1. Tonsillitis and Adenoiditis
Islamic University
Nursing College

2. 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

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

4. 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

5. Causes
Viral.
Bacterial ( group A beta hemolytic streptococci (GABHS).

6. 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

7. Surgical treatment Tonsillectomy. If recurrent.
Not recommended before 3 years of age due to:
Excessive blood loss.
Tonsils grow back.

8. Nursing Care for the Tonsillectomy and Adenoidectomy Patient
Why is collection of blood for assessment of bleeding and clotting times so important?

9. 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).

10. 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

11. 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

12. 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

13. 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

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

15. Thank you