Tonsillitis and Adenoiditis
Islamic UniversityNursing College
Tonsillitis
Inflammation of tonsils.Masses of lymphoid tissue in pairsOften occurs withpharyngitisCharacterized by fever,dysphagia, or respiratory problems forcing breathing to take place through nose
Nurse Alert!
Key to understandingprevention of URI iscareful hand-washingand avoiding exposureto infectedpersons.
Nurse Alert!
The nurse should remind the child with a positive throat culture for strep to discard their toothbrush and replace it with a new one after they have been taking antibiotics for 24 hours
Causes
Viral.Bacterial ( group A beta hemolytic streptococci (GABHS).
Clinical Manifestations
TonsillitisFeverPersistent or recurrent sore throatAnorexiaGeneral malaiseDifficulty in swallowing, mouth breather, foul odor breathEnlarged tonsils, bright red, covered withexudateAdenoiditisStertorousbreathing - snoring, nasal quality speechPain in ear, recurringotitismedia
Surgical treatment
Tonsillectomy. If recurrent.Not recommended before 3 years of age due to:Excessive blood loss.Tonsils grow back.
Nursing Care for the Tonsillectomy and Adenoidectomy Patient
Post-operative Care
Providing comfort and minimizing activities or interventions that precipitate bleedingPlace on abdomen or side until fully awakeManage airwayMonitor bleeding, esp. new bleedingIce collar, pain medsAvoiding fluids until fully awake --then liquids and soft cold foods. Avoid citrus juices, milkDo not use straws or put tongue blade in mouth, no smoking (in teenagers).
Nurse Alert for Post-Op T/A surgery
Most obvious sign of early bleedingis the child’s continuousswallowing of trickling blood.Note the frequency ofswallowing and notifythe surgeon immediately
Epiglottitis
Bacterialform of croup (H influenza) with unique symptoms and treatmentBacterial infection invades tissues surrounding the epiglottisEpiglottis becomes edematous, cherry red and may completed obstruct airwayProgresses rapidly, child is unable to swallow, drooling
Cardinal signs and symptoms
May have had mild URI few days priorDroolingDysphasiaDysphoniaDistressed respiratory effortsTripod position: supported by arms, chin thrust out, mouth open
ER Management
NEVER leave child unattendedDon’t examine or culture throat or start IV/Blood samplesPatent airway ASAPMonitor oxygenation status, (continuous pulse ox, humidified O2)Antipyretics suppositoryCalm the parent! Explain what is going on…a calm parent=calmer child!OR- intubationThroat & blood cultures done after intubationUsuallyextubatedafter 48hAntibiotics for 7-10 daysDischarge
Nursing Interventions on unit once stable
Continually assess for s/s of respiratory distressMaintain pulse ox above 95% with PaO2 between 80-100mmHgMaintain patent airwayPosition for comfort (never force to lie down)Relieve anxietyMonitor temp (antipyretics, ABX)
Thank you
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