Ch. 17: Tonsillitis and Tonsillectomy Flashcards
What are tonsils?
Masses of lymph-type tissue found in pharyngeal area
What do tonsils do?
Filter pathogenic organisms (viral and bacterial), which helps to protect the resp and GIT tracts; they also contribute to antibody formation
Where are palatine tonsils located?
Both sides of the oropharynx
What are the other tonsils?
Pharyngeal tonsils, also known as the adenoids
What is the name of the surgery to remove the palatine tonsils?
Tonsillectomy
What is the name of the surgery to remove the pharyngeal tonsils (aka the adenoids)?
Adenoidectomy
Are tonsils vascular or avascular?
Highly vascular
Since tonsils are highly vascular, what does this do?
Help them protect against infection because foreign materials, such as viral or bacterial organisms, that enter the body through the mouth
What can enlarged tonsils do?
- Can block nose and throat (interfers with breathing, nasal & sinus drainage, sleeping, swallowing, and speaking)
- Can disrupt function of eustachian tube (impedes hearing)
Acute tonsillitis occurs when the tonsils become ____ & ____
Inflamed and reddened
What may be visible on inflamed and reddened tonsils?
Small patches of yellowish pus
Can acute tonsillitis become chronic?
Yes
Nursing care: What does it mean to provide symptomatic care for viral tonsillitis?
Rest
Cool fluids
Warm salt-water gargles
Why would we give an antipyretic for tonsillitis?
Decrease fever and manage pain
What are some antibiotics to give for tonsillitis?
IM penicillin G Erythromycin Azithromycin Cephs Ampxocillin
What is pre op for tonsillectomy?
NPO status
What is the positioning for post-op care of tonsillectomy?
- Side lying position or on abdomen to facilitate drainage
- Elevate HOB when child is fully awake
What do we assess for during post op care of tonsillectomy?
- Evidence of bleeding
- Assess airway and VS
- Monitor difficulty breathing r/t oral secretions, edema and/or bleeding
Post op care of tonsillectomy: One of the things we assess for is evidence of bleeding. What are signs of this?
- Frequent swallowing
- Clearing the throat
- Restlessness
- Bright red emesis
- Tachycardia
- Pallor
Post-op care of tonsillectomy: Comfort measures?
- Give pain meds at regular schedule
- Provide ice collar
- Offer ice chips, sips of water to keep throat moist
- Give analgesics as prescribed
Post op care of tonsillectomy: What is the diet?
- Clear fluids and liquids after a return of gag reflex
- Avoid red color liquid, citrus juice, and milk based foods initially
- Advance diet with soft, bland foods
Post op care of tonsillectomy: What should we discourage?
Coughing
Throat clearing
Nose blowing
*discourage all this to protect the surgical site
Post op care of tonsillectomy: Refrain from placing _____ in the back of the throat
Pointed objects
Post op care of tonsillectomy: During instruction, what should we alert parents about?
That there may be clots or blood-tinged mucus in vomit
Post op of tonsillectomy: When should we instruct the fam to notify the provider?
If bright red bleeding occurs
Discharge: When should we instruct parents to contact provider?
If child experiences difficulty breathing, lack of oral intake, increase pain, and/or indications of infection
Discharge: Make sure the parents own that the child does not need to put anything sharp in the mouth. Examples?
Ice cream stick
Straw
Discharge: Encourage fluid intake and diet advancement to a soft diet with no _____, or hard/sharp foods like ______ until full recovery
No spicy foods or hard/sharp foods like corn chips till full recovery
Discharege: Instruct the child and family to limit strenuous activity an physical play with no swimming for ____ as prescribed
2 weeks
When does full recovery usually occur?
14 days
What are some complications of tonsillitis/tonsillectomy?
Hemorrhage
Dehydration
Chronic infection
A nurse is caring for a child who is in the post op period following a tonsillectomy. Which of the following is a clinical finding of post op bleeding?
A. Hgb of 11.6 and Hct of 37%
B. Inflamed and reddened throat
C. Frequent swallowing and clearing of the throat
D. Blood tinged mucus
C
A nurse is caring for a child in the post op period of a tonsillectomy. Which of the following is an appropriate action for nurse to take?
A. Encourage the child to blow nose gently
B. Administer analgesics on a schedule
C. Offer OJ
D. Position child supine
B
