Chapter 23: Tonsillitis Flashcards
Tonsillitis
an inflammation of the tonsils, which are masses of lymphoid tissue located within the pharynx
-inflammation of the tonsils often occurs with pharyngitis, which may lead to diagnosis of tonsillitis or tonsillopharyngitis
Role of the Tonsils
protect the respiratory and alimentary tracts from infection by inducing secretory immunity and regulating the production of secretory immunoglobulin
-tonsils normally enlarge progressively between 2 and 10 years of age and reduce progressively during preadolescence, which makes the tonsils of children larger than those of adults
Most common cause of Tonsillitis
- viruses
- group A beta-hemolytic streptococcus
- exposure to a viral or bacterial agent
- immature immune systems (younger children)
Types of Tonsillitis
-acute
-recurrent
-chronic
-peritonsillar abscess
>symptoms usually resolve in 3 to 4 days; some patients may remain symptomatic for up to 2 weeks, even during therapy
Symptoms in Acute Tonsillitis
- fever
- chills
- foul breath (halitosis)
- dry throat
- dysphagia (difficulty in swallowing)
- referred otalgia (pain in the ears)
- headache
- malaise (fatigue)
- muscular pains
- enlarged cervical nodes
- enlarged tonsils (tonsils that are observed to touch at the midline are called “kissing tonsils” or are 4+ in size)
- airway obstruction may occur b/c of enlarged tonsils and lead to mouth breathing
Recurrent Tonsillitis
presents with multiple episodes of the illness in a year
Symptoms of Chronic Tonsillitis
- foul breath (halitosis)
- chronic sore throat
- foreign body sensation
- a hx of expelling foul tasting, smelly, cheesy lumps
Symptoms of Peritonsillar Abscess
- severe throat pain
- fever
- drooling
- foul breath (halitosis)
- difficulty opening the mouth
- changes in voice quality
- partial deafness may occur as a result of the inflammatory process brought about by infection
Diagnosis
based on the presenting symptoms and inspection of the throat
Prevention
- good hand washing, covering the nose and mouth when coughing, and care in avoiding touching eyes and nose can help the spread of the organism
- avoid secondhand smoke
- avoid crowded places during flu season
- avoid contact with persons known to have pharyngitis, which is associated with the development of tonsillitis
Nursing Care
- cool-mist humidifiers help maintain hydration of the mucous membrane during periods of mouth breathing
- warm saline gargles, throat lozenges, an antipyretics may be ordered to reduce discomfort
- soft or liquid diet preferred
Medical Care
- antibiotics, antipyretics, and analgesics
- Penicillin, erythromycin (Erythrocin), and amoxicillin (Amoxil) are commonly prescribed antibiotics
- Cephalosporins or clindamycin (Cleocin)= more effective with chronic conditions
Surgical Care
Tonsillectomy (surgical removal of the tonsils) is used for recurrent or chronic
-no criteria for number of infections before tonsillectomy is carried out
>suggest occurrence of 3 or more treated infections per year as sufficient to necessitate surgical intervention
-surgery performed 6 weeks after an acute infection has been resolved
After Surgery
-children kept on their side to facilitate drainage of secretions
-providing comfort and reducing activities that may aggravate bleeding is PRIORITY; coughing, clearing the throat, and blowing the nose are avoided
>secretions and vomitus are checked for fresh blood
-b/c the throat is sore after surgery, the nurse can apply ice packs and an ice collar to provide relief
-food and fluids offered when the child is alert: cool water, crushed ice, and flavored ice pops
>red or brown colored fluids not given so the nurse is able to distinguish drainage, which might be fresh or old blood
-as child begins to tolerate food, items such as gelatin cooked fruit, sherbet, soup, and mashed potatoes are offered
>foods to avoid: milk, ice cream, and pudding =they coat the mouth and throat and cause the child to try to clear the throat which may cause bleeding
Food After Surgery (Tonsillectomy)
-foods and fluid offered when alert
-initial foods: cool water, crushed ice, flavored ice pops
-as child begins to tolerate food: gelatin, cooked fruit, sherbet, soup, mashed potatoes
>Avoid: red or brown colored fluids; milk, ice cream and pudding as they can coat the mouth and cause the child to try to clear the throat which can cause bleeding
Home Discharge Teaching Following a Tonsillectomy
- keep the child away from highly seasoned food and “sharp” foods (e.g. nacho chips) for a period of 2 weeks; the scab is most likely to be dislodge at 8 to 12 days
- avoid gargling an vigorous tooth brushing
- not cough or clear throat
- limit child’s activities that may result in bleeding
Signs of Bleeding after Tonsillectomy
- if the child is continuously swallowing, it is indicative of bleeding
- additional signs: restlessness, increased pulse rate, and pallor (late symptom)
Erythromycin
- treat bacterial infections; antibiotic
- Indications: infections caused by susceptible organisms including upper and lower respiratory tract infections
- IV, PO
- Actions: suppresses protein synthesis at the level of the 5OS ribosome
- Therapeutic Effects: bacteriostatic action against susceptible bacteria spectrum: streptococci, staphylococci and gram-positive bacilli
- Contraindications: hypersensitivity
- Adverse Reactions/ Side Effects: CNS: seizures, EENT: ototoxicity, QTC: prolongation, ventricular arrhythmias, GI: nausea, vomiting, abdominal pain, DERM: rashes
- Nursing Implications: inform parents of medication administration, prepare to administer around the clock, use calibrated measuring device for liquid preparations do not crush or chew delayed-release capsules or tablets; swallow whole
ATI: Tonsils
masses of Lymph-type tissue found in the pharyngeal area
- filter pathogenic organisms (viral and bacterial) which helps to protect the respiratory and gastrointestinal tracts
- contribute to antibody formation
- highly vascular, which helps them to protect against infection because foreign materials enter the body through the mouth
ATI: Expected Findinga
- report of sore throat with difficulty swallowing
- history of otitis media and hearing difficulties
ATI: Physical Assessment Findings
- mouth odor
- mouth breathing
- snoring
- nasal qualities in voice
- fever
- tonsil inflammation with redness and edema
- difficulty swallowing or eating
ATI: Laboratory Test
Throat culture: group A beta-hemolytic streptococci (GABHS)
ATI: Nursing Care
- provide treatment for manifestations of viral tonsillitis (rest, warm fluids, warm salt-water gargles)
- administer antibiotic therapy as prescribed for bacterial tonsillitis
ATI: Antipyretic/analgesic
- acetaminophen
- hydrocodone indicated for the child having difficulty drinking fluids
ATI: Antipyretics
decrease fever and manage pain
- be aware of allergies
- appropriate dosing for acetaminophen and ibuprofen
ATI: Preoperative measures for Tonsillectomy
maintain NPO status
ATI: Plimitostoperative Nursing Actions for Tonsillectomy
> Positioning
- place in position to facilitate draining
- elevate head of bed when child is fully awake
> Assessment
-assess for evidence of bleeding (frequent swallowing, clearing the throat, restlessness, bright red emesis, tachycardia, and/or pallor
> Comfort Measures
- administer liquid analgesics or tetracaine lollipops as prescribed
- provide ice collar
- offer ice chips or sips of water to keep throat moist
- administer pain medications on a regular schedule
> Diet:
- clear liquids and fluids after return of the gag reflex
- avoid red colored liquids, citrus juice, and milk-based foods
- advance the diet with soft, bland foods
> Instruction:
- discourage coughing, throat clearing, and nose blowing
- avoid straws
- it is normal for clots or blood-tinged mucus in vomitus
ATI: Client Education
- contact provider if experiences difficulty breathing, lack of oral intake, increase in pain, and/or indications of infection
- ensure child does not put objects in mouth
- administer pain medications for discomfort
- intake plenty of fluids
- advance to a soft diet
- avoid foods that are irritating and highly seasoned
- limit activity to decrease the potential for bleeding
- full recover in approximately 14 days
- observe for manifestations of hemorrhage, dehydration, and infection
