INTRODUCTION Acute tonsillopharyngitis is an inflammatory process of the oropharynx.

It can become a particularly horrible throat infection involving Mycoplasma pneumoniae and Chlamydia pneumonia organisms that often occur in children. It can also come to pass in patients who are given antibiotics for simpler infections 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 oftonsillopharyngitis. 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 thefirst 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.

OBJECTIVES General Objectives: My General objective is to understand what Acute Tonsilopharyngitis is. 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 AcuteTonsilopharyngitis. 5. To improve myself on formulating Nursing Care Plans.

PHYSICAL ASSSESSMENT: Head skull is normocephalic. Hair long length hair, quantity is normal, evenly distributed, black colorand there is presenceno 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 upperportion 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 uponinspection.

Neck Its coloris similar to other body parts. No lumps or goiternoted 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 Cardiac rate is 115 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.

PATIENT PROFILE:

Name: Tugas, Paul Adrian Age: 3 Address: Sto. Domingo, Ilocos Sur Civil status: Single Religion: Roman Catholic Occupation: Student Date & time admitted: 03/09/11 Ward: NS1 Final diagnosis: ATP w/ Exudative. Attending physician: Dr.Mahor

ANATOMY AND PHYSIOLOGY 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 commonly 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 involvedin 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.

PATHOPHYSIOLOGY Viral Influenza(parasite) Para- Influenza Chlamydia Herpes simplex Measles Chicken pox Cytomegato- virus rhinovirus Bacterial Streptococcus(group A beta) Hemolytic Fungal candida Miscellaneous Toxoplasma

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 A.Medication Difflam gargle TID until total relief. B. Exercise Be sure to get enough rest and sleep on a daily basis. C. Treatment Dont 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.

LABORATORY RESULTS: Lab. Reports IMPRESSION: PRIMARY PTB IS CONSIDERED Hematology CBC Component Hgb Hct WBC Platelet Differential count Neutrophils Lymphocytes Monocytes Eosinophils Basophils NURSING CARE PLAN Assessment Scientific backgroun d Cues: Redness S>Masakita and ng pain is lalamunanko, caused by the as verbalized inflammati O>Temp.36. on of 1 the tonsil. Pulse rate:115 RR: 26 > (+) redness @ neck area >(+) pain and swelling @ neck area >(+) cough and colds Diagnosis Planning Nursing Rationale Evaluati interventi on on At the > Give due > Assess >the end of meds. as effectivenes patient shift, the ordered s of will patient orally Difflam report will show (Zertin gargle that signs and after 30 there is of relief Difflam mins. no after a gargle) more >Hot and cold swelling satisfacto compress is and pain ry relief > Render health applied to measure in his teaching the neck. to swelling/pai Upon patient: nful assessme use of area to nt, hot/cold lessen the neck compress the pain area methods will have to no relieve redness. pain He will also report no signs of coughing Results 132 0.398 21.8 314 Unit g/L I/L X10^9/l X10^9/l Normal value 115-180 0.37-0.54 4.6-10.2 150-400

80.6 14.5 3.8 0.8 0.3

% % % % %

50-70 20-40 2-8 1-4 0-2

Ineffective Airway Clearance r/t inflammati on of tonsils

Republic of the Philippines University of Northern Philippines Tamag, Vigan City

College of Health Sciences

In partial fulfilment of the requirements In NCM104 Related Learning Experience (Hospital)

A CASE STUDY ACUTE TONSILOPHARYNGITIS

Submitted to: Mrs. Kimberly Palacpac,RN Clinical Instructor

Submitted by: Cherry Rose Cuello III-A