Pharyngitis and Laryngitis

Pharyngitis

• The most common etiologies are viral infections like Adenovirus and Influenza
• Another etiology is bacterial infections such as Group A Streptococcus
• Clinical manifestations include a fiery-red pharynx and tonsils with exudate, enlarged cervical lymph nodes, and a fever greater than 101°F
• A key sign for strep is the absence of cough.
• Patients often experience malaise and halitosis
• Rapid Antigen Detection Test (RADT) and a throat culture (24 hours) are used for diagnostic purposes.
• The first-line medication for strep is Penicillin V, taken for 10 days
• Alternatives include Azithromycin, Clarithromycin, and Cephalosporins
• Analgesics such as acetaminophen and aspirin can be used for pain relief
• Return to school or work is advised after 24 hours of antibiotics.
• Warm saline gargles, a soft diet, and 2–3L of fluids per day are recommended
• It is important to prevent complications like rheumatic fever and nephritis.

Laryngitis

• Etiologies include viral or bacterial infections, GERD, vocal abuse, and smoking.
• Clinical signs include hoarseness or aphonia, dry cough, and sore throat
• Management includes resting the voice and hydration of 2–3L/day
• A "tickle" in the throat is common, worsening in the morning
• Corticosteroids such as beclomethasone are used if laryngitis is chronic
• PPIs like Omeprazole is administered for GERD-induced laryngitis
• Surgery is rarely needed but may be considered for chronic or severe cases if conservative treatment fails or malignancy is suspected.

Laryngitis Surgical Options

• Microlaryngoscopy allows for direct visualization and possible removal of nodules, polyps, or lesions on vocal cords
• Microlaryngoscopy is often performed under general anesthesia with microscopic guidance
• Laser surgery, such as CO2 laser, is used to remove benign vocal cord lesions or reflux-related granulomas
• Laryngeal framework surgery (medialization thyroplasty) is indicated in vocal cord paralysis to improve voice quality
• A biopsy is performed if chronic hoarseness persists beyond 2–3 weeks to rule out malignancy

Nursing Care Post-Laryngitis Surgery

• Monitor airway patency, bleeding, and voice changes.
• Voice rest is required for a prescribed period.
• Hydration and humidified air are administered
• Patient education focuses on vocal hygiene and avoiding irritants.

Viral Rhinitis (Common Cold)

• Symptoms include sneezing, rhinorrhea, and nasal congestion
• Additional symptoms are low-grade fever, malaise, and watery eyes.
• Symptom relief with NSAIDs and decongestants such as phenylephrine and oxymetazoline is administered
• Guaifenesin is given as an expectorant.
• Antibiotics should be avoided unless a bacterial infection is present.
• Education includes hand hygiene, using tissues when sneezing into the upper arm, and receiving an annual flu vaccination.

Sinusitis (Rhinosinusitis)

• Acute cases last less than 4 weeks, subacute lasts 4–12 weeks, and chronic lasts more than 12 weeks
• Symptoms include Purulent nasal drainage, facial pain/pressure, and a high fever greater than 102°F if bacterial
• ABRS (Acute Bacterial Rhinosinusitis) managed with Amoxicillin-clavulanate
• AVRS (Acute Viral Rhinosinusitis) is managed with NSAIDs, antihistamines, and decongestants
• Intranasal corticosteroids are administered
• Functional Endoscopic Sinus Surgery (FESS) for chronic cases

Important Labs/Drugs for Sinusitis

• Diphenhydramine, cetirizine, and fexofenadine are administered
• Nasal saline lavage is used to clear mucus.

Acute Tracheobronchitis

• Can result from Strep pneumoniae, H. influenzae, or Mycoplasma pneumoniae
• Symptoms include a dry, hacking cough, night sweats, purulent sputum, stridor, wheezing, and fever
• Antibiotics are administered if bacterial
• Bronchoscopy is used for secretion removal
• Antihistamines should be avoided because they thicken mucus
• Increased fluid intake is recommended to promote effective coughing.

Pneumonia

• Types include CAP (Community-Acquired Pneumonia), HCAP (Healthcare-Associated Pneumonia), HAP (Hospital-Acquired Pneumonia), and VAP (Ventilator-Associated Pneumonia)
• Symptoms in adults include fever, chills, productive cough, pleuritic chest pain, SOB, and coarse crackles
• Symptoms in the elderly include confusion, anorexia, tachypnea, and often no fever or cough

Pneumonia Diagnostics, Treatment and Complications

• Diagnostics include chest X-ray (CXR), arterial blood gas (ABG), sputum culture and sensitivity (C/S), and blood cultures
• Antibiotics are administered per culture and bronchodilators
• O2 therapy and antipyretics can be administered
• Hydration and rest are implemented
• Complications can include sepsis, ARDS, pleural effusion, delirium, and atelectasis (collapsed alveoli)

Tuberculosis (TB)

• Etiology is Mycobacterium tuberculosis
• Risk factors include being immunocompromised, residing in long-term care (LTC), homelessness, and working as a healthcare worker
• Symptoms include low-grade fever, night sweats, weight loss, hemoptysis, and fatigue

Tuberculosis (TB) Diagnostics, Medications, and Precautions

• The Mantoux Test (PPD) is positive if ≥10mm, ≥5mm if immunocompromised
• IGRAs (Interferon-Gamma Release Assays):, QuantiFERON-TB Gold can be use for diagnostics
• AFB smear & culture and CXR (chest x-ray) are also used for diagnostics
• RIPE (Rifampin, Isoniazid, Pyrazinamide, Ethambutol) therapy is administered
• Rifampin can cause orange body fluids
• Isoniazid (INH) to be administered with vitamin B6 (pyridoxine)
• Ethambutol can cause vision changes (optic neuritis)
• Precautions include airborne isolation, N95 mask use, and negative pressure room

Cholecystitis and Cholelithiasis

• Cholecystitis comes in two types, calculous (90%) caused by a stone blocks bile and acalculous, caused by post-surgery or trauma
• Cholecystitis S/S: RUQ pain, Murphy's sign, radiates to R shoulder, N/V, dark urine, clay-colored stool, fever, and leukocytosis
• Cholelithiasis is when one has cholesterol stones (75%) – pale yellow
• Pigment stones are dark and seen in cirrhosis, hemolysis.
• Mixed stones have a sticky appearance
• Cholelithiasis S/S: Often asymptomatic otherwise it can manifest as biliary colic after a fatty meal, jaundice, steatorrhea, and fat-soluble vitamin deficiencies (A, D, E, K)
• Management: Ursodeoxycholic acid, Chenodeoxycholic acid – dissolve stones and take a low-fat diet
• Surgical: Laparoscopic cholecystectomy – Preferred or open cholecystectomy, Choledochostomy
• Post-op Complications: Bile leak, pneumonia, DVT, ileus
• Patient Education: Avoid fatty foods, resume activity gradually and report fever, jaundice, worsening pain

Diagnostics and Management of Disorders

• Ultrasound (NPO prior), ERCP: sedation, monitor for perforation/infection and Cholescintigraphy or HIDA scan, are different diagnostics
• Alcohol, gallstones, trauma, and hyperlipidemia are etiologies for acute pancreatitis
• Drugs such as corticosteroids, sulfonamides, and thiazides can also cause acute pancreatitis
• Premature trypsin activation leads to autodigestion of the pancreas.
• Symptoms include severe mid-epigastric pain radiating to back, being worse when lying flat, steatorrhea, rigid abdomen, and N/V
• Medical management includes NPO, NG suction, enteral preferred, parenteral if needed, IV fluids, acid suppressants (PPIs: Pantoprazole), Opioids: Morphine, Fentanyl, and avoid NSAIDs if bleeding risk

Acute Pancreatitis Labs and Respiratory Support

• Labs to consider: ↑ Amylase (100–300 U/L), ↑ Lipase (0–60 U/L), ↑ WBC (>16,000) and ↓ Calcium, Mg
• Treat with Incentive spirometry, oxygen, high-Fowler's and monitor for pleural effusion or ARDS
• Gradually begin oral intake – low-fat, high-protein, avoid alcohol and caffeine and monitor with imaging

Normal Lab Values

• Amylase has a lab value of 100-300 U/L
• Lipase has a lab value of 0-60 U/L
• WBC has lab value of 4,000-11,000 /mm³ but if infected the value is above >16,000 /mm³
• Calcium should be 8.5-10.5 mg/dL
• Magnesium should be 1.6-2.6 mg/dL