For this patient, there are two possibilities; on one hand she may be having tonsillitis and secondly there is the probability of pharyngitis. With tonsillitis, the primary infection is within the tonsils while with pharyngitis, the primarily within the throat. In this case, the patient’s subjective data implies that she developed a sore throat and is the primary reasons she has presented at the clinic as the symptoms have progressed from the sore throat to chilling and fever. Further, she admits to having had strep sore throat before and denies contact with any one with strep.
Evidently, owing to the patient’s health history she has pharyngitis as the primary illness which has now extended to the tonsils. The enlarged, tender and bilateral cervical nodes in the neck are an indication that the throat infection from where the initial signs were experienced or noted is has a high infection rate which is now spreading and manifesting in the tonsils (Shulman et al., 2012). The treatment will focus on minimizing the infection within the throat based on the physical examination and the patient’s history. Despite the infection manifesting widely within the tonsils the apparent lack of tonsil exudates implies that the infection within the tonsils is secondary and manifesting from the infection of the throat. The patient’s history of previous strep throat further backs p the reason as to why the treatment will focus on the throat as the primary region of infection (Jarvis, 2015). The management will thus be within the aspects of pharyngitis treatment as opposed to tonsillitis.
In the treatment or care plan for this patient, the focus will be on using antibiotics since the infection has been proven as bacterial based on previous cases she has admitted. While penicillin would have been a good choice for medication, the patient is resistant to penicillin (Jarvis, 2015). Erythromycin will be considered that it is regarded an effective medication for those patients who indicate penicillin resistance (Harris, Hicks & Qaseem, 2016). On the other hand, there is a need to recognize the importance of pain relief, fever relief as well as sore throat relief. In this case, a medication in the form of acetaminophen or paracetamol will be used. It is important to recognize that even though aspirin can act as a pain relief as well as fever relief, it is an anti inflammatory medication and this could be a contraindication for the antibiotics used. The patient should also be encouraged on increased fluid intake (Bosch et al., 2013).
References
Bosch, A. A., Biesbroek, G., Trzcinski, K., Sanders, E. A., & Bogaert, D. (2013). Viral and bacterial interactions in the upper respiratory tract. PLoS Pathog, 9(1), e1003057.
Harris, A. M., Hicks, L. A., & Qaseem, A. (2016). Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention. Annals of internal medicine.
Jarvis, C. (2015). Physical Examination and Health Assessment–. Elsevier Health Sciences.
Shulman, S. T., Bisno, A. L., Clegg, H. W., Gerber, M. A., Kaplan, E. L., Lee, G., & Van Beneden, C. (2012). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), e86-e102.
