NR 602 Pharyngitis Soap Note

Pharyngitis

Pharyngitis, Tonsillitis, and Tonsillopharyngitis

Pharyngitis is an inflammation of the mucosa lining the structures of the throat, including the tonsils, pharynx, uvula, soft palate, and nasopharynx. It can be due to infectious agents or noninfectious causes, such as smoke or other air irritants. The illness is generally acute and involves an inflammatory response, including erythema, exudate, or ulceration.

The etiology could include a number of viruses and bacteria. If there are nasal symptoms, it is called nasopharyngitis, but if there are no nasal symptoms, the disease is called pharyngitis or tonsillopharyngitis. Most cases of pharyngitis are caused by viruses (Gereige and Cunill-De Sautu, 2011). Adenovirus is the most common cause of nasopharyngitis (Cherry, 2009c). Other viruses include Epstein-Barr virus (EBV), herpes simplex virus (HSV), cytomegalovirus (CMV), enterovirus, influenza virus, parainfluenza, and human immunodeficiency virus (HIV). The viral organisms generally present with upper nasal symptoms. The common bacterial etiology is GABHS in children between 5 and 11 years old, whereas 40% of reported cases of gonococcal infections occur in females 15 to 19 years old. Other organisms include Corynebacterium diphtheriae, Arcanobacterium haemolyticum, Neisseria gonorrhoeae, group C and group G streptococci, Chlamydia trachomatis, Francisella tularensis, and Mycoplasma pneumonia (Gereige and Cunill-De Sautu, 2011).

NR 602 Pharyngitis Soap Note

Acute Viral Pharyngitis, Tonsillitis, or Tonsillopharyngitis

Adenoviruses are more likely to cause pharyngitis as a prominent symptom. Other viruses (e.g., rhinovirus) are associated with …

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Clinical Findings

History

The following may be reported:

Pain
Myalgia and arthralgia
Fever
Sore throat and dysphagia
Rhinitis, cough, hoarseness, stomatitis, stridor and conjunctivitis, nonspecific rash, or diarrhea points to a viral cause (Gereige and Cunill-De Sautu, 2011)
Acute onset of sore throat with headache, nausea, vomiting, and abdominal pain in the winter and early spring points to GABHS (Gereige and Cunill-De Sautu, 2011)

Physical Examination

Common findings include:

Erythema of the tonsils and the pharynx
Reactive cervical lymphadenopathy

Virus-specific physical findings include the following:

EBV can produce exudate on the tonsils, soft palate petechiae, and diffuse adenopathy.
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Diagnostic Studies

A RADT and/or culture should be performed in children older than 3 years old with pharyngitis, …

Management

For viral infection, only supportive care is needed, including fever and sore throat pain relief with acetaminophen or ibuprofen. Adequate fluid intake should be encouraged.

NR 602 Pharyngitis Soap Note

Acute Bacterial Pharyngitis and Tonsillitis

The most common bacterial cause of pharyngitis …

Clinical Findings

History

The following characterize GABHS infection:

Most commonly found in 5- to 13-year-old children; infrequent in children younger than 3 years old
Abrupt onset without nasal symptoms
Constitutional symptoms, such as arthralgia, myalgia, headache
Moderate to high fever, malaise, prominent sore throat, dysphagia
Nausea, abdominal discomfort, vomiting, headache
Presentation in late winter or early spring
Lack of a cough or nasal symptoms, along with an exudative, erythematous pharyngitis with a follicular pattern and typical historical findings point to GABHS

Physical Examination

The following may be seen in GABHS:

Petechiae on soft palate and pharynx, swollen beefy-red uvula, red enlarged tonsillopharyngeal tissue
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Diagnostic Studies

It is important to use RADT for patients with clinical features consistent …

NR 602 Pharyngitis Soap Note

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Management

Antibiotics should only be used in a symptomatic child with GABHS when the RADT or throat culture is positive due to increasing antibiotic resistance associated with overuse (Shulman et?al, 2012). The goal of antibiotic therapy is to shorten the course and severity of illness, prevent the spread of illness to others, and prevent the development of suppurative and nonsuppurative complications. The use of beta-lactam antibiotics during an acute CMV or EBV infection causes a diffuse, morbilliform skin eruption (Schleiss, 2012) and should not be prescribed. It is important to treat these children within 9 days to prevent the nonsuppurative complication of rheumatic fever (Shulman et?al, 2012). The management plan includes the following:

Antimicrobial therapy is based on positive tests results in a symptomatic patient (Shulman et?al, 2012):
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NR 602 Pharyngitis Soap Note

Complications

Major nonsuppurative late complications caused by GABHS are rheumatic fever, poststreptococcal reactive arthritis, and acute glomerulonephritis. Suppurative complications include cervical adenitis, rhinosinusitis, otitis media, pneumonia, mastoiditis, and retropharyngeal or peritonsillar abscess. Retropharyngeal abscess is more common in children younger than 6 years old, whereas peritonsillar abscess is more common from the ages of 20 to 40 years old (Gereige and Cunill-De Saut, 2011). …

NR 602 Pharyngitis Soap Note