A teenage client is diagnosed with “strep throat.” Which clinical manifestation would the nurse expect of the client?
A. A fiery red pharyngeal membrane and fever.
B. Pain over the sinus area and purulent nasal secretions.
C. Foul-smelling breath and noisy respirations.
D. Weak cough and high-pitched noise on respirations.
Correct Answer: A. A fiery red pharyngeal membrane and fever.
Strep throat, or acute pharyngitis, results in a red throat, edematous lymphoid tissues, enlarged lymph nodes, fever, and sore throat. Physical exam findings including cervical lymphadenopathy, pharyngeal inflammation, and tonsillar exudate. Palatine petechiae and uvular edema are also suggestive.
Option B: Pain over the sinus area and purulent nasal secretions would be evident with sinusitis. Major factors include facial pain/pressure, facial congestion/fullness, nasal obstruction, nasal or postnasal purulence, hyposmia, and fever.
Option C: Foul-smelling breath and respirations indicate adenoiditis. Physical findings include purulent rhinorrhea, post-nasal drip, nasal obstruction, snoring, fever, mouth breathing, and halitosis. Indirect mirror exam may allow the practitioner to observe enlarged adenoids with exudates, though this can be a very challenging exam to perform in children.
Option D: A weak cough and high-pitched noisy respirations are associated with foreign-body aspiration. Sudden onset of cough, choking, and/or dyspnea have been found to be the most common symptoms. One prospective study has cited a sensitivity of 91.1% and specificity of 45.2% for choking and acute cough. Wheeze on auscultation has been found to be a major physical finding and in one study was documented in 60% of cases.
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