Tonsillitis and Pharyngitis (Pediatric Nursing)

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.