Tonsillitis
Chapter 26
Pages: 894-896 12/13/2020 Suhaila Halasa RN, PhD, CIMI,CPT 1
Objectives
• By the end of this discussion you will be able to:
• Define tonsillitis
• Identify the etiology
• Explain the pathophysiology
• Discuss the clinical manifestations
• Discuss the therapeutic management
• Discuss the nursing care management
12/13/2020 Suhaila Halasa RN, PhD, CIMI,CPT 2
Please review the attached video
https://www.youtube.com/watch?v=oSRtTclbtsE
12/13/2020 Suhaila Halasa RN, PhD, CIMI,CPT 3
Location of tonsils
4https://en.wikipedia.org/wiki/Tonsil
Location of tonsils
https://teachmeanatomy.info/neck/misc/tonsils-and-adenoids/
Tonsils
• Masses of lymphoid tissue located in pharyngeal cavity
• Children have large tonsils than adolescents and adults (protect against URTIs)
• Pink in color
• Filter and protect the respiratory and alimentary tracts from pathogenic
organism
Waldeyer’s Ring
7https://pt.slideshare.net/MayurPatel64/tonsil-59371082/3
First line of defense against microbes
Waldeyer’s Ring
• Consists of four tonsillar structures:
• Pharyngeal/ Adenoids (roof of the
nasopharynx)
• Tubal (near the posterior nasopharynx
opening to the eustachian tubes)
• Palatine (side of the oropharynx)
• Lingual tonsils (the base of the tongue)
8
Palatine tonsils
• Visible during oral examination
• Removed during tonsillectomy
9
Tonsillitis
• Inflammation of the tonsils
• Occurs often with pharyngitis
• Common cause of illness in young children
• Caused by viral or bacterial infection 10
Etiology of Tonsillitis
• Viral (majority of infections)
• Bacteria
• Group A beta-hemolytic Streptococcus (GABHS)
• The most common cause of tonsillopharyngitis
11
Bacterial and Viral Tonsillitis
12
Infected Palatine Tonsils
13https://www.shutterstock.com/search/tonsils
Pathophysiology When tonsils get inflamed
Red, swollen (enlarge from edema) and may develop pus pockets
Discharge (exudate)
Obstruction of the passage of air or food14
Clinical Manifestations Palatine Tonsillitis
• Kissing tonsils
• Obstruction of air and food passage
• Difficulty of swallowing and breathing
• Obstruction of breathing during sleep
(chronic enlargement)https://www.sciencedirect.com/topics/medicine-and-dentistry/tonsillitis
Clinical Manifestations/Pharyngeal (Adenoid) Tonsillitis
Clinical ManifestationsPharyngeal/ Adenoid Tonsillitis
• Air cannot pass from the nose to the throat
• Child breath from mouth
• Obstruction of breathing during sleep (chronic
enlargement)
https://medlineplus.gov/ency/presentations/100076_2.htm
Clinical ManifestationsPharyngeal/ Adenoid Tonsillitis
• Mouth breathing continuous
• Dry and irritate mucous membranes
of the oropharynx
• Offensive mouth odor
• Impaired senses of taste and smellhttps://www.dhakatribune.com/uncategorized/2014/12/12/are-adenoids-deforming-your-child
Clinical ManifestationsPharyngeal/ Adenoid Tonsillitis
• Muffled and nasal voice
• Persistent cough
• Frequent otitis media (blocked ET)
• Difficulty of hearinghttps://www.slideshare.net/ophthalmgmcri/eustachian-tube-anatomy-test-and-disorders-drvijaya-sundarm-200317
Clinical Manifestations
H ttps://www.ent-surgery.com.au/ent-resources/childrens-ent/tonsillitis-symptoms-in-children/
Clinical Manifestations
21
Therapeutic Management
• Medical treatment:
• Self-limited disease
• Treatment of viral pharyngitis is symptomatic
• Throat culture positive (GABHS) antibiotic is required
Therapeutic Management
• Surgical treatment: of chronic tonsillitis is Controversial
https://www.youtube.com/watch?v=oM-8a4dGFVY
• https://www.youtube.com/watch?v=o45P_UKzDcE
• Tonsillectomy: surgical removal of palatine tonsils is indicated for:
• Massive hypertrophy (difficulty in breathing or eating)
• Peritonsillar abscess (bacterial infection that usually begins as a
complication of untreated tonsillitis)
Therapeutic Management
• PFAPA syndrome that consists of recurrent episodes OF:
• Periodic Fever
• Aphthous stomatitis
• Pharyngitis and cervical adenitis
• Airway obstruction
Therapeutic Management
• Chronic tonsillitis and non- responsive to antibiotic
• Multiple antibiotic allergies
• Tonsils requiring tissue pathology
-
Therapeutic Management
• Consideration of tonsillectomy: if tonsillitis occurs at least:
• 7 episodes in the previous year
• 5 episodes in each of the previous 2 years
• 3 episodes in each of the previous 3 years
-
Therapeutic Management
• Consideration of tonsillectomy: if tonsillitis occurs at least:
• 1 episodes and sore throat plus one of the following:
• Fever more than 38.3°C
• Cervical adenopathy (more than 2 cm)
• Presences of exudate
• Positive culture of GABHS
-
Therapeutic Management
Adenoidectomy: surgical removal of adenoid
- Hypertrophied adenoids obstruct nasal breathing
- History of 4 or more episodes of recurrent rhinorrhea in the previous 12
months (children under 12 years)
- Persisting symptoms after 2 courses of antibiotics
Therapeutic Management
Adenoidectomy: surgical removal of adenoid
- Sleep disturbances with nasal obstruction lasting over 3 months
- Hyponasal speech
- Otitis media with effusion (OME) greater than 3 months
- Dental malocclusion
- Cardiopulmonary complications
Therapeutic Management
Contraindications for surgery treatment:
• Cleft palate
• Acute infections (at the time of surgery)
• Uncontrolled systemic disease or blood dyscrasias
• Before the age of 3 or 4 years of age
Nursing Care Management
➢ Provide comfort and minimize activities that precipitate bleeding
➢Soft or liquid diet
➢Warm salt water gargles
➢Warm fluids
➢ Analgesic (every 4 hours)
➢ Antipyretic
Nursing Care Management
➢ If surgery required, child needs psychological preparation and physical care
➢Preoperative care:
➢Take complete history (bleeding)
➢Monitor vital signs
➢Observe any signs of URI
➢Obtain bleeding and clotting time
➢Assess the presence of any loose teeth
Nursing Care Management
Post operative care:
➢Position the child to facilitate drainage of secretions (Post-
tonsillectomy position)
➢Sitting up position
➢Perform suctioning carefully
➢Discourage child from coughing frequency or clearing their
throat
Nursing Care Management
Post operative care:
• Examine the throat directly for bleeding
• Observe the early sign of bleeding/postoperative hemorrhage:
• Tachycardia
• Pallor
• Restlessness
• Frequent clearing of the throat
• Continues swallowing of the trickling blood (especially during sleeping)
• Vomiting of bright red blood
Nursing Care Management
Post operative care:
➢Inspect the secretion and vomitus (fresh bleeding)
➢Observe for dark brown (old) blood
➢Give ice collar to relief pain
➢Administer analgesics IV to avoid oral route
Nursing Care Management
Post operative care:
➢Local anesthetics (tetracaine lollipops or ice pops)
➢Administer antiemetics
➢Restrict food and fluid
➢Give cool water, crushed ice and diluted fruit juice
Nursing Care Management
Post operative care:
Avoid:
➢Fluids with a red or brown color
➢Using straw
➢Citrus juice
➢Milk, ice-cream and pudding
➢Give soft food on the 1st or 2nd day postoperative
• Keep suction equipment and oxygen available
• Airway obstruction (edema or accumulated secretions)
Respiratory distress
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Nursing Care Management
Family support and home care
• Teach the child and family to avoid:
• Irritating or highly seasoned food
• Gargle or vigorous tooth brushing
• Coughing or clearing throat or putting object in the mouth
Family support and home care
• Teach the child and family to:
• Use analgesia or ice collar for pain
• Limit activities
• Observe signs of bleeding
• Inform children about postoperative discomfort
• Children go back to normal activity within 1-2 weeks after the surgery
• https://www.youtube.com/watch?v=S1jTbsMz5zc
Thank you
12/13/2020 Suhaila Halasa RN, PhD, CIMI,CPT 41