Chapter 23: Tonsillitis

Question 1

Tonsillitis

Answer 1

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

Question 2

Role of the Tonsils

Answer 2

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

Question 3

Most common cause of Tonsillitis

Answer 3

• viruses
• group A beta-hemolytic streptococcus
• exposure to a viral or bacterial agent
• immature immune systems (younger children)

Question 4

Types of Tonsillitis

Answer 4

-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

Question 5

Symptoms in Acute Tonsillitis

Answer 5

• 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

Question 6

Recurrent Tonsillitis

Answer 6

presents with multiple episodes of the illness in a year

Question 7

Symptoms of Chronic Tonsillitis

Answer 7

• foul breath (halitosis)
• chronic sore throat
• foreign body sensation
• a hx of expelling foul tasting, smelly, cheesy lumps

Question 8

Symptoms of Peritonsillar Abscess

Answer 8

• 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

Question 9

Diagnosis

Answer 9

based on the presenting symptoms and inspection of the throat

Question 10

Prevention

Answer 10

• 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

Question 11

Nursing Care

Answer 11

• 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

Question 12

Medical Care

Answer 12

• antibiotics, antipyretics, and analgesics
• Penicillin, erythromycin (Erythrocin), and amoxicillin (Amoxil) are commonly prescribed antibiotics
• Cephalosporins or clindamycin (Cleocin)= more effective with chronic conditions

Question 13

Surgical Care

Answer 13

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

Question 14

After Surgery

Answer 14

-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

Question 15

Food After Surgery (Tonsillectomy)

Answer 15

-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

Question 16

Home Discharge Teaching Following a Tonsillectomy

Answer 16

• 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

Question 17

Signs of Bleeding after Tonsillectomy

Answer 17

• if the child is continuously swallowing, it is indicative of bleeding
• additional signs: restlessness, increased pulse rate, and pallor (late symptom)

Question 18

Erythromycin

Answer 18

• 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

Question 19

ATI: Tonsils

Answer 19

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

Question 20

ATI: Expected Findinga

Answer 20

• report of sore throat with difficulty swallowing

- history of otitis media and hearing difficulties

Question 21

ATI: Physical Assessment Findings

Answer 21

• mouth odor
• mouth breathing
• snoring
• nasal qualities in voice
• fever
• tonsil inflammation with redness and edema
• difficulty swallowing or eating

Question 22

ATI: Laboratory Test

Answer 22

Throat culture: group A beta-hemolytic streptococci (GABHS)

Question 23

ATI: Nursing Care

Answer 23

• provide treatment for manifestations of viral tonsillitis (rest, warm fluids, warm salt-water gargles)
• administer antibiotic therapy as prescribed for bacterial tonsillitis

Question 24

ATI: Antipyretic/analgesic

Answer 24

• acetaminophen

- hydrocodone indicated for the child having difficulty drinking fluids

Question 25

ATI: Antipyretics

Answer 25

decrease fever and manage pain - be aware of allergies - appropriate dosing for acetaminophen and ibuprofen

Question 26

ATI: Preoperative measures for Tonsillectomy

Answer 26

maintain NPO status

Question 27

ATI: Plimitostoperative Nursing Actions for Tonsillectomy

Answer 27

>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

Question 28

ATI: Client Education

Answer 28

- 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