CaseSt2Pharyg.docx

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CASE STUDY: Acute Pharyngitis

Case Study 2: Pharyngitis #6324949

Andrea Williams, RN, SFNP
NUR 630 Primary Care or Adults & Aged
Charles R. Drew University of Medicine and Science
September 30, 2020

Case Study 2: Pharyngitis #6324949

Name: John Doe Age: 62 Gender: Male

SUBJECTIVE:

CC: C/O Sore throat and cough x1 week.

HPI: 62 y/o AA male present to clinic with c/o sore throat and cough x 1 week and urine odor x 2 week

Past Medical History: HTN, Hemiplegia and hemiparesis following cerebral infarction affecting right side

Allergies: NKA

Medications: Aspirin 81mg po daily, Atorvastatin 40mg po daily, Fish oil 1 capsule po daily, K-Tab 10meq po daily, Losartan/HCTZ 50-12.5mg po daily, Naproxen 375mg po q12h prn pain, Nortriptyline 10mg po qHS;

Surgical history: N/A

Family History: None noted

Social History: Married, unemployed, denies illicit drugs, alcohol use, former smoker (Stop 2015)

REVIEW OF SYSTEMS

CONSTITUTIONAL: A/O x4, no change in weight or loss of appetite, denies fever, no apparent distress, well-groomed/nourished. Appropriate to situation.

Head: Denies headache, dizziness

Eyes: Denies blurred vision, dry eyes

Ears: Denies hearing difficulty, ringing, or earaches

Nose: Denies sinus issues, nosebleed, snoring, frequent sneezing

Mouth: C/O sore throat & cough x1 week

Skin: Denied rash, no lesions, no dryness, no sensitivity to sunlight, skin allergies, healing surgical scar left foot.

Cardiovascular: Denied chest pain, no SOB, no bleeding, no bruising, heart murmur, palpitations, and edema.

Respiratory: (+) Cough, denies shortness of breath, or sputum.

Gastrointestinal: Pt denies abdominal tenderness. No change in bowel, Denies heartburn, anorexia, nausea, vomiting, constipation or diarrhea, blood in the stool.

Genitourinary: C/O urine odor x2 weeks, denies burning on urination, Dysuria, and urinary frequency.

Neurological: Denies dizziness, headache, syncope, numbness or tingling in the extremities.

Musculoskeletal: Denies muscle aches, tenderness of the joints, muscular weakness, or cramps.

Hematologic: Denies bleeding or bruising.

Lymphatic: Denies enlarged nodes.

Psychiatric: Denies depression or anxiety, hallucinations, suicidal ideation

Endocrinology: Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

PHYSICAL EXAMINATION

General: Well nourished, well groomed, afebrile, no weakness, or acute distress noted.

Vital signs: Temp: 97.8, Pulse: 105 bpm, BP: 107-78 mmhg, HT: 67.00 in, WT: 193.50 lbs., BMI: 30.30

Skin: Warm and dry to touch, clear, no lesions, rashes, or erythema

Eyes: Pink palpebral conjunctiva, no conjunctival redness, anicteric sclerae, PERRLA, EOM intact, no discharge, no pallor.

Ears: No lesions on external ear clear external auditory canal, no redness, no discharge, tympanic membrane intact or bulging

Nose: Nares are patent, no lesions, no discharge, normal nasal turbinate’s, (-) post-nasal drip, no sinus tenderness.

Mouth: Abnormal with erythema but no exudates.

Neck: Supple, no masses, no tenderness, no tracheal deviation, no thyromegaly, no lymphadenopathy

Heart: PMI palpable in the left 5th intercostal space, midclavicular line, normal rate and rhythm, no murmurs noted.

Thorax and back: C/O sore throat, Symmetrical chest expansion with breathing, no spinal tenderness, and no costovertebral angle tenderness

Lungs: normal resonance on percussion, clear and equal breath sounds, no crackles, wheezing or rhonchi.

Abdomen: Active bowel sounds, soft, non-distended, no tenderness on palpation, liver edge not palpable, no masses palpated

Musculoskeletal: Tenderness of left lateral foot noted with erythema.

Extremities: Good range of motion, no edema, no varicosities, no cyanosis, symmetrical/strong peripheral pulses, no calf tenderness. Patient demonstrated a full range of motion regarding her ability to walk, stand, and bend.

Neurologic: A/O to person, place and time, CN II-XII intact, motor strength is 5/5 in all extremities, normal gait, no tremors, normal sensation, and speech clear and concise, no focal neurologic deficits.

Pathophysiology

This is an infection or the irritation of the pharynx or the tonsils that is caused by the bacteria or the virus. These microorganisms are invading the pharyngeal mucosa leading to an inflammatory response. The virus such as rhinovirus and the coronavirus irritate the pharyngeal mucosa secondary to other symptoms like the nasal secretions (Kakuya, et al., 2018). The irritation of the pharyngitis leads to the production of the local toxins and the proteases.

Differential Diagnosis

Strep Throat & Tonsillitis:

This is a bacterial infection that is causing sores and scratchy throat. It presents similar symptoms to the acute pharyngitis for example the patient might experience sore throat and rise in body temperature. It also leads to the inflammation and the infection of the throats that results in the scratchy throat (Kakuya, et al., 2018).

The Upper respiratory infection or the common cold

: this is an acute contagious infection of the upper respiratory such as the nose, pharynx, larynx, and the bronchi. The example of the upper respiratory infection includes common cold, sinusitis, pharyngitis, epiglottitis, and the tracheobronchitis (Kakuya, et al., 2018). These conditions are presenting similarly to the acute pharyngitis for example there is a rise in body temperature.

Diagnostic Test procedures

One of the test procedures is a single-swab throat culture which gives about 90 to 95 percent sensitivity. There is also rapid antigen detection testing (RADT) which allows early treatment, improvement of the symptoms, and the reduction of the spread of the disease. The sensitivity is depending on the commercial RADT kit which can also be used with other older latex agglutination assays. Other test procedures can involve the use of the enzyme-linked immunosorbent assays, optical immunoassays, and the chemiluminescent DNA probes (Kakuya, et al., 2018).

The medication management

Even though this condition can be a self-limited and can resolve by itself after a few days without medication, some situations require treatment. The antibiotic medication is used to help in the relief of the acute symptoms, prevention of the suppurative (bacteremia, cervical lymphadenitis, endocarditis, and mastoiditis) and non-suppurative complications (rheumatic fever and post-streptococcal glomerulonephritis), and to resolve the reduced communicability. The antibiotics are used to help in shortening the duration of the symptoms. The common antibiotics being prescribed include penicillin, ampicillin, amoxicillin, clindamycin, and the group of cephalosporins. The prescription of these medications is based on the consideration of the factors such as safety, effectiveness, a spectrum of the activity, the costs, and the dosing schedule (Zhou et al., 2018).

Supportive Care; Primary options

URIs are mostly treated for relief of symptoms. Some patients benefit from the use of
cough suppressants, expectorants, vitamin C, and zinc to reduce symptoms or shorten the duration other treatments include:
· Analgesics- acetaminophen and NSAIDs can help reduce fever, aches, and pain.
1. Nasal decongestants- can improve breathing, but treatment may be less effective with
repeated use and can cause rebound congestion.
2. Steam inhalation- and gargling with salt water are a safe way to get relief from URI symptoms.

Secondary Options.

Maintenance

Rest and regular fluid intake are recommended. Reassure patient that symptoms usually clear within 7-10 days.

Follow Up/ Referral

Inform patient to follow up with primary physician after 2 weeks of if symptoms worsen
or if they exceed the expected recovery.

Education

Advise patient about the self-limiting nature of the condition. Rest and increase fluids.
Practice good hand hygiene, covering the mouth and nose when sneezing or coughing.

References
Mayo Clinic. 2021. Sore Throat – Symptoms And Causes. [online] Available at:
Kakuya, F., Kinebuchi, T., Okubo, H., Matsuo, K., Kuroda, M., & Fujiyasu, H. (2018). Acute pharyngitis associated with Streptococcus dysgalactiae subspecies equisimilis in children. The Pediatric Infectious Disease Journal, 37(6), 537-542.
Zhou, Z., Mou, S.-F., Chen, X.-Q., Gong, L.-L., & Ge, W.-S. (2018). Anti-inflammatory activity of resveratrol prevents inflammation by inhibiting NFκB in animal models of acute pharyngitis. Molecular Medicine Reports, 17(1), 1269-1274.