tonsillitis - nursing lijan

Tonsillitis

Chapter 26

Pages: 894-896 12/13/2020 Suhaila Halasa RN, PhD, CIMI,CPT 1

Objectives

• By the end of this discussion you will be able to:

• Define tonsillitis

• Identify the etiology

• Explain the pathophysiology

• Discuss the clinical manifestations

• Discuss the therapeutic management

• Discuss the nursing care management

12/13/2020 Suhaila Halasa RN, PhD, CIMI,CPT 2

Please review the attached video

https://www.youtube.com/watch?v=oSRtTclbtsE


https://www.youtube.com/watch?v=oSRtTclbtsE

Location of tonsils

4https://en.wikipedia.org/wiki/Tonsil

Location of tonsils

https://teachmeanatomy.info/neck/misc/tonsils-and-adenoids/

Tonsils

• Masses of lymphoid tissue located in pharyngeal cavity

• Children have large tonsils than adolescents and adults (protect against URTIs)

• Pink in color

• Filter and protect the respiratory and alimentary tracts from pathogenic

organism

Waldeyer’s Ring

7https://pt.slideshare.net/MayurPatel64/tonsil-59371082/3

First line of defense against microbes

Waldeyer’s Ring

• Consists of four tonsillar structures:

• Pharyngeal/ Adenoids (roof of the

nasopharynx)

• Tubal (near the posterior nasopharynx

opening to the eustachian tubes)

• Palatine (side of the oropharynx)

• Lingual tonsils (the base of the tongue)

8

Palatine tonsils

• Visible during oral examination

• Removed during tonsillectomy

9

Tonsillitis

• Inflammation of the tonsils

• Occurs often with pharyngitis

• Common cause of illness in young children

• Caused by viral or bacterial infection 10

Etiology of Tonsillitis

• Viral (majority of infections)

• Bacteria

• Group A beta-hemolytic Streptococcus (GABHS)

• The most common cause of tonsillopharyngitis

11

Bacterial and Viral Tonsillitis

12

Infected Palatine Tonsils

13https://www.shutterstock.com/search/tonsils

Pathophysiology When tonsils get inflamed

Red, swollen (enlarge from edema) and may develop pus pockets

Discharge (exudate)

Obstruction of the passage of air or food14

Clinical Manifestations Palatine Tonsillitis

• Kissing tonsils

• Obstruction of air and food passage

• Difficulty of swallowing and breathing

• Obstruction of breathing during sleep

(chronic enlargement)https://www.sciencedirect.com/topics/medicine-and-dentistry/tonsillitis

Clinical Manifestations/Pharyngeal (Adenoid) Tonsillitis

Clinical ManifestationsPharyngeal/ Adenoid Tonsillitis

• Air cannot pass from the nose to the throat

• Child breath from mouth

• Obstruction of breathing during sleep (chronic

enlargement)

https://medlineplus.gov/ency/presentations/100076_2.htm


• Mouth breathing continuous

• Dry and irritate mucous membranes

of the oropharynx

• Offensive mouth odor

• Impaired senses of taste and smellhttps://www.dhakatribune.com/uncategorized/2014/12/12/are-adenoids-deforming-your-child


• Muffled and nasal voice

• Persistent cough

• Frequent otitis media (blocked ET)

• Difficulty of hearinghttps://www.slideshare.net/ophthalmgmcri/eustachian-tube-anatomy-test-and-disorders-drvijaya-sundarm-200317

Clinical Manifestations

H ttps://www.ent-surgery.com.au/ent-resources/childrens-ent/tonsillitis-symptoms-in-children/

Clinical Manifestations

21

Therapeutic Management

• Medical treatment:

• Self-limited disease

• Treatment of viral pharyngitis is symptomatic

• Throat culture positive (GABHS) antibiotic is required


• Surgical treatment: of chronic tonsillitis is Controversial

https://www.youtube.com/watch?v=oM-8a4dGFVY

• https://www.youtube.com/watch?v=o45P_UKzDcE

• Tonsillectomy: surgical removal of palatine tonsils is indicated for:

• Massive hypertrophy (difficulty in breathing or eating)

• Peritonsillar abscess (bacterial infection that usually begins as a

complication of untreated tonsillitis)

https://www.youtube.com/watch?v=oM-8a4dGFVY

https://www.youtube.com/watch?v=o45P_UKzDcE


• PFAPA syndrome that consists of recurrent episodes OF:

• Periodic Fever

• Aphthous stomatitis

• Pharyngitis and cervical adenitis

• Airway obstruction


• Chronic tonsillitis and non- responsive to antibiotic

• Multiple antibiotic allergies

• Tonsils requiring tissue pathology

-


• Consideration of tonsillectomy: if tonsillitis occurs at least:

• 7 episodes in the previous year

• 5 episodes in each of the previous 2 years

• 3 episodes in each of the previous 3 years

-


• Consideration of tonsillectomy: if tonsillitis occurs at least:

• 1 episodes and sore throat plus one of the following:

• Fever more than 38.3°C

• Cervical adenopathy (more than 2 cm)

• Presences of exudate

• Positive culture of GABHS

-


Adenoidectomy: surgical removal of adenoid

- Hypertrophied adenoids obstruct nasal breathing

- History of 4 or more episodes of recurrent rhinorrhea in the previous 12

months (children under 12 years)

- Persisting symptoms after 2 courses of antibiotics


Adenoidectomy: surgical removal of adenoid

- Sleep disturbances with nasal obstruction lasting over 3 months

- Hyponasal speech

- Otitis media with effusion (OME) greater than 3 months

- Dental malocclusion

- Cardiopulmonary complications


Contraindications for surgery treatment:

• Cleft palate

• Acute infections (at the time of surgery)

• Uncontrolled systemic disease or blood dyscrasias

• Before the age of 3 or 4 years of age

Nursing Care Management

➢ Provide comfort and minimize activities that precipitate bleeding

➢Soft or liquid diet

➢Warm salt water gargles

➢Warm fluids

➢ Analgesic (every 4 hours)

➢ Antipyretic


➢ If surgery required, child needs psychological preparation and physical care

➢Preoperative care:

➢Take complete history (bleeding)

➢Monitor vital signs

➢Observe any signs of URI

➢Obtain bleeding and clotting time

➢Assess the presence of any loose teeth


Post operative care:

➢Position the child to facilitate drainage of secretions (Post-

tonsillectomy position)

➢Sitting up position

➢Perform suctioning carefully

➢Discourage child from coughing frequency or clearing their

throat



• Examine the throat directly for bleeding

• Observe the early sign of bleeding/postoperative hemorrhage:

• Tachycardia

• Pallor

• Restlessness

• Frequent clearing of the throat

• Continues swallowing of the trickling blood (especially during sleeping)

• Vomiting of bright red blood



➢Inspect the secretion and vomitus (fresh bleeding)

➢Observe for dark brown (old) blood

➢Give ice collar to relief pain

➢Administer analgesics IV to avoid oral route



➢Local anesthetics (tetracaine lollipops or ice pops)

➢Administer antiemetics

➢Restrict food and fluid

➢Give cool water, crushed ice and diluted fruit juice



Avoid:

➢Fluids with a red or brown color

➢Using straw

➢Citrus juice

➢Milk, ice-cream and pudding

➢Give soft food on the 1st or 2nd day postoperative

• Keep suction equipment and oxygen available

• Airway obstruction (edema or accumulated secretions)

Respiratory distress



Family support and home care

• Teach the child and family to avoid:

• Irritating or highly seasoned food

• Gargle or vigorous tooth brushing

• Coughing or clearing throat or putting object in the mouth

Family support and home care

• Teach the child and family to:

• Use analgesia or ice collar for pain

• Limit activities

• Observe signs of bleeding

• Inform children about postoperative discomfort

• Children go back to normal activity within 1-2 weeks after the surgery

• https://www.youtube.com/watch?v=S1jTbsMz5zc

https://www.youtube.com/watch?v=S1jTbsMz5zc

Thank you


tonsillitis - nursing lijan

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