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Tonsillitis and Pharyngitis (Pediatric Nursing)

by Paula Ruedebusch

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    00:01 Now we will explore some common throat conditions.

    00:05 First is pharyngitis.

    00:06 This is inflammation of the mucous membranes that line the pharynx of the throat.

    00:10 This is a symptom, this is what the patient feels.

    00:13 They're gonna feel a sore throat.

    00:15 That's in contrast to tonsilitis which is just inflammation of the tonsils.

    00:19 This is an objective finding and this may or may not be associated with pain.

    00:25 Pharyngitis and tonsillitis can be caused by many things, including: viral infections, bacterial infections, fungal infections, seasonal allergies, just general inflammation and malignancies, although this is uncommon in the pediatric population.

    00:42 Bacteria and viruses can cause direct invasion of the pharyngeal mucosa.

    00:47 The body's gonna react by intiating the inflammatory process that results in irritation, pain and edema.

    00:54 Sometimes the irritation is secondary to nasal secretions contacting the tissue Such as with the rhinovirus or the common cold.

    01:01 When the patient has a runny nose, some of that's gonna run down the back of the throat and can irritate the local tissues quite easily.

    01:08 Let's explore the signs and symptoms of pharyngitis.

    01:11 The patient is gonna have pain in the pharynx or in the throat.

    01:14 They may have a dry throat and a scratchy throat.

    01:18 They may have tender or enlarged lymph nodes in the neck.

    01:22 When a patient has tonsillitis, they're going to have enlarged, swollen tonsils.

    01:26 Remember, -itis means inflammation of, tonsils.

    01:30 They may have a sore throat and difficulty swallowing and this can be a mechanical problem due to the enlarged tonsillar size.

    01:37 They may have changes in their voice, they may sound like Kermit the frog, and they'll also have tender or enlarged lymph nodes in the neck.

    01:46 These patients, depending on the source of their tonsillitis may also have foul breath or halitosis.

    01:52 On the left you'll see a normal throat.

    01:54 The uvula is pink, it's midline, it's non-edematous.

    01:58 The pharynx is clear, the soft palate is without any discoloration and the patient has a normally sized tonsil.

    02:05 On the right, on the abnormal throat, the patient may have throat redness or erythema, White spots on their tonsils called exudate and their tonsils may be enlarged.

    02:16 In the exam, we look in the throat and you see that the patient may have pharyngeal mucosal congestion.

    02:22 They may have swelling present, and the uvula may be edematous as well as the soft palate.

    02:28 You're looking for redness and you're feeling for swollen and tender lymph nodes.

    02:34 When you look in, the tonsils will be enlarged.

    02:38 So how do we diagnose this? We need to have a way to describe tonsillar size.

    02:43 We can't just say that a patient has small tonsils, or medium tonsils or large size tonsils.

    02:48 So there's a grading system.

    02:50 Grade 0 tonsils are tonsils that are fully inside the tonsillar pillars.

    02:54 Grade 1 tonsils are hidden within the tonsillar pillars.

    02:59 Grade 2 is pretty typical tonsils, these are extending to the pillars.

    03:04 Grade 3 tonsils extend beyond the pillars, and grade 4, this is a problem.

    03:09 This is where tonsils extend to midline.

    03:11 Sometimes they impinge on the uvula, and sometimes these are referred to as kissing tonsils.

    03:16 Now let's say your patient has had a tonsillectomy.

    03:19 They don't have tonsils anymore.

    03:20 The nurse can document that the tonsils are surgically absent.

    03:25 Remember, pharyngitis is a symptom.

    03:27 And tonsilitis is an objective finding that you see when you look in the throat.

    03:32 So how do we manage pharyngitis and tonsilitis? Well, sometimes it hurts, right? So over the counter analgesics, this includes acetaminophen or NSAIDS.

    03:42 I find that my patients get more relief when they take NSAIDS because this also has anti-inflammatory properties and a lot of the pain is caused by the inflammation.

    03:50 Patients can also suck on throat lozenges or hard candy.

    03:53 And this can help increase the salivary production and help wash away some of that irritation.

    03:58 Patients can also mix up warm salt water and gargle it in their throat.

    04:02 And I just tell patients, take a small cup of water, add some salt and stir it up.

    04:06 Gargle it in the back of their throat and spit it out.

    04:08 They can do this as many times as needed.

    04:11 How do we treat different conditions that cause pharyngitis and tonsilitis? Well, it depends on what's causing the problem.

    04:17 If it's a bacterial problem like strep throat, we do need to treat these with antibiotics.

    04:22 If the patient has a viral sore throat, they're just gonna need rest, time and symptomatic care.

    04:27 This will be self limiting.

    04:29 If the patient's sore throat is caused by allergies, we'll place them on antihistamines.

    04:34 If the patient has fungal sore throat called thrush, they're gonna need anti fungal therapy.

    04:40 So patients can become dehydrated from both the sore throat and the increased tonsil size but these are for different reasons.

    04:47 In patients with pharyngitis or sore throat, they're gonna have pain with eating and drinking, so they're going to avoid it.

    04:53 And this is especially prevalent in the pediatric population.

    04:56 If you have a baby or a young child then their throat is really hurting, they're not going to want to drink.

    05:01 You have to treat their pain.

    05:03 In tonsillitis, the pain can be involved, but really, it's a mechanical issue.

    05:07 Because food and fluid sometimes can't pass beyond the tonsils.

    05:11 In strep throat, the patients can develop plenty of complications.

    05:16 And in viral infections, the patients have few.

    05:19 So what are signs and symptoms of dehydration? Well in adults, they can experience headache or dizziness.

    05:25 They may feel faint and tired and they may feel thirsty.

    05:29 Their muscles may feel weak, they may have dark yellow urine and they may have a decreased urinary output.

    05:36 Kids can look pretty different when they're dehydrated.

    05:38 Sometimes they're usually sleepy or drowsy, They may cry but not produce tears, and this is actually a late sign of dehydration They may have a dry mouth or mucous membranes and a dry or sticky tongue.

    05:50 A high fever can contribute to dehydration and the patient may have a decrease in wet diapers.

    05:56 I always ask parents, "How many wet diapers has your child made in the last 24 hours?" And I use this to discern if the child is dry.


    About the Lecture

    The lecture Tonsillitis and Pharyngitis (Pediatric Nursing) by Paula Ruedebusch is from the course Eye, Ear, and Throat Disorders – Pediatric Nursing (release in progress).


    Included Quiz Questions

    1. Inflammation
    2. Irritation
    3. Edema
    4. Coughing
    5. Nausea
    1. Antibiotics
    2. Antihistamines
    3. Antifungals
    4. Opioids
    1. Ask the infant's caregiver how often wet diapers occur.
    2. Ask the infant's caregiver if the child has been playful.
    3. Ask the infant's caregiver if the infant's mouth is feeling dry.
    4. Ask the infant's caregiver if the infant has been having muscle weakness.

    Author of lecture Tonsillitis and Pharyngitis (Pediatric Nursing)

     Paula Ruedebusch

    Paula Ruedebusch


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