6.4 Pharyngitis and Tonsilitis

Question 1

Pharyngitis

Answer 1

• Inflammation of pharynx
• MAJORITY OF SORE THROATS ARE VIRAL
• Throat culture should occur for bacteria (specifically looking for strep)

Question 2

Pharyngitis Symptoms

Answer 2

• Sore throat (most common)
• General malaise (headache, abdominal pain, vomiting, fatigue)
• May have a rash

Question 3

Strep Pharyngitis Treatment

Answer 3

Antibiotics
- Amoxicillin or Penicillin V for 10 days
- IMPORTANT TO FINISH FULL COURSE OF ANTIBIOTICS

Fever and Pain management
- Warm/Cool compress on neck
- Warm saline gargles
- Soft foods to eat

• DROPLET PRECAUTIONS
• Patient is no longer contagious after 24 hours of antibiotics and no fever

Question 4

Tonsilitis

Answer 4

• Normally occurs with pharyngitis
• Swelling of tonsilitis (if they swell so much where they meet in middle it is caused kissing tonsils)
• Can be either viral or bacterial

Grading
0 - Normal
1 - Hidden within view
2 - Halfway (at the pillars)
3 - Touching epiglottis
4 - Touching each other at midline

Question 5

Tonsilitis Treatment

Answer 5

Viral
- Supportive care
- Comfort, soft food, cool mist to decrease inflammation, warm saline gargles, throat lozenges, analgesic sprays, anti-pyrectics

Strep
- Antibiotics

Chronic
- Surgical treatment where tonsils are removed (especially if it is obstructing breathing or decreasing intake)

Question 6

Tonsillectomy/Adenoidectomy

Answer 6

Tonsillectomy (typically preformed in younger kids preschool-school-aged)
- Scrape away tonsillar tissues and burn away that tissue.
POST SURGERY
- Have children on their side or abdomen until they are awake to promote drainage of secretions in mouth
- After awake, keep HOB elevated
- DO NOT SUCTION BACK OF THROAT (only outside) because of scars from burnt tissues in the back.
- Discourage coughing or clearing throat to irritate surgical site
- Encourage “ICE COLLAR” or frozen peas to put on throat for comfort
- Pain medication is Tylenol and Motrin around the clock. IMPORTANT BECAUSE THIS WILL GET PAINFUL
- Do not want children to be too rambunctious or screaming/crying because this will irritate throat and cause post-op bleeding

Nutrition
- Immediately post-op clear liquid diet (24 hours) CANNOT GIVE ANYTHING RED OR BROWN BECAUSE IF THE CHILD WERE TO VOMIT WE WOULD NEED TO KNOW IF THEY ARE VOMITING BLOOD
- AVOID CITRUS JUICES OR SODA DUE TO IRRITATION
- AVOID MILK BECAUSE IT WILL COAT THE THROAT AND CAUSE CHILDREN TO COUGH

• Progression to soft food on 2-3 days

Question 7

What to look out for?

Answer 7

• Observe airways for signs of obstruction, secretions, edema because these can cause compromised airways
• Lookout for hemorrhage like restlessness
• If child is frequently swallowing it could mean blood is dripping down back of throat

Question 8

Education

Answer 8

• Teach parents to avoid foods that will irritate throat (spicy foods, highly seasoned foods)
• Discourage coughing, clearing throat, vigorous tooth brushing
• Minor analgesics and ice collars (frozen peas)
• Scab in back of throat will come off on its own in the first 7-10 days putting them at risk for re-bleed/hemorrhage.
• Minimal activity for 1-2 weeks for scar to heal.