Tonsillectomy & Adenoidectomy See Exemplar Provided

Objectives Assess the anatomy, physiology, and pathophysiology of the tonsillectomy & adenoidectomy Assess the anatomy, physiology, and pathophysiology of the tonsillectomy & adenoidectomy Analyze the diagnostic and surgical interventions for a patient undergoing a _______________. Analyze the diagnostic and surgical interventions for a patient undergoing a _______________. Plan the intraoperative course for a patient undergoing_____________. Plan the intraoperative course for a patient undergoing_____________. Assemble supplies, equipment, and instrumentation needed for the procedure. Assemble supplies, equipment, and instrumentation needed for the procedure.

Objectives Choose the appropriate patient position Choose the appropriate patient position Identify the incision used for the procedure Identify the incision used for the procedure Analyze the procedural steps for_____________. Analyze the procedural steps for_____________. Describe the care of the specimen Describe the care of the specimen Discuss the postoperative considerations for a patient undergoing _______________ Discuss the postoperative considerations for a patient undergoing _______________

Terms & Definitions A AdenoidsEpiglottisFaucesGlottis LarynxPalatineTonsilsPapillomaPharynx StomatitisThyroidCartilageTracheaVocalCords

Definition/Purpose of Procedure Removal of tonsils & adenoids by sharp or blunt dissection Removal of tonsils & adenoids by sharp or blunt dissection Adenoids are removed to facilitate breathing, prevent recurrent otitis media, and to restore hearing loss due to obstruction of the eustachian tube Adenoids are removed to facilitate breathing, prevent recurrent otitis media, and to restore hearing loss due to obstruction of the eustachian tube

Relevant A & P

See Video clip See Video clip

Pathophysiology Upper aerodigestive tract Upper aerodigestive tract Tonsillitis of the palatine tonsils Tonsillitis of the palatine tonsils

Terms & Definitions Hypertrophy Hypertrophy

Diagnostics Exams Exams H & P H & P Visual exam Visual exam C & S C & S Preop testing Preop testing CBC: PTT-7 minutes CBC: PTT-7 minutes

Surgical Intervention: Special Considerations OR table position OR table position Order of extraction varies Order of extraction varies Best technique (not sterile) Best technique (not sterile) Surgeon may prefer to stand or sit Surgeon may prefer to stand or sit Typical peds Typical peds Adults: under local and sitting up Adults: under local and sitting up

Surgical Intervention: Anesthesia General General Peds mask induction Peds mask induction Oral ET tube Oral ET tube Lubricate and protect eyes Lubricate and protect eyes

Surgical Intervention: Positioning Supine, neck hyperextended Supine, neck hyperextended Supplies and equipment Supplies and equipment Neck roll Neck roll Arm sleds or draw sheet Arm sleds or draw sheet Safety strap Safety strap Foam headrest or donut Foam headrest or donut Move patient to edge for ease of access Move patient to edge for ease of access Special considerations: high risk areas Special considerations: high risk areas

Surgical Intervention: Skin Prep N/A N/A

Surgical Intervention: Draping/Incision Head wrap or cover sheet Head wrap or cover sheet Peritonsillar incision Peritonsillar incision

Surgical Intervention: Supplies General General ½ sheet x 2; raytex; towels; gowns & gloves, suction tubing, ESU w/extension; small basin ½ sheet x 2; raytex; towels; gowns & gloves, suction tubing, ESU w/extension; small basin Specific Specific Suture: 2-0 plain heavy, tapered 5/8 in needle Suture: 2-0 plain heavy, tapered 5/8 in needle Meds: local of choice (marcaine or lidocaine w/epinephrine) Meds: local of choice (marcaine or lidocaine w/epinephrine) Tonsil sponges Tonsil sponges # 12 knife blade # 12 knife blade Insulated suction cautery Insulated suction cautery Syringe for irrigation Syringe for irrigation Supplies for local (needle, syringe) Supplies for local (needle, syringe)

Surgical Intervention: Instruments T & A set T & A set

Surgical Intervention: Equipment Sitting stool Sitting stool Headlamp Headlamp ? Harmonic scalpel ? Harmonic scalpel Suction apparatus Suction apparatus

Surgical Intervention: Procedure Steps See Exemplar and Procedure 17-6 STST See Exemplar and Procedure 17-6 STST

Counts Initial: sponges and sharps Initial: sponges and sharps First closing First closing Final closing Final closing Sponges Sponges Sharps Sharps

Specimen & Care Rt and left tonsils and adenoids Rt and left tonsils and adenoids Ask about separating—may “tag rt w/safety pin” Ask about separating—may “tag rt w/safety pin”

Postoperative Care Destination PACU—outpatient Destination PACU—outpatient Position pt on side once extubated Position pt on side once extubated Elevate HOB Elevate HOB Cold fluids Cold fluids Expected prognosis Expected prognosis Return to normal activities within 2 wks Return to normal activities within 2 wks Reduced incident of sore throat & ear infections Reduced incident of sore throat & ear infections

Postop Care Complications Complications Hemorrhage up to 10 days post op Hemorrhage up to 10 days post op Infection Infection Wound Classification : II—increased for inflammation or infection Wound Classification : II—increased for inflammation or infection

Resources STST Procedure 17-6 STST Procedure 17-6 STST pp. 618 STST pp. 618