Acute

Tonsillopharyn
gitis

Case by: Leslie Joe Sañol

BSN-3C
GROUP-4

Clinical Instructor
Ms. Olilang, R.N.
INTRODUCTION- I

Acute tonsillopharyngitis is an inflammatory process of the

oropharynx. It can become a particularly horrible throat infection
involving Mycoplasma pneumoniae and Chlamydia pneumoniae
organisms that often occur in children. It can also come to pass in
patients who are given antibiotics for simpler infectins and founder
to take the prescribed regimen (dose and time).

Viruses

The adenoviruses are the most common cause of tonsillopharyngitis,

especially types 1, 2, 3, and 5, which are the types that infect small children
most frequently. Other respiratory viruses are less common causes of
tonsillitis; the parainfluenza viruses probably are the most frequently isolated
in this group. Herpes simplex virus also is recognized as an occasional cause
of tonsillopharyngitis, as is Epstein-Barr virus. The most frequent causes of
the common cold, the rhinoviruses and coronaviruses, involve the tonsils.

Bacteria. Group A Streptococcus is the most important and frequent cause

of tonsillopharyngitis. It is frequently associated with acute rheumatic fever
and acute glomerulonephritis. Appropriate treatment of streptococcal
pharyngotonsillitis prevents the occurrence of rheumatic fever.

Epidemiology

Prevalence. The average incidence of all acute URIs is five to seven per
child per year. It is estimated that children have one streptococcal infection
every 4 to 5 years. Group A streptococci is isolated in 30-36.8% of children
with pharyngitis.

Age Occurrence. Pharyngitis is infrequent in the first 2 years of life, when

all URIs are most frequent. Most cases of pharyngitis occur in school-age
children, when the incidence of all infections is still high but less than in the
first 2 years.

Etiology

Viruses are isolated in about 50% of children less than 2 years old but
infrequently after that.

Group A streptococcus is isolated most frequently in school-age children,

while M pneumoniae is most often in teenagers.

Contact

All respiratory agents are spread by close contact or large droplets, with the
exception of influenza, which also is spread by small droplets and the
airborne route.
A history of a household, school, or outside contact with another patient who
has tonsillopharyngitis due to a known agent, especially the group A
Streptococcus, increases the likelihood that the index infection has the same
etiology.

OBJECTIVES- II

General Objectives:

My General objective is to understand what Acute Tonsilopharyngitis is.

Specific Objectives:

Specifically

1. To know what causes to have Acute Tonsilopharyngitis.

2. To know the anatomy and physiology of the body organ

involved in Acute Tonsilopharyngitis.

3. To understand the pathophysiology of Acute

Tonsilopharyngitis.

4. To relate my patient chief complaint on her condition having

Acute Tonsilopharyngitis.

5. To improve myself on formulating Nursing Care Plans.

6. To relate the medications and medical procedures done to

Ms. JDA on her condition of having Acute Tonsilopharyngitis.
ANATOMY AND PHYSIOLOGY- III

The upper respiratory tract primarily refers to the parts of the respiratory
system lying outside of the thorax or above the sternal angle. Another
definition commomly used in medicine is the airway above the glottis or
vocal cords. Some specify that the glottis (vocal cords) is the defining line
between the upper and lower respiratory tracts; yet even others make the
line at the cricoid cartilage..

Upper respiratory tract infections are amongst the most common infections
in the world.

NOSE: Physically a nose is an organ on the face. Anatomically, a nose is a

protuberance in vertebrates that houses the nostrils, or nares, which admit
and expel air for respiration in conjunction with the mouth. Behind the nose
is the olfactory mucosa and the sinuses. Behind the nasal cavity, air next
passes through the pharynx, shared with the digestive system, and then into
the rest of the respiratory system. In humans, the nose is located centrally
on the face; on most other mammals, it is on the upper tip of the snout.

NASAL CAVITY: A large fluid filled space above and behind the nose in the
middle of the face.
PHARYNX: The part of the neck and throat situated immediately posterior
to (behind) the mouth and nasal cavity, and cranial, or superior, to the
esophagus, larynx, and trachea.

NASOPHARYNX: The uppermost part of the pharynx. It extends from the

base of the skull to the upper surface of the soft palate; it differs from the
oral and laryngeal parts of the pharynx in that its cavity always remains
patent (open).

OROPHARYNX: Reaches from the Uvula to the level of the hyoid bone. It
opens anteriorly, through the isthmus faucium, into the mouth, while in its
lateral wall, between the two palatine arches, is the palatine tonsil.

LARYNX: Commonly called the voice box, is an organ in the neck of

mammals involved in protecting the trachea and sound production. It
manipulates pitch and volume. The larynx houses the vocal folds, which are
an essential component of phonation. The vocal folds are situated just below
where the tract of the pharynx splits into the trachea and the esophagus

VITAL INFORMATION- IV

Name: Ms. J.D.A.

Age: 8

Address: Roxas City, Capiz

Civil status: Single

Religion: Roman Catholic

Occupation: Student

Date & time admitted: 08/04/10

Ward: Blessed Sr. Roselie Rendu Ward Room 115

Chief complaint: Fever

Impression / admitting diagnosis: ATP w/ Exudative t/c Pneumonia t/c Dengue

Fever

Final diagnosis: ATP w/ Exudative t/c Pneumonia t/c Dengue Fever

Attending physician: Dr. Diaz

BRIEF SOCIAL, CULTURAL AND RELIGIOUS BACKGROUND- V

A. Educational background

Grade 2 student at Chinese school

B. Occupational background

A student and not yet working

C. Religious practices

A Roman Catholic goes to mass every Sunday and receive sacraments

D. Economic status

Family is in a middle class family

CLINICAL ASSESSMENT- VI

A) NURSING HISTORY

2 days prior to admission, the patient experienced fever accompanied

with pain in the throat, fatigue, and signs of weakness pt. Family thought
it was dengue and consulted the attending physician and was advised to
be admitted.
B) PAST HEALTH PROBLEM/STATUS

a) Flu

b) Fever

c) Sore throat

d) Cough

e) No allergies noted

f) No records of past hospitalization

C) FAMILY HISTORY OF ILLNESS

Family has history of

a) Heart disease,

b) Diabetes,

c) HTN,

Genogram

J.A. A.C.A.

J.D.A.

CLINICAL EXAMINATION- VII

A. General
Ms. J.D.A. An 8 year old girl strong and with good sensory and motor
response to the people around her she lies with a pillow on her head
and with an IVF at the left metacarpal vein.
B. Vital signs
a. Upon admission
• Temperature: 38.2˚C
• Blood Pressure 110/80
• Cardiac rate: 90 bpm
• Respiratory rate: 23 breaths per minute
b. During care
• Temperature: 36.5˚C
• Blood Pressure 100/70
• Cardiac rate: 83 bpm
• Respiratory rate: 20 breaths per minute

Head, Eyes, Ear, Nose, Hair, Mouth, Throat

• Head – skull is normocephalic.

• Hair – long length hair, quantity is normal, evenly distributed,
black color and there is presence no flakes.
• Eyes – the conjunctive is pinkish, eye lashes are black, eyebrows
are also black and it is evenly distributed, pupil size is 3mm and
corneas are clear and no lesions noted upon inspection.
• Ears - there is presence of ear wax in the ear canal, its upper
portion is in line with the outer part of the eye and he has a good
hearing acuity.
• Nose – the mucosa is pinkish in color and the nasal septum is at
the midline.
• Mouth – lips are symmetrical, pale, dry and without lesions. Oral
mucosa is pink and the frenulum under the tongue is at the
center.
• Throat – no inflammations noted but slight pain noted upon
inspection.

Neck
• Its color is similar to other body parts. No lumps or goiter
noted upon inspection. No palpable lymph nodes noted upon
palpation but pain of 5 out of 10 was noted noted.

Chest, Breast and Axilla

 • Chest and Lungs – it is symmetrical, same in color and equal
in size and shape. Crepitus or tactile fremitus noted upon
auscultation.
• Breast – It is symmetrical. The aroela is brownish in color. No
masses and tenderness noted upon percussion.
• Axilla – no palpable lymph nodes noted upon palpation.

Heart
• Cadiac rate is 83 beats per minute during my care. No S3 and S4
heart sound noted upon auscultation.

Abdomen
• It is symmetrical and the umbilicus is at the center. No lesions
noted upon inspection.

Back
• Symmetrical to the head, straight and there are no lesions but
sores are noted upon inspection. He has a skin color similar to
other body parts.

Upper and lower extremities

• They are symmetrical to their opposites. Finger nail are non-
cyanotic and no clubbing noted upon inspection. Skin color is
similar to other body parts.

Skin
• Color of the skin is light brown, its moisture is dry, warm to touch
and she has a good skin tugor.

General Appraisal:

a. Hygiene: has a good personal hygiene.

b. Sleep: has normal sleep pattern.
c. Language: speaks in the dialect but is noted to be shy in
communicating with strangers
d. Hearing: has a good hearing acuity to moderate voice.
e. Memory: can remember well as evidence by
remembering the medication name that she takes.
LABORATORY & DIAGNOSTIC DATA- VIII

X-RAY

• L lower lung field and retrocardiac area are hazy

• The CP angles and diaphragm are intact

• The trachea is at the midline

• The osseous and soft tissue structures are unreadable

Impression: L basal pneumonia

HEMATOLOGY 08/05/10

HEMATOCRIT 0.37

HEMOGLOBIN 123 gm/L

RED CELL COUNT 4.31x10^12/L

WHITE CELL 4.9x10^9/L

COUNT

PLATELET 312X10^9/L

HEMATOLOGY 08/04/10

HEMATOCRIT 0.35

HEMOGLOBIN 116 gm/L

RED CELL COUNT 4.08x10^12/L

WHITE CELL 7.6x10^9/L

COUNT

PLATELET 278X10^9/L
PATHOPHYSIOLOGY- IX

Viral Bacterial Fungal Miscellaneous

Influenza Streptoccus Candida Toxoplasma

(parasite)

Para-influenza (Group A beta

Chlamydia

Herpes simplex hemolytic)

Measles Diphtheria

Chickenpox Gonococcus

Cytomegalo-virus

Rhinovirus

MILD INFECTIONS:

Discomfort in throat

Malaise

Low grade fever

Congested pharynx but no lymphadenopathy

MODERATE TO SEVERE INFECTIONS

Pain in throat

Dysphagia

Headache
DISCHARGE PLANNING- XII

A. Medication

Difflam gargle TID until total relief.

B. Exercise

Be sure to get enough rest and sleep on a daily basis.

C. Treatment

Don’t start smoking even if at the legal age already

Avoid stress, fatigue, sudden change in temperature and excessive

alcohol intake when already in legal age, all of them lowers resistance
to pneumonia.

D. Hygiene

Take a bath daily

 Promote frequent oral hygiene

E. Diet

Drink plenty of water (at least 8 glasses everyday), especially during

warm weather.

Eat a healthy, balanced diet and take in a sufficient amount of non-

alcoholic fluids each day.