Evaluation of an Evidence-Based Throat-Pain Protocol to Reduce Left-Without-Being-Seen, Length of Stay, and Antibiotic Prescribing.

BACKGROUND: Increasing numbers of people are seeking unscheduled medical care in United States' emergency departments, which contributes to delayed throughput and increased patient length of stay. Implementation of nurse-initiated protocols, such as those for throat pain, initiates early diagnostic testing, optimizes patient throughput strategies, and promotes adherence to clinic practice guidelines for an additional segment of patients. AIM: To evaluate the effect of an evidence-based throat-pain protocol. METHODS: The medical records for 117 patients presenting with throat pain to the emergency department were reviewed and separated into 3 groups: no testing, medical provider-initiated testing, or nurse-initiated testing using the protocol. Main outcome variables were number of patients that left without being seen (LWBS), patient length of stay, and antibiotic prescribing. RESULTS: No patients LWBS from the nurse-initiated testing group or no-testing group compared with 3% from the medical provider-initiated group. By eliminating these LWBS patients, there is a potential cost savings of $3,420 over a 12-month period. The overall mean length of stay was 6 minutes shorter in the nurse-initiated group than the other 2 groups evaluated. Antibiotic prescriptions were given for 48% of patients in the protocol group compared with 52% in the medical provider group and 70% in the no-testing group. CONCLUSION: Although this department has only partially implemented a protocol for throat pain, it highlights the benefits to reduce the number of patients that LWBS and reduce patient length of stay. The use of the protocol also improved adherence to clinical practice guidelines for testing and antibiotic prescribing.

Effects of Aroma Gargling, Cold Water Gargling, and Wet Gauze Application on Thirst, Halitosis, and Sore Throat of Patients After Spine Surgery.

This study compared and examined the effects of aroma gargling, cold water gargling, and wet gauze application on thirst, halitosis, and sore throat in patients after spine surgery. A quasiexperimental pretest/posttest control group design was employed. Samples were total 70 patients (aroma gargling: 24 samples, cold gargling: 24 samples, and wet gauze: 22 samples) after spine surgery in K Hospital in Seoul, Korea. The aroma gargle solution as an experimental intervention was prepared by blending peppermint, tea tree, and lemon oils at a ratio of 1:2:2. A 60 cc of aroma gargle solution was used 3 times for 15 to 20 seconds. The visual analog scale was used to measure the degrees of thirst and sore throat, and a portable device was used to examine the degree of halitosis. There were significant differences in the degrees of thirst, halitosis, and sore throat according to interaction between group and duration. In the comparison among 3 groups, aroma gargling provided better oral health by decreasing thirst, halitosis, and sore throat for patients with spine surgery. Aroma gargling can be utilized as an effective nursing intervention for decreasing thirst, halitosis, and sore throat for patients with spine surgery in clinical practice. Results suggest, therefore, that health professionals should consider an array of methods including aroma gargling for patients after spine surgery.

School Nurses on the Front Lines of Medicine: A Student With Fever and Sore Throat.

Fever and sore throat are common chief complaints encountered by school nurses. This article explains the etiology of both fever and sore throat in children, describes the office assessment, and delineates life-threatening complications associated with fever and sore throat that may prompt the school nurse to transfer the child to a local emergency department.

Sore throats.

This work looks at how a nurse practitioner can assess, diagnose and treat a patient that presents to the Accident and Emergency (A&E) department with a sore throat. A brief look is taken at the common causes of sore throat. The reader is then introduced to a simple scoring system (McIsaac scoring) to determine whether a patient requires antibiotics to treat their sore throat. A list is then given of alternative diagnoses and how they should be treated.

School-age girl with sore throat.

In summary, the evidence to date from multiple reviews provides guidance for some of the questions most frequently raised when caring for children like Jasmin who come to ambulatory care settings with the chief complaint of a sore throat. It is also clear that while this presenting symptom is one of the most common seen in everyday practice, the evidence to support practice for this clinical entity is evolving and requires continued monitoring for new developments in the state of the science.

Pharyngitis: soothing the sore throat.

Sore throat is a common presentation in primary care. Accurate identification of cause is important for appropriate treatment. Clinical scoring systems and diagnostic tests are recommended to identify group A beta-hemolytic streptococcus, which warrants guideline-driven therapy. The article explores causes, diagnosis, management, and possible complications of pharyngitis.

The "Think Aloud" seminar for teaching clinical reasoning: a case study of a child with pharyngitis.

The "Think Aloud" seminar is a group teaching method to assist pediatric nurse practitioner students to develop critical thinking and clinical reasoning skills. Seminar proceedings simulate the iterative clinical reasoning process that occurs in an actual clinic or office visit. Students' requests for subjective and objective data must be followed by the rationale as to why the information was requested. This method is effective for teaching and evaluating students' skills in differential diagnosis and management of common illness in children. The process will be demonstrated with the presenting symptom of a sore throat followed by a description of the procedures that are used. J Pediatr Health Care.

Prediction of streptococcal pharyngitis: an option for school nurses?

In this article the authors address the dilemma confronting school nurses in determining whether or not to counsel parents about seeking medical care for a child with a sore throat. The use of a clinical scorecard in the school setting as an aid in predicting streptococcal pharyngitis is investigated. The authors conclude that the only valid solution to the dilemma is the availability of the throat culture to schools. Using the culture as an additional assessment tool augments those already proven over time--the stethoscope, scoliosis and vision screening, and the otoscope.

National Guideline Clearinghouse guideline syntheses and comparisons.

As the number of clinical practice guidelines relevant to clinical practice continues to grow, nurse practitioners may find it confusing to choose from two or more guidelines on the same or similar topics. The National Guideline Clearinghouse provides two resources to assist clinicians in comparing multiple guidelines on similar topics: guideline syntheses and guideline comparisons. This column describes the features of these two resources, using examples from guidelines on acute pharyngitis.

The judicious use of antibiotic agents in common childhood respiratory illness.

Increased bacterial resistance is caused most frequently by the widespread use of antimicrobial agents. Antimicrobial agents are often used inappropriately to treat common respiratory illnesses in children. This article discusses the judicious use of antimicrobials in the common cold, otitis media, acute sinusitis, pharyngitis, and bronchitis.

Diagnostic considerations in the evaluation and treatment of sore throat.

Adults with sore throats make 40 million visits to medical facilities each year, and sore throat is the third most common reason for visits to primary care practitioners. While often associated with pharyngitis, a complaint of sore throat may also herald a variety of other underlying disorders, both common and uncommon. These disorders range from local to systemic diseases, and include infectious as well as non-infectious etiologies. This article focuses on the differential diagnosis of sore throat and reviews useful approaches to the evaluation of this prevalent symptom. Specific strategies for history taking, key findings to look for on physical exam and recommendations for the selection of appropriate laboratory studies are included. A summary of management options for the more common problems is also provided.

Identifying poststreptococcal glomerulonephritis.

Expedient antimicrobial treatment of group A beta-hemolytic streptococcal tonsillopharyngitis prevents suppurative complications and rheumatic fever; however, timely therapy does not prevent acute poststreptococcal glomerulonephritis. Acute poststreptococcal glomerulonephritis is the most common form of postinfectious glomerulonephritis and a leading cause of acute and chronic renal failure in childhood. This article discusses clinical presentation, diagnostic workup, treatment, and prevention of poststreptococcal glomerulonephritis in adults and children in the primary care setting.

Differential diagnosis of common causes of pediatric pharyngitis.

Pharyngitis or sore throat is a common result of illness in pediatric and adolescent populations. Sore throat can signal either nonsystemic or systemic disease processes. Clinicians in ambulatory settings are often faced with deriving a differential diagnosis based on this symptom. Prompt and appropriate treatment depends on identification of the underlying causative agent or illness. This article examines common causes of sore throat in the pediatric and adolescent populations. These diagnoses are: (1) group A beta-hemolytic streptococcal pharyngitis; (2) non-group A beta-hemolytic streptococcal bacterial pharyngitis; (3) viral pharyngitis; (4) infectious mononucleosis; and (5) chronic conditions. Less common causes are also considered. Differential diagnosis is dependent on complete and accurate history, distinct physical finding, and interpretation of adjunct diagnostic tests. The value of critical data sources is essential in arriving at a differential diagnosis of pharyngitis. Once a diagnosis is established, an appropriate treatment plan can be initiated.

Sore throat in women after intubation with 6.5 or 7.0 mm endotracheal tube: a quantitative study.

BACKGROUND: Women experience more sore throats than men after endotracheal intubation. AIM: The aim of this study was to investigate the incidence of self-rated sore throat immediately, and 2-4 hours postoperatively, in women after elective gynaecological surgery under general anaesthesia using an endotracheal tube (ETT) size 6.5 or 7.0mm in inner diameter. METHOD: Eighty-two female participants who had undergone elective gynaecological surgery participated, 44 and 38 were intubated with size 6.5 mm ETT and 7.0mm ETT respectively. They estimated the occurrence of sore throat preoperatively and postoperatively, according to a 4-point Likert scale. Statistical data were analysed using the Package for Social Science (SPSS) 19. RESULTS: Sore throat was present in 29.5% of participants who were intubated with size 6.5 mm ETT immediately postoperatively and in 39.5% of those who were intubated with size 7.0 mm ETT. CONCLUSION: Nurses specialising in the supervision of daily care specific to the intubated patient should note and alleviate sore throat as part of their nursing care.