as a result of trauma,Nosebleeds may occur as a result of trauma,hypertension, blood dyscrasia (e.g. leukemia),hypertension, blood dyscrasia (e.g. leukemia),inflammation, tumor, decreased humidity, noseinflammation, tumor, decreased humidity, noseblowing, nose picking, chronic cocaine use, andblowing, nose picking, chronic cocaine use, andprocedures such as nasogastric suctioning.procedures such as nasogastric suctioning.

Men are usually affected more often other thanMen are usually affected more often other than

women. Older adults tend to bleed most often fromwomen. Older adults tend to bleed most often fromthe posterior portion of the nose.the posterior portion of the nose.


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COLLABORATIVE MANAGEMENTCOLLABORATIVE MANAGEMENT

ASSESSMENTASSESSMENT

The client often reports that the bleedingThe client often reports that the bleedingstarted after sneezing or blowing the nose.started after sneezing or blowing the nose.

Document the amount and color of the bloodDocument the amount and color of the bloodand take the vital signs.and take the vital signs.

Ask the client about the number, duration andAsk the client about the number, duration and

causes or previous bleeding episodes. Recordcauses or previous bleeding episodes. Recordthis information in the clients medical record.this information in the clients medical record.


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INTERVENTIONSINTERVENTIONS

Position the client upright and leaningPosition the client upright and leaning

Reassure the client and attempt to keep him quiet.Reassure the client and attempt to keep him quiet.

Apply direct lateral pressure to the nose for 5 minutes, andApply direct lateral pressure to the nose for 5 minutes, andapply ice or cool compresses to the nose and face if possible.apply ice or cool compresses to the nose and face if possible.

Maintain standard and body substance precautions.Maintain standard and body substance precautions. If nasal packing is necessary, loosely pack both nares withIf nasal packing is necessary, loosely pack both nares with

gauze.gauze.

To prevent reTo prevent re--bleeding from dislodging clots, instruct the clientbleeding from dislodging clots, instruct the clientnot to blow the nose for several hours after the bleeding stops.not to blow the nose for several hours after the bleeding stops.

Seek medical assistance if these measures are ineffective or ifSeek medical assistance if these measures are ineffective or ifthe bleeding occurs frequently.the bleeding occurs frequently.

Posterior nasal bleeding is an emergency.Posterior nasal bleeding is an emergency.


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RHINITISRHINITIS

An inflammation of the nasal mucosa, and can be caused by anAn inflammation of the nasal mucosa, and can be caused by aninfection (viral or bacterial) or contact with allergens.infection (viral or bacterial) or contact with allergens.

ALLERGIC RHINITIS, often called hay fever or allergies.ALLERGIC RHINITIS, often called hay fever or allergies.

CHRONIC RHINITIS occurs either intermittently with a noCHRONIC RHINITIS occurs either intermittently with a no

seasonal pattern or continuously.Other causes of rhinitis includeseasonal pattern or continuously.Other causes of rhinitis includea rebound nasal congestion from overuse of nose drops ora rebound nasal congestion from overuse of nose drops orsprays (rhinitis medicamentosa) and chronic inhalation ofsprays (rhinitis medicamentosa) and chronic inhalation ofcocaine.cocaine.

ACUTE VIRAL RHINITIS (coryza, common cold) is caused byACUTE VIRAL RHINITIS (coryza, common cold) is caused by

any one of at least 200 viruses. It spreads from person toany one of at least 200 viruses. It spreads from person toperson by droplets from sneezing or coughing. It is mostperson by droplets from sneezing or coughing. It is mostcontagious in the first 2 to 3 days after symptoms appear.contagious in the first 2 to 3 days after symptoms appear.


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In both acute and chronic allergic rhinitis, theIn both acute and chronic allergic rhinitis, thepresence of the allergenspresence of the allergens -- a release of naturala release of naturalchemicals (histamines )from white blood cells in thechemicals (histamines )from white blood cells in thenasal mucosa = local blood vessel dilation and capillarynasal mucosa = local blood vessel dilation and capillaryleak = edema and swelling of the nasal mucosa.leak = edema and swelling of the nasal mucosa.

The resulting symptoms include headache, nasalThe resulting symptoms include headache, nasalirritation, sneezing, nasal congestion, rhinorrheairritation, sneezing, nasal congestion, rhinorrhea

(watery drainage from the nose) and itchy watery(watery drainage from the nose) and itchy wateryeyes.eyes.

Viral or bacterial invasion of the nasal passagesViral or bacterial invasion of the nasal passages -- soresoredry throat and a low grade fever.dry throat and a low grade fever.


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Administration of antihistamines andAdministration of antihistamines anddecongestants.decongestants.

Antipyretics are given if with fever.Antipyretics are given if with fever.Antibiotics are given only bacterial rhinitis.Antibiotics are given only bacterial rhinitis.

Rhinitis caused by overuse of nasal drops orRhinitis caused by overuse of nasal drops orsprays is treated by discontinuing thesprays is treated by discontinuing the

offending drug.offending drug. Steroid nasal sprays are used to decrease theSteroid nasal sprays are used to decrease the

rebound nasal congestion.rebound nasal congestion.


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COMPLEMENTARY AND ALTERNATIVE THERAPYCOMPLEMENTARY AND ALTERNATIVE THERAPY

Instruct the client about importance of rest (8 to 10Instruct the client about importance of rest (8 to 10hours a day) and fluid intake of at least 2000 ml/day.hours a day) and fluid intake of at least 2000 ml/day.

Humidifying the air helps to relieve congestion.Humidifying the air helps to relieve congestion.

Teach the client to reduce the risk of spreading theTeach the client to reduce the risk of spreading thecold.cold.

Instruct the client to avoid close contact with peopleInstruct the client to avoid close contact with peoplewho are more susceptible to infection.who are more susceptible to infection.

The client with recurrent allergic rhinitis can haveThe client with recurrent allergic rhinitis can haveallergy testing to determine the cause.allergy testing to determine the cause.

Uncomplicated cold subsides within 7 to 10 days.Uncomplicated cold subsides within 7 to 10 days.


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SINUSITISSINUSITIS An inflammation of the mucous membrane of one or more of theAn inflammation of the mucous membrane of one or more of the

sinuses.sinuses.

Swelling can obstruct the flow of secretions from the sinuses,Swelling can obstruct the flow of secretions from the sinuses,which may then become infected. The disorder follows rhinitis.which may then become infected. The disorder follows rhinitis.

In chronic sinusitis, the mucous membrane is permanentlyIn chronic sinusitis, the mucous membrane is permanentlythickened from repeated inflammation.thickened from repeated inflammation.

The most common organisms causing sinus infection areThe most common organisms causing sinus infection areStreptococcus pneumoniae, Hemophilus influenzae, DiplococcusStreptococcus pneumoniae, Hemophilus influenzae, Diplococcusor Bacteroides.or Bacteroides.

Sinusitis most often develops in the maxillary and frontalSinusitis most often develops in the maxillary and frontal

sinuses. Complications include cellulites, abscess and meningitis.sinuses. Complications include cellulites, abscess and meningitis. Transillumination of the affected sinus is decreased. OtherTransillumination of the affected sinus is decreased. Other

diagnostic tests for sinusitis include sinus xdiagnostic tests for sinusitis include sinus x--rays, endoscopicrays, endoscopicexamination and computed tomography.examination and computed tomography.


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Manifestations of sinusitis include nasalManifestations of sinusitis include nasal

swelling and congestion, headache, facialswelling and congestion, headache, facialpressure, pain, tenderness to touch overpressure, pain, tenderness to touch overthe involved area, lowthe involved area, low--grade fever,grade fever,cough and purulent or bloody nasalcough and purulent or bloody nasal

drainage.drainage.


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Treatment includes the use of broadTreatment includes the use of broad--spectrumspectrumantibiotics (e.g. amoxicillin), analgesics for pain andantibiotics (e.g. amoxicillin), analgesics for pain andfever, decongestants, steam humidification, hot andfever, decongestants, steam humidification, hot andwet packs over the sinus area and nasal irrigations.wet packs over the sinus area and nasal irrigations.

Instruct the client to increase fluid intake to moreInstruct the client to increase fluid intake to morethan 10 glasses of water or juice per day unless otherthan 10 glasses of water or juice per day unless othermedical problem requires fluid restriction.medical problem requires fluid restriction.

CALDWELLCALDWELL--LUC PROCEDURE an incision is madeLUC PROCEDURE an incision is made

under the upper lip into maxillary sinus. The infectedunder the upper lip into maxillary sinus. The infectedmucosa is removed.mucosa is removed.

ENDOSCOPIC SINUS SURGERYENDOSCOPIC SINUS SURGERY -- inspection of theinspection of thesinuses through a sinus endoscope with the clientsinuses through a sinus endoscope with the clientunder general anesthesia.under general anesthesia.


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NASAL POLYPSNASAL POLYPS

Are benign grapelike clusters of mucousAre benign grapelike clusters of mucousmembrane and connective tissue.membrane and connective tissue.

They often occur bilaterally and areThey often occur bilaterally and arecaused by irritation to the nasal mucosacaused by irritation to the nasal mucosaor sinuses, allergies or infection. Ifor sinuses, allergies or infection. Ifpolyps become too large, airwaypolyps become too large, airway

obstruction may result.obstruction may result.


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Manifestations of nasal polyps includeManifestations of nasal polyps include

obstructed nasal breathing, a change inobstructed nasal breathing, a change inthe character of nasal discharge and athe character of nasal discharge and achange in speech quality.change in speech quality.


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Surgery is the treatment of choice for nasal polyps.Surgery is the treatment of choice for nasal polyps.

BENIGN NASAL POLYPS are treated with nasallyBENIGN NASAL POLYPS are treated with nasallyinhaled steroids and surgical removalinhaled steroids and surgical removal(POLYPECTOMY).(POLYPECTOMY).

INVERTING PAPILLOMA is a rare, benign lesion thatINVERTING PAPILLOMA is a rare, benign lesion thaterodes nasal and facial bones and is often firsterodes nasal and facial bones and is often firstdiagnosed as a benign polyp.diagnosed as a benign polyp.

JUVENILE ANGIOFIBROMAS are cellularlyJUVENILE ANGIOFIBROMAS are cellularly

different from other polyps. These tumors oftendifferent from other polyps. These tumors oftenoccur in adolescents males and may resolveoccur in adolescents males and may resolvespontaneously when adulthood is reached. When thespontaneously when adulthood is reached. When thelesions are local, they can be removed by nasallesions are local, they can be removed by nasalsurgery.surgery.


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NASAL FRACTURENASAL FRACTURE

Nasal fracture often results fromNasal fracture often results frominjuries received during falls, sportsinjuries received during falls, sportsactivities, motor vehicle accidents oractivities, motor vehicle accidents orphysical assaults.physical assaults.

Displacement of either bone orDisplacement of either bone orcartilage can cause airway obstructioncartilage can cause airway obstruction

or cosmetic deformity and is a potentialor cosmetic deformity and is a potentialsource of infection.source of infection.


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COLABORATIVE MANAGEMENTCOLABORATIVE MANAGEMENT


Document any nasal problem, includingDocument any nasal problem, including

deviation, maligned nasal bridge, and adeviation, maligned nasal bridge, and achange in nasal breathing, crepitus (dry,change in nasal breathing, crepitus (dry,crackling sound) on palpation, midfacecrackling sound) on palpation, midfacebruising and pain.bruising and pain.

Blood or clear fluid rarely drains fromBlood or clear fluid rarely drains fromone or both nares. The presence ofone or both nares. The presence ofdrainage could indicate a skull fracture.drainage could indicate a skull fracture.


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Simple closed reduction of nasal fractureSimple closed reduction of nasal fracturewithin the first 24 hours after injury.within the first 24 hours after injury.

Treatment focuses on pain relief and localTreatment focuses on pain relief and local

cold compresses to decrease swelling.cold compresses to decrease swelling. RHINOPLASTY is a surgical reconstruction ofRHINOPLASTY is a surgical reconstruction of

the nose for cosmetic purposes and tothe nose for cosmetic purposes and toimprove airflow.improve airflow.

NASOSEPTOPLASTY or submucous resection,NASOSEPTOPLASTY or submucous resection,straightens a deviated septum when chronicstraightens a deviated septum when chronicsymptoms or discomfort occur.symptoms or discomfort occur.


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DISORDERS OF THE THROATDISORDERS OF THE THROAT

TONSILLITISTONSILLITIS

An inflammation and infection of the tonsilsAn inflammation and infection of the tonsilsand lymphatic tissues located on each sides ofand lymphatic tissues located on each sides of

the throat.the throat. Tonsillitis is a contagious airborne infection.Tonsillitis is a contagious airborne infection.

The infection is usually more severe when itThe infection is usually more severe when itoccurs in adolescents or adults.occurs in adolescents or adults.

ACUTE TONSILLITIS usually lasts 7 to 10ACUTE TONSILLITIS usually lasts 7 to 10days and is usually caused by bacteria. Thedays and is usually caused by bacteria. Themost common organism is Streptococcus.most common organism is Streptococcus.


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ASSESSMENTASSESSMENT keyfeaturesofAcutetonsillitiskeyfeaturesofAcutetonsillitis

suddenonsetofa mildtoseveresorethroatsuddenonsetofa mildtoseveresorethroat

feverfever

muscleachesmuscleaches

chillschills Dysphagia, odynophagia (painfulswallowingoffood)Dysphagia, odynophagia (painfulswallowingoffood)

PainintheearsPainintheears

HeadacheHeadache

AnorexiaAnorexia

MalaiseMalaise

Hot potatovoice (thickenedvoiceofpoorquality)Hot potatovoice (thickenedvoiceofpoorquality)

Tonsils usuallyswollenandredwith pusTonsils usuallyswollenandredwith pus

Tonsils may becoveredawhiteoryellowexudatesTonsils may becoveredawhiteoryellowexudates

Purulentdrainage may beexpressed by pressingatonsilPurulentdrainage may beexpressed by pressingatonsil

UvulavisuallyedematousorinflamedUvulavisuallyedematousorinflamed

Cervicallymphnodes usuallytenderandenlargedCervicallymphnodes usuallytenderandenlarged


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Administration of antibiotics for 7 to 10 days (penicillin orAdministration of antibiotics for 7 to 10 days (penicillin orazithromycin).azithromycin).

Warm saline throat gargles, analgesics, antipyretics andWarm saline throat gargles, analgesics, antipyretics andlozenges with topical anesthetic agents may provide symptomlozenges with topical anesthetic agents may provide symptom

relief.relief. Surgery is performed after the client has recovered from anSurgery is performed after the client has recovered from an

acute tonsillitis and no infection is present.acute tonsillitis and no infection is present.

Surgery may involve complete tonsil removal or a partial tonsilSurgery may involve complete tonsil removal or a partial tonsilremoval without infection.removal without infection.

Tonsillectomy and adenoidectomy is performed under generalTonsillectomy and adenoidectomy is performed under generalanesthesia.anesthesia.

After surgery, assess for airways clearance, provide pain reliefAfter surgery, assess for airways clearance, provide pain reliefand monitor for excessive bleeding.and monitor for excessive bleeding.


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PHARYNGITISPHARYNGITIS

Or sore throat is a commonOr sore throat is a commoninflammation of the mucous membranesinflammation of the mucous membranesof the pharynx.of the pharynx.

This condition often occurs with acuteThis condition often occurs with acuterhinitis and sinusitis.rhinitis and sinusitis.


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The client with pharyngitis has throatThe client with pharyngitis has throat

soreness and dryness, throat pain, painsoreness and dryness, throat pain, painon swallowing (odynophagia), difficulty inon swallowing (odynophagia), difficulty inswallowing and fever.swallowing and fever.


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VIRAL PHARYNGITISVIRAL PHARYNGITIS

LowLow--gradefevergradefever retractedordulltympanicretractedordulltympanic

membranemembrane

ScantornotonsillarexudatesScantornotonsillarexudates

SlighterythemaofpharynxSlighterythemaofpharynxandtonsilsandtonsils

possiblelymphadenopathypossiblelymphadenopathy NorashNorash

Nocough, rhinitis. mildNocough, rhinitis. mildhoarseness, headachehoarseness, headache

CBC usuallynormalCBC usuallynormal

WBC usuallylowerthanWBC usuallylowerthan

10,000/mm10,000/mm negativecultureresultsnegativecultureresults

onsetisgradualonsetisgradual

BACTERIAL PHARYNGITISBACTERIAL PHARYNGITIS

Hightemperature 38.5 to 40Hightemperature 38.5 to 40

retractedordulltympanicretractedordulltympanicmembranemembrane

severehyperemiaofpharyngealseverehyperemiaofpharyngealmucosa, tonsilsand uvulamucosa, tonsilsand uvula

erythemaoftonsilswithyellowerythemaoftonsilswithyellowexudatesexudates

anteriorcervicalanteriorcervicallymphadenopathyandtendernesslymphadenopathyandtenderness

possiblescariatiniform rashpossiblescariatiniform rash

possible petechiaeonchestorpossible petechiaeonchestorabdomenorbothabdomenorboth

Nocough, voicecharacterized byNocough, voicecharacterized bypainonvoicingandslurredpainonvoicingandslurred

speech, headache, arthralgia,speech, headache, arthralgia,myalgiamyalgia

CBC abnormalCBC abnormal

WBC usually >12,000/mmWBC usually >12,000/mm

Throatcultureresults positiveforThroatcultureresults positiveforbetabeta--hemolyticstreptococcushemolyticstreptococcus

AbruptonsetAbruptonset


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Treatment includes rest, increased fluid intake, humidifying theTreatment includes rest, increased fluid intake, humidifying theair, analgesics for pain, warm saline gargles and throat lozengesair, analgesics for pain, warm saline gargles and throat lozengescontaining mild anesthetics.containing mild anesthetics.

Use of antibiotics. For streptococcal infection, oral penicillin orUse of antibiotics. For streptococcal infection, oral penicillin orcephalosporin is prescribed. If allergic to penicillin, azithromycincephalosporin is prescribed. If allergic to penicillin, azithromycinor erythromycin.or erythromycin.

Stress the importance of completing the antibiotic prescription,Stress the importance of completing the antibiotic prescription,even when symptoms improve or subsideseven when symptoms improve or subsides..

Any client whose bacterial pharyngitis does not improve withAny client whose bacterial pharyngitis does not improve withantibiotics should consider HIV testing.antibiotics should consider HIV testing.

EPIGLOTTITIS complication of pharyngitis in adults, infectionEPIGLOTTITIS complication of pharyngitis in adults, infectionof the epiglottis and supraglottic structures.of the epiglottis and supraglottic structures.

Teach the client how to take her oral temperature accuratelyTeach the client how to take her oral temperature accuratelyevery morning and evening until infection resolves.every morning and evening until infection resolves.

The client is not contagious 24 hours after antibiotic therapy.The client is not contagious 24 hours after antibiotic therapy.


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LARYNGITISLARYNGITIS

Inflammation of the mucous membrane lining theInflammation of the mucous membrane lining thelarynx and may or may not include edema of the vocallarynx and may or may not include edema of the vocalcords.cords.

Common causes include exposure to irritatingCommon causes include exposure to irritatinginhalants and pollutants (chemical agents, tobacco,inhalants and pollutants (chemical agents, tobacco,alcohol and smoke), overuse of the voice, inhalation ofalcohol and smoke), overuse of the voice, inhalation ofvolatile gases (eg. glue, paint thinner, butane), orvolatile gases (eg. glue, paint thinner, butane), orintubationintubation

An increasingly common cause of laryngitis isAn increasingly common cause of laryngitis isGASTROESOPHAGEAL REFLUX (gerd)GASTROESOPHAGEAL REFLUX (gerd)


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Assess the client for acute hoarseness, dry cough andAssess the client for acute hoarseness, dry cough anddifficulty swallowing.difficulty swallowing.

Complete but temporary voice loss (aphonia) also mayComplete but temporary voice loss (aphonia) also mayoccur.occur.

A laryngeal mirror is used to examine the larynxA laryngeal mirror is used to examine the larynxvisually and to identify inflammation, polyps, edema orvisually and to identify inflammation, polyps, edema ortumor.tumor.

If suspicious lesions are present an xIf suspicious lesions are present an x--ray, computedray, computedtomography or fiberoptic laryngoscopic examination.tomography or fiberoptic laryngoscopic examination.


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Voice rest, steam inhalations, increased fluid intakeVoice rest, steam inhalations, increased fluid intakeand throat lozenges.and throat lozenges.

Antibiotic therapy or bronchodilators .Antibiotic therapy or bronchodilators .

Inform the client and family about relief measures;Inform the client and family about relief measures;infection prevention; and avoidance of alcohol,infection prevention; and avoidance of alcohol,tobacco and pollutants.tobacco and pollutants.

Preventive therapyPreventive therapy

Emphasize activities that place an added strain on theEmphasize activities that place an added strain on thelarynxlarynx

Speech therapySpeech therapy


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Documents

Care of Clients With Nose and Throat Disorders