Tonsillitis and adenoiditis
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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.

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Tonsillitis and adenoiditis

Tonsillitis and Adenoiditis

Islamic University

Nursing College


Tonsillitis
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
Nurse Alert!

Key to understanding

prevention of URI is

careful hand-washing

and avoiding exposure

to infected persons.


Nurse alert1
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
Causes

  • Viral.

  • Bacterial ( group A beta hemolytic streptococci (GABHS).


Clinical manifestations
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
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
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
Post-operative Care

  • 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
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
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
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
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
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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