Acute Nasopharyngitis Nursing Care Planning and Management

Acute nasopharyngitis is the common cold, a viral infection of the nose and throat. Most cases are self-limiting, so your care is symptomatic: keep the airway clear, keep the child hydrated, ease the discomfort, and watch for the one situation that changes the plan. In children 2 years or older, untreated group A beta-hemolytic streptococcal (GABHS) pharyngitis can lead to rheumatic fever, so a sore throat with the right history gets cultured and treated.

What is Acute Nasopharyngitis?

Upper respiratory infections involve any or all structures of the upper respiratory tract, producing runny or stuffy nose, sneezing, sore throat, and cough. Acute nasopharyngitis is caused by any of several viruses, usually rhinovirus, respiratory syncytial virus, adenovirus, influenza virus, or parainfluenza virus, and it is one of the most common infectious conditions of childhood.

Pathophysiology

Primary bacterial pathogens account for approximately 30% of pharyngitis cases in children. GABHS pharyngitis spreads through respiratory droplets in close contact and has an incubation period of 2-5 days. The bronchi and bronchioles become plugged with thick, viscid mucus, trapping air in the lungs. The child can breathe air in but struggles to expel it, gas exchange suffers, and cyanosis appears.

Statistics and Incidences

Pharyngitis is a leading cause of pediatric ambulatory visits. Approximately 10% of children seen by providers each year have pharyngitis, and 25-50% of those have GABHS. About 20% of asymptomatic children are chronic GABHS carriers. According to the Red Book, from 1990-1995 approximately 48,000 cases of epidemic diphtheria were reported in the former Soviet Union and central Asia. Peak prevalence of GABHS pharyngitis is in children aged 5-10 years.

Causes

Many things irritate and inflame the pharynx. GABHS is the organism of concern in most pediatric cases because appropriate antibiotics eliminate the cardiac complications of rheumatic fever. Viral causes include EBV (mononucleosis), rhinovirus, adenovirus, parainfluenza virus, coxsackievirus, coronavirus, echovirus, and cytomegalovirus (CMV).

Clinical Manifestations

Symptoms run more severe in infants and children than in adults. Fever is common, especially in young children; older children run low-grade fevers that appear early and suddenly. The onset of dyspnea is abrupt, sometimes preceded by cough or nasal discharge, and the cough is dry and persistent. Nasal inflammation obstructs the passages, and constant wiping of secretions irritates the skin around the nares. Suprasternal and substernal retractions are present, and the chest can take on a barrel shape from trapped air. Respirations run 60 to 80 breaths per minute. Viral pharyngitis is usually associated with sneezing, rhinorrhea, and cough.

Assessment and Diagnostic Findings

Diagnosis is clinical and confirmed by testing the mucus.

• Throat culture. The standard for diagnosis. Results can take as long as 48 hours and are highly sensitive and specific for GABHS, though they vary with technique, sampling, and culture media.
• Rapid testing. Useful when immediate therapy is desired and reliable when paired with throat culture. Compared with culture, rapid tests are 70-90% sensitive and 95-100% specific.
• Testing for viral causes. If Epstein-Barr virus (EBV) is suspected, obtain a CBC to detect atypical cells in the WBC differential, along with a Monospot or other rapid heterophile antibody test.
• Radiography. Imaging is usually unnecessary unless a retropharyngeal, parapharyngeal, or peritonsillar abscess is suspected; a plain lateral neck film is the initial screening tool.

Medical Management

Oxygen may be given along with the mist tent. For signs of dehydration, give adequate oral or IV fluids, remembering that pain can limit oral intake and complicate hydration.

Pharmacologic Management

Penicillin is the typical therapy for GABHS pharyngitis, alongside dehydration prevention and pain support. Antipyretics are prescribed for mild fever and discomfort. Corticosteroids (for example, dexamethasone) have been suggested as adjuncts to decrease pain and shorten symptom duration in adults with pharyngitis.

Nursing Management

For many parents, a cold is their first experience of illness in their infant.

Nursing Assessment

• History of exposure. Exposure to known carriers, plus fever, headache, and abdominal pain with a sore throat, suggests GABHS pharyngitis.
• History of intake. Because supportive care is the primary goal, oral intake and hydration status are key history.

Nursing Diagnoses

• Ineffective breathing pattern related to the inflammatory process in the respiratory tract.
• Ineffective airway clearance related to mechanical obstruction and increased secretions.
• Anxiety related to the illness the child is experiencing.

Nursing Care Planning and Goals

• The patient reports increased energy.
• The patient remains afebrile.
• The patient expectorates sputum effectively.
• The patient expresses comfort maintaining air exchange.
• The patient shows no further signs or symptoms of infection.

Nursing Interventions

• Positioning. Place the child in a semi-Fowler's position with pillows to support lung expansion.
• Fluids. Encourage increased fluid intake to thin secretions.
• Humidity. Use a cool mist vaporizer to relieve nasal stuffiness.
• Medications. Administer antibiotics as prescribed after a positive culture.

Evaluation

Goals are met when the patient reports increased energy, stays afebrile, expectorates sputum effectively, expresses comfort maintaining air exchange, and shows no further signs of infection.

Documentation Guidelines

• Breath sounds, presence and character of secretions, use of accessory muscles.
• Plan of care and teaching plan.
• Responses to interventions and actions performed.
• Attainment of or progress toward desired outcomes.
• Modifications to the plan of care.