ADULT PHARYNGITIS (SORE THROAT)

Transcription

1 Fr mre infrmatin r t prvide feedback n this r any ther decisin supprt tl, certifiedpractice@bccnp.ca ADULT PHARYNGITIS (SORE THROAT) DEFINITION Inflammatin r infectin f the mucus membranes f the pharynx. It may als affect the palatine tnsils. POTENTIAL CAUSES Infectius Viruses Adenvirus Influenza Parainfluenza virus Epstein-Barr Crnavirus Rhinvirus Entervirus Respiratry synctial virus Metapneumvirus Herpes simplex virus Bacterial Grup A beta-haemlytic strep Grup C and G streptccci Chlamydia pneumniae Diphtheria Mycplasma pneumnia Neisseria gnrrhea r chlamydia trachmatis (related t sexual activity) Fungi Candida albicans (immuncmprmised) BCCNP mnitrs and revises the BCCNP certified practice decisin supprt tls (DSTs) every tw years and as necessary based n best practices. The infrmatin prvided in the DSTs is cnsidered current as f the date f publicatin. BCCNP-certified nurses (RN(C)s) are respnsible fr ensuring they refer t the mst current DSTs. The DSTs are nt intended t replace the RN(C)'s prfessinal respnsibility t exercise independent clinical judgment and use evidence t supprt cmpetent, ethical care. The RN(C) must cnsult with r refer t a physician r nurse practitiner as apprpriate, r whenever a curse f actin deviates frm the DST. BCCNP June 2018/ Pub. 778

2 Nn-infectius Allergic rhinitis Sinusitis with pst nasal drip Muth breathing Trauma GERD (gastresphageal reflux disease) PREDISPOSING RISK FACTORS Previus episdes f pharyngitis r tnsillitis Smking, expsure t cigarette smke Overcrwding Immuncmprmised Sterids, ral r inhaled Diabetes mellitus Oral sex TYPICAL FINDINGS OF PHARYNGITIS Nte: Always cnsider the ptential fr epiglttitis and airway bstructin when a severely sre thrat is ut f prprtin t the findings f the rpharyngeal exam. Bacterial Histry Abrupt nset f sre thrat Pain with swallwing Absence f cugh Fever r chills Malaise Headache Anrexia May have nausea, vmiting and abdminal pain Physical Assessment Fever Pulse elevated Client appears ill Psterir pharynx red and edematus Tnsils enlarged, may be asymmetric

3 Purulent exudate may be present Tnsillar and anterir cervical ndes may be enlarged and tender Erythematus sandpaper rash f scarlet fever (may be present with streptcccal infectin) Liver/spleen enlargement +/- tenderness (e.g., mnnuclesis) Viral Histry Slw prgressive nset f sre thrat Mild malaise Cugh Nasal cngestin Physical Assessment Temperature elevated Psterir pharynx red and swllen Purulent exudate may be present Tnsillar and anterir cervical ndes may be enlarged and tender Petechiae r purple clur n palate (mnnuclesis) Vesicles (if herpes) Nn-infectius Slw prgressive nset f sre thrat Mild malaise Cugh Persistent, recurrent Pain n swallwing Psterir pharynx red and swllen Tnsillar and anterir cervical ndes may be enlarged and tender Exudate may be present

4 Nte: It is ften impssible t distinguish clinically between bacterial and viral pharyngitis. Mst pharyngitis is due t viruses (up t 90% in the adult ppulatin) and des nt require treatment with antibitics. Fr this reasn it is imprtant t utilize a sre thrat scre and diagnstic testing as available. Criteria Pints Temperature > 38 Celsius 1 Absence f cugh 1 Swllen, tender anterir cervical ndes 1 Tnsillar swelling r exudates 1 Age 3-14 years 1 Age years 0 Age 45 years and ver -1 Ttal Scre Risk f Streptcccal infectin (%) Suggested Management -1 t % N culture r antibitic required % Perfrm culture r rapid strep test. Treat nly if test is + 4 r mre 51-53% Start antibitic therapy if patient situatin warrants (e.g., high fever r clinically unwell) If culture r rapid strep test perfrmed and negative, discntinue antibitic Nte: Treatment with antibitics may be warranted regardless f the scre if there are cncerns such as: husehld cntact with streptcccal infectin, a cmmunity epidemic f streptcccal infectin, a client histry f rheumatic fever, valvular heart disease, r immunsuppressin, r a ppulatin in which rheumatic fever remains a prblem Geriatric cnsideratins: Treatment may als be warranted if client is 65+ years with acute cugh and 2 r mre f the fllwing criteria, r 80+ years with acute cugh and ne r mre f: - Hspitalizatin in the past year - Diabetes Mellitus - Cngestive Heart Failure - On gluccrticids. Diagnstic Tests Thrat swab fr culture and sensitivity (C&S) Rapid strep test (where available)

5 MANAGEMENT AND INTERVENTIONS Gals f Treatment Eradicate infectin Prevent cmplicatins Prevent spread f grup A streptcccus Nn-pharmaclgic interventins Bed rest during febrile phase Adequate ral intake f fluids Avidance f irritants Gargling with warm saline (1 tsp. in 1 cup warm water) Pharmaclgical Interventins Analgesics fr mild t mderate pain: acetaminphen 325mg, 1-2 tabs p q4-6h prn, r ibuprfen 200mg, 1-2 tabs p q4-6h prn Treat with ral antibitics if streptcccal infectin is suspected: Penicillin VK mg p tid fr 10 days Fr clients with penicillin allergy r requiring a suspensin (if pen V suspensin nt available): Cephalexin 500 mg p BID fr 10 days (DO NOT USE IF CLIENT HAS A SEVERE ANAPHYLACTIC REACTION TO PENICILLIN) OR Azithrmycin 500 mg p daily fr 3 days Pregnant and Breastfeeding Wmen Acetaminphen, penicillin VK, cephalexin and azithrmycin may be used as listed abve. DO NOT use ibuprfen in pregnant patients If the infectin has been determined t be due t chlamydia r gnrrhea, please refer t the apprpriate STI DST. POTENTIAL COMPLICATIONS Rheumatic fever (grup A strep)

6 Acute Glmerulnephritis (grup A strep) Peritnsillar abscess Epiglttitis Retrpharyngeal abscess Otitis media Sinusitis CLIENT EDUCATION AND DISCHARGE INFORMATION Gargle frequently with warm salt water (1 tsp. in 1 cup warm water) Increase rm humidity Eat sft bland fds MONITORING AND FOLLOW UP Return t clinic if nt imprved in hurs CONSULTATION AND/OR REFERRAL A cnsultatin with a physician r nurse practitiner may be necessary if cnditin is recurrent r persistent r an undiagnsed underlying pathlgy is suspected. An immuncmprmised client, r an unusual presentatin f candidiasis, shuld be referred prmptly t a physician r nurse practitiner. DOCUMENTATION As per agency plicy

7 REFERENCES Mre recent editins f any f the items in the Reference List may have been published since this DST was published. If yu have a newer versin, please use it. Anti-Infective Review Panel. (2012). Anti-infective guidelines fr cmmunity-acquired infectins. Trnt, ON: MUMS Guideline Clearinghuse. Blndel-Hill, E., & Fryters, S. (2012). Bugs and drugs: An antimicrbial infectius diseases reference. Edmntn, AB: Alberta Health Services. Cash, J. C., & Glass, C. A. (Eds.). (2014). Family practice guidelines (3rd ed.). New Yrk, NY: Springer. Canadian Pharmacists Assciatin. (2014). Therapeutic chices (7th ed.). Ottawa, ON: Authr. Canadian Pharmacists Assciatin. (2014). Therapeutic chices fr minr ailments. Ottawa, ON: Authr. Carill-Marquez, M. A. (2015). Bacterial pharyngitis. Retrieved frm Chan, P. D., & Jhnsn, M. T. (2010). Treatment guidelines fr medicine and primary care. Blue Jay, CA: Current Clinical Strategies Publishing. Chen, A., & Tran, C. (2011). Cmprehensive medical reference and review fr MCCQE and USMLE II. Trnt ntes frm medical students. Trnt: Trnt Ntes fr Medical Students, Inc. DynaMed. (2016, March 25). Antibitics fr streptcccal pharyngitis. DynaMed. (2016, March 25). Streptcccal pharyngitis. DynaMed. (2016, March 25). Pharyngitis. Gre, J. M. (2013). Acute pharyngitis. JAAPA: Jurnal f the American Academy f Physician Assistants, 26(2), Jensen, B., & Regier, L. D. (Eds). (2014). RxFiles: Drug cmparisn charts (10 th ed.). Saskatn, SK: RxFiles Natinal Institute fr Health and Clinical Excellence (NICE). (2008, July). Respiratry tract infectins antibitic prescribing: Prescribing f antibitics fr self-limiting respiratry tract infectins in adults and children in primary care. Manchester, UK: Authr. Retrieved frm Shepherd, A. B. (2013). Assessment and management f acute sre thrat. Nurse Prescribing, 11(11), Shulman, S.T., Bisn, A.L., Clegg, H.W., Gerber, M.A., Kaplan, E.L., Lee, G., Van Beneden, C. (2012). Clinical practice guideline fr the diagnsis and management f grup A streptcccal pharyngitis: 2012 update by the Infectius Diseases Sciety f America. Clinical Infectius Diseases. 55(10), e86-e102. Retrieved frm:

8 University f Michigan Health System. (2013, May). Pharyngitis: Guidelines fr clinical care: Ambulatry (Rev.). Ann Arbr, MI: Authr. Retrieved frm