. Tonsillitis/Tonsillectomy

Tonsillitis An inflammation (with infection) of the tonsils which can cause significant edema of the tonsils occluding airway making the passage of food (eating) and breathing difficult.

Tonsillitis

Etiology: caused by a bacteria or virus. Most common bacterial agent is Group A beta hemolytic streptococcus. (GABHS).

Nursing Assessment: Causative agent diagnosed by throat culture. Strep infection can be diagnosed in minutes using a “rapid strep” test. Enlarged, reddened tonsils with or without exudates Sore throat, difficulty swallowing due to sever sore throat Drooling caused by the inability to swallow secretions Lymphadenopathy Mouth breathing With strep child can have very distinct foul odor in their mouth (not always but very frequent) Fever (can be quite high with strep)

Treatment: If viral, none supportive care only: promote comfort, gargling with warm salt water, Tylenol/Motrin for pain, antiseptic throat sprays, and throat lozenges. If Group A beta hemolytic strep: antibiotic therapy. First choice of treatment is penicillin If PCN allergic: erythromycin, azithromycin, clairthromycin In addition to antibiotic therapy use supportive measures for comfort.

Nursing Interventions Patient teaching if bacterial infection stress importance of finishing prescription, a complete course of prescribed antibiotics is the only treatment for GABHS. Inadequate treatment of GABHS can lead to rheumatic fever. Patients ( and parents have a tendency to stop RX once the patient is feeling better)

Tonsillectomy Done when a child has a history of recurrent tonsillitis, peritonsillar abscess or respiratory compromise from airway obstruction (sleep apnea from very large tonsils). One of the most common surgical procedures in the pediatric population. Can be done in ambulatory day surgery unit or overnight (23) hour stay in hospital. Children must be free of infection 1 week prior to surgery

Post operative Nursing care –AIRWAY, Airway, airway –Potential for post operative edema, swelling – Monitor for s/s of bleeding frequent or continual swallowing (child is trying swallowing blood from operative site) Hemorrhage from surgical site, frank bleeding from nose, mouth, between teeth.

Nuring interventions –Strict I &O NPO until awake & alert, then offer clear fluid (H20), apple/white grape juice, yellow/green/orange Jell-O), popsicles. Avoid all RED colored liquids & Jell-O, if child vomits it could be mistaken for blood. Advance diet as tolerate to soft bland diet mashed potatoes, macaroni & cheese, pudding, ice cream, oatmeal, farina etc… When tolerating full po & has voided, IV is heplocked. –Pain Medication Usually po/pr Tylenol with codeine.

Discharge Child can usually be discharged the next morning. These procedures are frequently done as a 23 hour stay (admitted 9-10 am day 1, go to OR 12noon, return to floor 2pm, discharged 6-7am day 2 (to avoid a Full day hospitalization, it is a way to get insurance companies to pay for an overnight admission for observation but it is less than 1 full day so it is cheaper)