ACUTE TONSILLITIS

WHAT IS TONSILITIS?Inflammation of the tonsils, especially the palatine tonsils.

Tonsillitis is characterized by red, swollen tonsils and causes, but not necessarily, a sore throat and fever

often caused by a bacterial or virial.

Tonsillitis may be acute, chronic, or recurrent.

COMMON CAUSATIVE AGENT Beta-haemolytic streptococcus ( -haemolytic strep)

Streptococcus pneumoniae (S. pneumoniae) and;

Haemophilus influenzae ( H. influenzae ).

TYPES OF TONSILITISAcute tonsillitis can either be bacterial or viral in origin

Subacute tonsillitis is caused by the bacterium Actinomyces

Chronic tonsillitis, which can last for long periods if not treated, is mostly caused by bacterial infection

ACUTE TONSILITISAcute tonsillitis can last between 1-3 weeks and often affects school-going children, but also affects adults. It is rare in infants and in persons who are above 50 years of age.

Acute tonsillitis can either be bacterial or viral in origin.

Hemolytic streptococcus is the most commonly infecting organism.

ACUTE TONSILITISOther causes of infection may be staphylococci, pneumococci.

These may primarily infect the tonsil or may be secondary to a viral infection.

PATHOPHYSIOLOGYBacteria and virus enter the body through the nose and mouthBateria and viruses are filtered in the tonsilstonsils work by surrounding bacteria and virus with white blood cellsPrecipitating factorsAgeSexRaceUnhealthy LifestyleEnvironment Predisposing FactorsColdloss of sleepconstipation

infection and inflammation causes enlarge tonsils

SignsRed and swollen tonsils and uvulaRedness of throatPresence of purulent materialsTenderness on the jugulodiagastric lymph nodesGray furry tongueSymptomsSore throatDysphagiaFeverEarache Loss of appetiteConstitutional symptoms

SIGNSOften the patient has foetid breath and coasted tongue.There is hyperemia of pillars, soft palate and uvula.Tonsils are red and swollen with yellowish spots of purulent material.There may be a membrane over the surface of tonsils.The tonsils may be so much enlarged that they meet in the midline.Jugulodiagastric lymph nodes are enlarged and tender.

SYMPTOMSThe symptoms vary with severity of infection. The predominant symptoms are as follows:

Sore throat.Dysphagia (difficulty in swallowing due to local pain.Fever (may vary from 100 104 F and may be associated with chills and rigors).Earache (referred pain from tonsil or due to otitis media).Constitutional symptoms (headache, general body aches, malaise).

These symptoms are generally mild in viral infection and very severe in bacterial infection.

MEDICAL MANAGEMENTTonsillectomy is usually performed for recurrent tonsillitis when medical treatment is unsuccessful and there is severe hypertrophy, asymmetry, or peritonsillar abscess that occludes the pharynx, making swallowing difficult and endangering the airway (particularly during sleep).

Tonsillectomy or adenoidectomy is indicated only if the patient has had any of the following problems: repeated bouts of tonsillitis;hypertrophy of the tonsils and adenoids that could cause obstruction and obstructive sleep apnea; repeated attacks of purulent otitis media;suspected hearing loss due to serous otitis media that has occurred in association with enlarged tonsils and adenoids; and some other conditions, such as an exacerbation of asthma or rheumatic fever.

Antibiotic Therapy

oral penicillin - most common antimicrobial agent is which is taken for 7 days. Amoxicillinerythromycin

NURSING MANAGEMENTPROVIDING POSTOPERATIVE CAREposition client is prone with the head turned to the side to allow drainage from the mouth and pharynx

apply an ice collar to the neck,and a basin and tissues are provided for the expectoration of blood and mucus.

If the patient vomits large amounts of dark blood or bright-red blood at frequent intervals, or if the pulse rate and temperature rise and the patient is restless, the nurse notifies the surgeon immediately.the following items ready for examination of the surgical site for bleeding: a light, a mirror, gauze, curved hemostats, and a waste basin.

If there is no bleeding, water and ice chips may be given to the patient as soon as desired.

The patient is instructed to refrain from too much talking and coughing because these activities can produce throat pain.

TEACHING PATIENTS SELF-CAREthe patient and family must understand the signs and symptoms of hemorrhage

instructed patient to report frank red bleeding to the physician.

Alkaline mouthwashes and warm saline solutions are useful in coping with the thick mucus and halitosis that may be present after surgery

explain to the patient that a sore throat, stiff neck, and vomiting may occur in the first 24 hours.

A liquid or semiliquid diet is given for several days. Sherbet and gelatin are acceptable foods.

The patient should avoid spicy, hot, acidic, or rough foods.

Milk and milk products (ice cream and yogurt) may be restricted because they may make removal of mucus more difficult.

explains to the patient that halitosis and some minor ear pain may occur for the first few days.

to avoid vigorous tooth brushing or gargling, since these actions could cause bleeding.