Tonsillitis and Adenoiditis

Islamic University
Nursing College
 Tonsillitis
– Inflammation of tonsils.

– Masses of lymphoid tissue in pairs

– Often occurs with pharyngitis

– Characterized by fever, dysphagia, or respiratory

problems forcing breathing to take place through

nose
 Nurse Alert!

Key to understanding
prevention of URI is
careful hand-washing
and avoiding exposure
to infected persons.
 Nurse Alert!

The nurse should remind the

child with a positive throat
culture for strep to discard their
toothbrush and replace it with
a new one after they have been
taking antibiotics for 24 hours
 Causes

• Viral.

• Bacterial ( group A beta hemolytic

streptococci (GABHS).
 Clinical Manifestations
• Tonsillitis
– Fever
– Persistent or recurrent sore throat
– Anorexia
– General malaise
– Difficulty in swallowing, mouth breather, foul odor breath
– Enlarged tonsils, bright red, covered with exudate
• Adenoiditis
– Stertorous breathing - snoring, nasal quality speech
– Pain in ear, recurring otitis media
 Surgical treatment
• Tonsillectomy. If recurrent.
• Not recommended before 3 years of age due
to:
• Excessive blood loss.
• Tonsils grow back.
Nursing Care for the Tonsillectomy and
Adenoidectomy Patient
 Post-operative Care

• Providing comfort and minimizing activities or interventions that

precipitate bleeding
– Place on abdomen or side until fully awake
– Manage airway
– Monitor bleeding, esp. new bleeding
– Ice collar, pain meds
– Avoiding fluids until fully awake --then liquids and
soft cold foods. Avoid citrus juices, milk
– Do not use straws or put tongue blade in mouth,
no smoking (in teenagers).
Nurse Alert for Post-Op T/A surgery
• Most obvious sign of early bleeding

is the child’s continuous

swallowing of trickling blood.

• Note the frequency of

swallowing and notify

the surgeon immediately

 Epiglottitis
• Bacterial form of croup (H influenza)
with unique symptoms and treatment
• Bacterial infection invades tissues
surrounding the epiglottis
• Epiglottis becomes edematous, cherry
red and may completed obstruct airway
• Progresses rapidly, child is unable to
swallow, drooling
Cardinal signs and symptoms
• May have had mild URI few days
prior
• Drooling
• Dysphasia
• Dysphonia
• Distressed respiratory efforts
• Tripod position: supported by arms,
chin thrust out, mouth open
 ER Management
• NEVER leave child unattended
• Don’t examine or culture throat or start
IV/Blood samples
• Patent airway ASAP
• Monitor oxygenation status, (continuous pulse ox, humidified
O2)
• Antipyretics suppository
• Calm the parent! Explain what is going on…a calm
parent=calmer child!
• OR- intubation
• Throat & blood cultures done after intubation
• Usually extubated after 48h
• Antibiotics for 7-10 days
• Discharge
Nursing Interventions on unit once stable

• Continually assess for s/s of

respiratory distress
• Maintain pulse ox above 95% with PaO2
between 80-100mmHg
• Maintain patent airway
• Position for comfort (never force to lie
down)
• Relieve anxiety
• Monitor temp (antipyretics, ABX)