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

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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


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

  • 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)


Thank you


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