REFERENCE CARE PLAN: Tonsillectomy/Adenoidectomy Post-op

PATIENT POPULATION
This care plan is for patients who have undergone Tonsillectomy and/or Adenoidectomy surgery.
DEFINITIONS
The tonsils are two pads of tissue located on either side of the back of the throat. Tonsils can become enlarged in response to recurrent tonsil
infections or strep throat. They can also become a reservoir for bacteria.
Tonsillectomy is performed under general anesthesia either as an outpatient or with overnight observation (spending the night in the hospital).
Tonsillectomy is often performed with an adenoidectomy. The surgery takes 30 – 45 minutes and children remain at the hospital 2 – 4 hours
afterwards or overnight for observation.
The adenoids are pads of tissue found behind the nose in the throat. They cannot be seen by looking into the mouth. Adenoids can get big and
block the eustachian tube (leading to the ears) or the nasal airway (in the nose). Adenoids can also become a storage place for bacteria.
Nasal (Nose) Obstruction -Enlarged adenoids can block the nasal airway and lead to mouth breathing and snoring. Removing the adenoids, called
an adenoidectomy, allows the child to breathe normally through the nose again.
Chronic Ear Infections - Enlarged adenoids can block and allow bacteria to enter the eustachian tubes in the ear. This can lead to ear infections.
Removing the adenoids along with inserting ear tubes may help treat chronic ear infections.
An adenoidectomy is usually done as an out-patient. Your child will get medicine to make them sleep before surgery begins. The surgery takes
20-30 minutes and the child usually stays at the hospital one to two hours afterwards.

Reviewed/Revised: December 2016

Refer to online version – Print copy may not be current – Discard after use
-1-
 Problem/Potential
Objectives Anticipatory/Therapeutic Nursing Interventions Evidence-base/Rationale
Problem
Potential for airway Respiration will remain • Keep HOB elevated at least 30 degrees To ensure patient is assessed
obstruction due to easy, regular, quiet, and • Offer only cool liquids and food for tonsillectomy and ensure complications can
edema related to oxygen saturation will patients. be detected early and
surgical procedure. remain within normal • Monitor O2 saturation as ordered interventions can be initiated.
range. • Position sleeping patient to maximize open airway
(e.g. avoid neck flexion and sleeping flat on back). Snoring and mouth breathing
• Administer oxygen prn as per physician’s orders. are normal after surgery
• Notify physician immediately if increasingly noisy because of swelling. Normal
breathing, respiratory distress, or if amount of breathing should resume 10 –
oxygen required to maintain oxygen saturation is 14 days after surgery.
increasing.

Potential for Surgical site will remain • Assess skin colour, level of consciousness and vital Bleeding usually means the
bleeding related to free from bleeding signs (Temperature, Heart Rate, Respiratory Rate scabs have fallen off too early
surgical procedure and Blood Pressure –TPR and BP) with and this needs immediate
transferring RN. Confirm patient status is attention. Every reasonable
unchanged or improved from PACU. attempt will be made to control
• If patient is stable, then MONITOR vital signs: hourly the bleeding in the Emergency
x 4, then every 2 hours x 2, then as per physicians Department. Some children may
order thereafter or as per unit routine need to be taken to the
• Discourage crying, coughing, frequent clearing of Operating Room to control the
throat bleeding.
• Avoid hard objects in mouth
• Avoid sucking (ie.straws, soother)
• No red liquids , popsicles, jello, or foods with red
sauce ie.spaghetti sauce.
• Treat post-operative vomiting promptly
• No aspirin
• For adenoidectomy patients they can eat whatever
they want once they have progressed from clear
fluids to full fluids then diet as tolerated. The food
can be any temperature.
• Notify Physician immediately if any bleeding is noted.

Reviewed/Revised: December 2016

Refer to online version – Print copy may not be current – Discard after use
-2-
 Problem/Potential
Objectives Anticipatory/Therapeutic Nursing Interventions Evidence-base/Rationale
Problem
Pain related to Patient will remain • Assess for pain using appropriate pain scale q1- Establishing a pain-
surgical procedure comfortable enough to be 4h, post analgesic administration and prn. management plan based on the
able to maintain adequate • Administer ordered analgesics regularly, NOT findings from the assessment
fluid intake and sleep prn. and incorporating the person’s
• Ensure ordered analgesic dosage is appropriate beliefs and goals is important
for patient’s weight for minimizing pain and distress.
• If analgesia ineffective, notify ENT Physician
• Offer small amounts of cool fluids, popsicles, ice Unrelieved acute pain can
chips frequently cause long-term pain problems
• If a child is reluctant to drink, offer a favourite that affect body functioning
drink about one hour after analgesic is administered.
• Encourage child to talk at regular intervals and The chewing motion is
chew gum, if age appropriate, and if there is parental beneficial to relieve referred
approval. pain.
Potential for Patient will drink at regular • Measure intake and output. Note colour of urine Provides thorough assessment
dehydration due to intervals during indicating concentration/dilution. of infusion system so
inadequate fluid hospitalization • Offer preferred fluids and soft/frozen foods at complications can be detected
intake related to regular interval early and immediate
pain. • Maintain IV access and rate as per physician’s interventions can be provided in
orders a timely manner. Educates
• Monitor IV site q1h and PRN family on importance of
• Assess IV site using TLC performing the hourly site
• Teach and support families to assess IV site. assessments and engages
• Reinforce importance and benefits of maintaining them in the process
adequate fluid intake to patient and family

Potential for Surgical site will remain • Administer antibiotics if prescribed Provides thorough assessment
infection at surgical free of infection • Assist child in maintaining good oral hygiene of patients clinical status
site. (brush teeth but no gargling). including vitals, surgical wound,
• Report signs of infection (ie. Increased pain, and comfort to ensure
lethargy, general deterioration of condition) to complications can be detected
Physician. The patient may have a smell to their early and immediate
breath post-op. If the breath smell gets stronger interventions can be initiated
after they are discharged then they should notify
the physician.
Reviewed/Revised: December 2016
Refer to online version – Print copy may not be current – Discard after use
-3-
 Problem/Potential
Objectives Anticipatory/Therapeutic Nursing Interventions Evidence-base/Rationale
Problem

Anxiety related to Patient and family will
surgery and display positive coping
hospitalization skills during
hospitalization.
Discharge teaching Patient and family will
state an understanding of
information relevant to
post-op recovery and will
express realistic plans for
home care by discharge
• Orient patient/family to unit layout and routines
• Encourage parental/caregiver presence and
involvement as desired
• Encourage use of personal comfort measures i.e.
blanket, stuffy, etc.
• Prepare patient/family before any tasks or
procedures that need to be done.
• Encourage questions and discussion of
concerns.
.
• Review and ensure that the patient/family have a
copy of appropriate discharge pamphlet ‘Your
child has had a Tonsillectomy’ or ‘Adenoids and
Adenoidectomy’
• Ensure patient/family has the contact information
for ENT Clinic RN 604-875-2345 local 7053 or toll
free 1-888-300-3088 local 7053. Voicemail also
includes how to contact the ENT Resident on Call
Having open, reliable and
timely information available
regarding the plan of care for
family members and caregivers
increases families’ satisfaction
with the hospital experience.
To ensure the family
understands and is prepared to
care for the child at home with
the necessary equipment and
prescriptions as required

CROSS-REFERENCES
Any related policies/procedures, other care plans, teaching flow sheets, patient/family teaching resources, etc.
Nursing Assessment and Documentation
http://bccwhcms.medworxx.com/Site_Published/bcc/document_render.aspx?documentRender.IdType=30&document
Pre and Post-Operative Care
http://bccwhcms.medworxx.com/Site_Published/bcc/document_render.aspx?documentRender.IdType=30&document
Pamphlet ‘Your child has had a Tonsillectomy’

Reviewed/Revised: December 2016

Refer to online version – Print copy may not be current – Discard after use
-4-
http://www.cw.bc.ca/library/pdf/pamphlets/BCCH1026A_PainMedTonsillectomy.pdf
Pamphlet ‘Adenoids and Adenoidectomy’
http://www.cw.bc.ca/library/pdf/pamphlets/BCCH1648_AdenoidsAdenoidectomy_2013.pdf
Pamphlet ‘Helping Your Child when Tonsils/Adenoids are Removed’
http://www.cw.bc.ca/library/pdf/pamphlets/BCCH1026_TonsilsAdenoidsRemoved_2013.pdf

REFERENCES

Lewis, S.M., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems
(9th ed.). St. Louis: Mosby

Registered Nurses’ Association of Ontario. (2007) Assessment and management of pain. Best Practice Guidelines. Retrieved March 8th, 2016 from:
http://rnao.ca/bpg/guidelines/assessment-and-management-pain

https://www.cincinnatichildrens.org/health/t/tonsillectomy

Comp, D. (2011). Improving parent satisfaction by sharing the inpatient daily plan of care: An evidence review with implications for practice and
research. Pediatric Nursing, 37(5), 237-242 6p.

Reviewed/Revised: December 2016

Refer to online version – Print copy may not be current – Discard after use
-5-