Tonsillitis and Adenoiditis Islamic University Nursing College

Tonsillitis Inflammation of tonsils. Masses of lymphoid tissue in pairs Often occurs with pharyngitis Characterized by fever, dysphagia, or respiratory problems forcing breathing to take place through nose

Nurse Alert! Key to understanding prevention of URI is careful hand-washing and avoiding exposure to infected persons.

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 Tonsillitis Fever Persistent or recurrent sore throat Anorexia General malaise Difficulty in swallowing, mouth breather, foul odor breath Enlarged tonsils, bright red, covered with exudate Adenoiditis Stertorous breathing - snoring, nasal quality speech Pain in ear, recurring otitis media

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 Why is collection of blood for assessment of bleeding and clotting times so important?

Post-operative Care Place on abdomen or side until fully awake Providing comfort and minimizing activities or interventions that precipitate bleeding Place on abdomen or side until fully awake Manage airway Monitor bleeding, esp. new bleeding Ice collar, pain meds Avoiding fluids until fully awake --then liquids and soft cold foods. Avoid citrus juices, milk Do 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 bleeding is the child’s continuous swallowing of trickling blood. Note the frequency of swallowing and notify the surgeon immediately

Epiglottitis Bacterial form of croup (H influenza) with unique symptoms and treatment Bacterial infection invades tissues surrounding the epiglottis Epiglottis becomes edematous, cherry red and may completed obstruct airway Progresses rapidly, child is unable to swallow, drooling

Cardinal signs and symptoms May have had mild URI few days prior Drooling Dysphasia Dysphonia Distressed respiratory efforts Tripod position: supported by arms, chin thrust out, mouth open

ER Management NEVER leave child unattended Don’t examine or culture throat or start IV/Blood samples Patent airway ASAP Monitor oxygenation status, (continuous pulse ox, humidified O2) Antipyretics suppository Calm the parent! Explain what is going on…a calm parent=calmer child! OR- intubation Throat & blood cultures done after intubation Usually extubated after 48h Antibiotics for 7-10 days Discharge

Nursing Interventions on unit once stable Continually assess for s/s of respiratory distress Maintain pulse ox above 95% with PaO2 between 80-100mmHg Maintain patent airway Position for comfort (never force to lie down) Relieve anxiety Monitor temp (antipyretics, ABX)

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