Case Presentation OF Acute Tonsillitis: Nueva Ecija University of Science and

Republic of the Philippines
NUEVA ECIJA UNIVERSITY OF SCIENCE AND

Cabanatuan City, Nueva Ecija, Philippines
ISO 9001:2015 CERTIFIED
COLLEGE OF NURSING
CASE PRESENTATION
OF
ACUTE TONSILLITIS
Prepared by: BSN II-C
Datu, Beverly Jane L.
De Lara, Bianca Jesmine
Del Rosario, Trixie DC.
Domingo, Precious Mae
Transforming Communities through Science and Technology Contact No.Contact

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neustcollegeofnursing@gmail.com
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TABLE OF CONTENTS
Table of Contents……………………………………………………………………2
Table and Figures…………………………………………………………………...4
Chapter 1……………………………………………………………………………..5
General Objectives……………………………………………………………5
Specific Objectives……………………………………………………………5
Introduction …………………………………………………………………..6
Client’s Information…………………………………………………………..7
I. Client’s profile……………………………………………………...7
II. Presenting Complaints……………………………………………..7
III. Family History……………………………………………………7
IV. History of Past Illness……………………………………………..7
V. Birth History……………………………………………………….7
VI. Immunization……………………………………………………..8
VII. Drug History……………………………………………………..8
VIII. Admitting History ………………………………………………8
IX. Admitting Vital Signs…………………………………………..…8
X. Status of present Illness…………………………………………….9
X1. Physical Examination……………………………………………..9
Chapter 2 ……………………………………………………………………………12
Definition of the case…………………………………………………………12
Anatomy and physiology…………………………………………………….13
Pathophysiology (book-based) ………………………………………………15

Pathophysiology (client-based) ……………………………………………...17
Risk factors …………………………………………………………………..19

Clinical manifestation ………………………………………………………..19
Medical management ………………………………………………………...19
Nursing management ………………………………………………………....20
Chapter 3 …………………………………………………………………………….21

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Chapter 4 …………………………………………………………………………….24
Nursing Care Plans ……………………………………………………………24
Chapter 5 ……………………………………………………………………………..30
Drug study …………………………………………………………………….30
Chapter 6
Evaluation and findings ……………………………………………………….35

Recommendation ……………………………………………………………...36
References

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TABLES AND FIGURES CONTENT
Tables
Table 1. Physical Examinations…………………………………………………9
Table 2. Clinical Manifestation…………………………………………………..19
Table 3. CBC Test Result of the Client………………………………………………………………….22
Figures
Figure 1. Lymphatic system………………………………………………………13
Figure 2. Tonsil location…………………………………………………………..14
Figure 3. Pathophysiology (Book Based) …………………………………………15
Figure 4. Pathophysiology (Client-based) ………………………………………17

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CHAPTER I
General Objective:
As a level 2 NEUST-CON student nurse, the general objective of this case study is to gain more
knowledge and understanding about the illness, improved our skills as well as our attitude in
dealing with various clients, perform basic nursing skills with confidence and competence and to
provide an appropriate nursing management to a pediatric client with Acute Tonsillitis.
Specific Objective:
1. Perform a head-to-toe assessment focusing on parts affected by the Acute Tonsillitis;

2. Understand and define the causes of Acute Tonsillitis;
3. Obtain, document, and provide a comprehensive medical history;
4. Explain the anatomy and physiology of the Tonsil;
5. Understand the pathophysiology of Acute Tonsillitis;
6. Recognized the different medications used, its action in the management of Acute
Tonsillitis;
7. Know the suggested medical management used to address Acute Tonsillitis; and to
8. Formulate a specific Nursing Care Plan.

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INTRODUCTION
The palatine tonsils are commonly referred to as 'the tonsils'. They are located within the
tonsillar bed of the lateral oropharynx wall – between the palatoglossal arch (anteriorly) and
palatopharyngeal arch (posteriorly). They form the lateral part of the Waldeyer's ring. The
tonsils' job is to help fight germs that come in through our mouth or nose before they cause
infections in the rest of the body. Usually, tonsils do their job well. But sometimes bacteria or
viruses get into the tonsils and infect them. When this happens, you have tonsillitis.
Tonsillitis is most common in children and adolescents. The inflammation usually

extends to the adenoid and the lingual tonsils; therefore, the term pharyngitis may also be used.
Most cases of bacterial tonsillitis are caused by group A beta-hemolytic Streptococcus pyogenes.
Tonsillitis usually clears up on its own in 4 to 10 days. Tonsillitis is not infectious, but
the illnesses that cause it, such as colds and flu, are. Stay off work or leave the child at home
until the parent and the child is healthier to prevent these diseases from spreading. When the
person with tonsillitis cough or sneeze, use tissues to throw them out. If tonsillitis is left
untreated, a complication can develop called a peritonsillar abscess. This is an area around the
tonsils that's filled with bacteria, and it can cause these symptoms: Severe throat pain and
Muffled voice.
This Case Study will discuss about Acute Tonsillitis as well as it’s different causes,
specific signs and symptoms, medical management and other complication; the different nursing
intervention that are applicable to the condition.
Death cases rarely happened; however, tonsillar infection may result in serious and even life-
threatening manifestations with a reported overall mortality rate of 1/1000–1/27,000. Lethal
complications of acute tonsillitis include progression of sepsis and the development of airway
obstruction.

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I. CLIENT’S INFORMATION
Name: Client A
Age: 7 years old
Gender: Male
Date of Birth: February 24, 2014
Place of Birth: Cabanatuan City
Address: Mabini St. Cabanatuan City
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: April 7, 2021
Time: 10:00 AM
Attending Physician: Dr. Y
Admitting Diagnosis: Dysphagia
Final Diagnosis: Acute Tonsillitis
II. Presenting Complaints
 Sore throat
 Dysphagia
 Fever
 Loss of appetite
 Enlarged lymph nodes in neck
 Reddened and enlarged tonsil
III. Family History
No family history of any diseases related to Tonsillitis.
IV. History of Past Illness
The client had fever due to common cold 1 month ago.
V. Birth History
Birth Weight: 3.5 kg

Length: 50 cm

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VI. Immunization
-Hepatitis (B)
- Hepatitis (A)
-BCG
-Polio (IPV)
-Measles, mumps, and rubella (MMR)
-Chickenpox (Varicella)
-Influenza (Flu) (every year)
- Diphtheria, tetanus, and whooping cough (pertussis) (DTaP)
VII. Drug History
Generic Name: Paracetamol

Brand Name: TEMPRA
TID, PO
Adverse effects: No side effects
Generic Name: Phenylephrine HCl + Chlorphenamine Maleate

Brand Name: Disudrin
QID, PO
Adverse effects: Constipation, skin rash, difficulty of breathing, seizures, irregular heartbeat
VIII. Admitting History
A 7-year-old client named Client A, Roman Catholic, born on February 24, 2014, and
living in Mabini St., Cabanatuan City was admitted at 7th day of April 2021 at 10 am by
referring from Dr. Y, the client experiences difficulty in swallowing, sore throat, fever, and loss
of appetite. The mother is the primary historian and is deemed reliable.
IX. Admitting Vital Signs
T: 38.9 C
P: 92 Beats/ mins
R: 22 Breaths/mins
BP: 95/70 mmHg
During the initial assessment, the client was feeling the sensational of hard swallowing saliva.
The mother stated that the child cries often as a result of sore throat.

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X. Status of present Illness
Five days prior to admission, the client manifested sore throat and difficulty in
swallowing foods. No consultation has done.
Two days prior to admission, the client developed moderate grade fever
associated with decreased of appetite, body weakness and cried many times.
Few hours prior to admission, persistence of above condition, prompt to consult to

a hospital in Cabanatuan City. The Mother stated that the condition of her child worsened
as she seems to noticed breathy raspy voice and having poor appetite as the result of
imbalance nutrition. She also noticed how her child cries often while taking care of her
child.
X1. Physical Examination
The table below shows the physical assessment of the client from head to toe.
Name: Client A
Age: 7 y/o
Date of Assessment: April 7, 2021
General Appearance Normal Actual findings Interpretation and
Analysis
Mood and effect Normally calm Slightly Irritated The client has discomfort
The client has a sign of

Posture Relaxed and Uncoordinated weakness.
coordinated movement noted.
movement
The client has good proper
Hygiene and Well cleaned, He has a pleasant hygiene.
Grooming presentable odor, well cut nail
and neatly combed
hair
Presentable.
Types of clothing Accurate to the He wears polo shirt
environment and pants.
He possesses signs of
Quantity and quality Having a good He can’t talk weakness and fussiness.
of speech quality of speech properly and sore
throat is presence.
He was responsive but
Relevance and Well good, having He was slightly fussiness is presence
organization of good decisions participating.
thoughts

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VITAL SIGNS
Moderate hyperthermia.
0 0 0
Body Temperature 36.5 C to 37.5 C 38.9 C Normal Range of Pulse rate.
Pulse Rate 90 to 110 bpm 92 bpm Normal range of respiratory

rate.
Respiratory Rate 18 to 30 cpm 22 cpm
Normal weight.
Weight
17 to 23 kg 17 kg.
Body Parts Normal Findings Actual Findings Interpretation and

Analysis
Skin The skin normally uniform, He has smooth, brown Not normal
whitish pink or brown in color and lesion free skin but
depending on the race of the warm to touch.
The client’s skin was
client. No strong odor should be
evident and the skin should be warm to touch due to
lesion free
fever.
Head The head should be He has smooth, non- Normal
normocephalic and symmetrical,
tender and without
normal skull is smooth, non-
tender and without masses and masses and depression
depression.
Eyes The eyes are normally aligned, His eyes are aligned; her Not normal
there should not have excessive pupils are equally round
discharge from lacrimal duct. and reactive to light.
Pupils are normal and reacted to Teary eyes were reflected
light around the tear duct. The causation of
teary eye was the
expressions of pain.
Ears Should be position centrally in No discharges noted Normal
proportion to the head.
Nose It is located symmetrically in the The nose and Normal

middle of the face and must not nasopharynx function to
have presence of lesion and humidify, filter and warm
masses. inspired air
Mouth The lips and membranes should The buccal mucosa Abnormal
be pink and moist and to show appeared not moist and
no evidence of lesions and has yellow tonsillar
Visible bright-red,
inflammation. exudate.
enlarged tonsils;
yellow tonsillar
exudate.
Neck Neck is straight The client’s neck is Not normal
No visible mass or lumps straight.
No jugular venous distention There are palpable lumps

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assessed on the client's
neck Presence of palpable
lumps
Chest Symmetrical. Bronchovesicular Chest is symmetrical, Normal

sounds and unblemished skin Unheard Wheezes upon
Good capillary refill. auscultation
Nails/Fingers Symmetrical Absence of bluish bed Normal

/Toes nails; no tenderness and
lesions.
Table 1. Physical Examinations
CHAPTER II

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DEFINITION OF THE CASE
Tonsillitis is inflammation of the tonsils, two oval-shaped pads of tissue at the back of the
throat — one tonsil on each side. It's usually caused by a viral infection or, less commonly, a
bacterial infection. Signs and symptoms of tonsillitis include swollen tonsils, sore throat,
difficulty swallowing and tender lymph nodes on the sides of the neck
Children’s pharyngeal tonsils (adenoids) are two glands of tissue visible in the back of
the throat. The tonsils function to help your child’s immune system protect the body from
infections. When the tonsils become infected with a virus or bacterial infection, it is called
tonsillitis - meaning inflammation of the tonsils. Tonsillitis is a very common childhood illness,
typically affecting school-aged children, aged four to sixteen.
A complication of tonsillitis is a peritonsillar abscess, which happens when the infection

spreads behind the tonsils. When this happens, early treatment is necessary because swollen
tissue in the neck and chest can possibly block your child’s airway.

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ANATOMY AND PHYSIOLOGY
Figure 1. Lymphatic system

(Encyclopedia Britannica, 2013)
LYMPHATIC SYSTEM
The lymphatic system is a network of tissues and organs that help rid the body of toxins,
waste, and other unwanted materials. The lymphatic system transports lymph, a fluid containing
infection-fighting white blood cells throughout the body. It consists of lymphatic vessels similar
to the veins and capillaries of the circulatory system. The tonsils are part of the lymphatic
system. They are large clusters of lymphatic cells found in the pharynx.

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Figure 2. Tonsil location

(WebMD, 2009)
IMMUNE SYSTEM
The immune system is a complex group of defense responses found in humans and other
advanced vertebrates that helps repel disease-causing organisms (pathogens). It keeps record of
every microbe it has ever defeated so it can recognize and destroy the microbe quickly if it enters
the body again. The tonsils are the immune system’s first line of defense against microbes that
enter the mouth. This function makes the tonsil particularly vulnerable to infection and
inflammation.
TONSILS
Tonsil is a small mass of lymphatic tissue located in the wall of the pharynx at the rear of
the throat of humans and other mammals. In humans, the term is used to designate any of three
sets of tonsils, most commonly the palatine tonsils. These are a pair of oval-shaped masses
protruding from each side of the oral pharynx behind the mouth cavity. The exposed surface of
each tonsil is marked by numerous pits that lead to deeper lymphatic tissue. Debris frequently
lodges in the pits and causes inﬂammation, a condition called tonsillitis.
The function of the palatine tonsils is thought to be associated with preventing infection
in the respiratory and digestive tracts by producing antibodies that help kill infective agents.
Frequently, however, the tonsils themselves become the objects of infection. (Encyclopedia
Britannica,2020)

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PATHOPHYSIOLOGY (BOOK-BASED)
ENTRY OF PATHOGENS
TRIGGERING OF MAST
CELLS
RELEASE OF INFLAMMATORY
MEDIATORS
INFLAMMATION OF THE
TONSILS
DEVELOPMENT OF RELATED SIGN

AND SYMPTOMS

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Figure 3. Pathophysiology (Book Based)

(Hitt, M. E., Zoran, D. L. (2008) Handbook of Small Animal Practice (Fifth Edition))
Microorganisms that penetrate the tonsillar epithelium are phagocytized and processed by
macrophages, presented to B and T lymphocytes, and subsequently stimulate both humoral and
cell-mediated immune responses. Lymphoid hyperplasia and reactivity occur when chronic
infection overwhelms the tonsillar defense mechanisms. A ring of lymphoid tissue encircles the
pharynx, forming a protective barrier against upper respiratory infection. This ring consists of
groups of lymphoid tonsils, including the faucial, the commonly known tonsils; pharyngeal,
known as adenoids; and lingual tonsils. Lymphoid tissue normally enlarges progressively in
childhood between the ages of 2 and 10 years and shrinks during preadolescence. If the tissue
itself becomes a site of acute or chronic infection, it may become hypertrophied and can interfere
with breathing, may cause partial deafness, or may become a source of infection in itself.

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PATHOPHYSIOLOGY (CLIENT-BASED)
v
Modifiable Factors: Non-modifiable
Playing outside Factors:
(Too exposed to Age

microorganisms) (School age: 5 – 10
Bacteria or virus enter the body through years old)
Poor hand hygiene
the nose and mouth
(Microorganisms in Sex
client’s hand may be put (Male)
into his mouth causing Bacteria or viruses are filtered in the
bacteria to enter) tonsils which helps in alerting immune
system
Unhealthy Lifestyle
(Child prioritizes to play Bacteria or viruses begins to infect the
than to eat causes a weak tissue around the tonsil
immune system)
Environment Immune cells in the tonsil recognize the
microbes and alerts the immune system
(Poor sanitation may
expose the client to
pathogenic
Immune system sends a barrage of cells
microorganisms)
(WBC) to destroy the microbes.
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There are several factors that causes tonsillitis such as age, sex, environment, and lifestyle. It is
one of the most common illness of children due to being exposed outside while playing which
made them to become more vulnerable to microorganisms and poor hygiene makes the bacteria
and viruses to easily enter the body. Nose and mouth are the passage for the bacteria and viruses
to enter the body but these will be filtered in the tonsils and as these microorganisms were
detected by the tonsils, white blood cells will work in fighting the infection which result to have
an inflamed tonsil and some symptoms persists such as sore throat, dysphagia, fever, loss of
appetite, enlarged lymph nodes in neck, and reddened and enlarged tonsils resulting to Acute
Tonsillitis.
Without immediate treatment for the infection, the condition of the person will worsen.

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RISK FACTORS
Risk factors for tonsillitis include:
Young age. Tonsillitis most often occurs in children but rarely in those younger than age
2. Tonsillitis caused by bacteria is most common in children ages 5 to 15.
Frequent exposure to germs. School-age children are in close contact with their peers
and frequently exposed to viruses or bacteria that can cause tonsillitis.
CLINICAL MANIFESTATION
BOOK-BASED CLIENT-BASED
 Fever  Fever
 Sore throat  Sore throat
 Tonsillar exudates  Dysphagia
 Foul Breath  Loss of appetite
 Tender cervical lymph nodes  Reddened and enlarged tonsil
 Odynophagia  Enlarged lymph nodes in the neck
 Dysphagia
Table 2. Clinical Manifestation
MEDICAL MANAGEMENT
Treatment for tonsillitis depends on the cause. If the cause is a virus, there is no medicine to treat
it. If the cause is a bacterial infection, such as group A Streptococcus bacteria, the client will
need to take some antibiotics. It is important to finish the antibiotics even if he feels better. If
treatment stops too soon, some bacteria may survive and may re-infect the client.
These are the things that can help for the client to feel better. Make sure the client:
 Gets a lot of rest

 Drinks plenty of fluids
 Tries eating soft foods if it hurts to swallow
 Tries eating warm liquids or cold foods like popsicles to soothe the throat
 Sleeps in a room with a humidifier
 Gargles with salt and water
 Sucks on a lozenge (but do not give them to children under four; they can choke on them)
 Takes an over-the-counter pain reliever such as acetaminophen. Children and teenagers
should not take aspirin.

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NURSING MANAGEMENT
 Relieve pain. administer pain medication as ordered; encourage the mother to remain at
the bedside to provide soothing reassurance; crying irritates the raw throat and increases
the child’s discomfort; thus, it should be avoided if possible.
 Encourage fluid intake. record intake and output until adequate oral intake is
established. Without proper hydration, the oral mucosa is more vulnerable to damage and
to protect deeper tissues, muscle, nerve and blood supplies from mechanical insults, such
as trauma during chewing, and also prevents the entry of bacteria and some toxic
substances into the body.
 Recommend Soft and liquid diet. to ease difficulty in chewing and/or swallowing
 Provide family teaching. family constitutes an important source of psychological
stability for the client, as well as a source of support for better recovery.

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CHAPTER III
Since studies have no part in the diagnosis or treatment of tonsillitis, laboratory testing is
not regularly conducted. Laboratory tests, on the other hand, can be helpful in verifying a history
of GABHS infection in clients who have other GABHS-related disorders, such as rheumatic
fever and heart disease.
Evaluation for tonsillitis includes physical examination, risk stratification by scoring
systems, and consideration of rapid antigen testing and/or throat culture and other laboratory
tests. Imaging is rarely necessary for uncomplicated infections.
Modified Centor score

This scoring system uses the following criteria: the presence of a fever, tonsillar enlargement
and/or exudates, tender cervical lymphadenopathy, and absence of a cough. The information
from a thorough history and physical exam are needed to calculate the Centor score.
Rapid Streptococcal Antigen test

It is used to identify the presence of Group A beta-hemolytic Streptococcus pyogenes (GABHS).
Antigens are substances that cause an immune response. A rapid strep test can provide results in
10–20 minutes. If a rapid test is negative, but the physician thinks that the child has strep throat,
he or she may order a throat culture.
If the rapid in-clinic test comes back positive, then the child almost certainly has a bacterial
infection. If the test comes back negative, then your child likely has a viral infection. The
physician will wait, however, for the more reliable out-of-clinic lab test to determine the cause of
the infection.
Throat swab for Culture

It is performed by using a throat swab to detect the presence of group A streptococcus bacterium,
the most common cause of strep throat. It provides a more accurate diagnosis than a rapid test,
but it can take 24–48 hours to get results.
Monospot test for EBV

The mononucleosis test is used to help determine whether a person with symptoms has infectious
mononucleosis (mono). The test is used to detect proteins in the blood called heterophile
antibodies that are produced by the immune system in response to an Epstein-Barr virus (EBV)
infection, the most common cause of mono. Epstein-Barr virus (EBV) infection usually occurs in
early childhood and may persist in tonsillar lymphocytes, thus leading to the onset of recurrent
tonsillitis.
Complete Blood Cell count (CBC)

A blood test known as complete blood cell count (CBC) to identify the cause of the infection. A
high white blood cell count or the presence of abnormal cells is an indication of a viral infection.
A CBC is not often needed to diagnose strep throat. However, if the strep throat lab test is
negative, the CBC may be needed to help determine the cause of tonsillitis.
CT imaging
CT imaging of the neck with intravenous contrast to exclude dangerous causes such as abscess,
Lemierre disease, and epiglottitis. It can be done if complicated infections, including clients with

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unstable vital signs, toxic appearance, inability to swallow, inability to tolerate oral intake, or
trismus, occurred.
 COMPLETE BLOOD COUNT

Table 4. CBC Test Result of the Client.
Complete Blood Count (CBC)
Normal Results Interpretation Clinical
Significance
WBC 5.00 - 10.00 g/L 11.00 g/L Not Normal Elevated WBC
count to fight
infection
RBC 4.50 – 5.20 L 5.00 L Normal No risk of anemia
and
erythrocytosis
Hgb 140 – 170 g/L 125 g/L Normal No risk of anemia
No risk of
Platelet 200 – 400 g/L 351 10 g/L Normal thrombocytopenia
Test Purpose
RBC An RBC count is a blood test that measures how many red blood cells (RBCs) you have.
WBC A WBC count is a blood test to measure the number of white blood cells (WBCs) in the
blood. WBCs are also called leukocytes.
HGB The hemoglobin test is often used to check for anemia, usually along with a hematocrit or as part
of a complete blood count (CBC)
HCT A hematocrit test measures how much of your blood is made up of red blood cells. Red blood cells
contain a protein called hemoglobin that carries oxygen from your lungs to the rest of your body.
Platelet A platelet blood count is a blood test that measures the average number of platelets in
the blood. Platelets help the blood heal wounds and prevent excessive bleeding. High or
low platelet levels can be a sign of a severe condition.
CHAPTER IV
NURSING CARE PLAN

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Assessment Diagnosis Outcome Planning Intervention Evaluation
identification
Subjective: Hyperthermia After 1 hour of SHORT TERM: Independent: After 1 hour of
related to nursing nursing
”Nilalagnat After 1 hour of Establish rapport
inflammation intervention, the intervention,
po ang anak nursing
of tonsils as client’s body - Building rapport aims the client’s
ko kagabi pa.” evidenced intervention, the
temperature will to get the client’s trust body
As verbalized by increased client’s body
decrease from and cooperation to temperature
by the client’s temperature temperature will
38.9 C to 37 C render an effective will decrease
mother (38.9 C) decrease from
but fever may nursing care from 38.9 C to
Warm to 38.9 C to 37 C
reoccur due to 37 C but fever
touch, and infection. Do tepid sponge bath to may reoccur
reddened lower the client’s body due to
enlarged temperature infection.
Objective:
tonsil - To facilitate the body
 Warm
in cooling down and
to provide comfort.
touch
 Redde Eliminate excess Goal was met.
ned clothing or covers.
and
-Exposing skin to room
enlarg
air decreases warmth
ed
and increases
tonsils
evaporative cooling.
Promote oral fluid
 Palpab intake.
le - Without proper
lymph nutrition and hydration,
node the oral mucosa is more
in the vulnerable to damage
neck and this will prevent
V/S: dehydration
Prepare soft diet foods
as prescribed such as
T: 38.9 C warm oatmeal, mashed
potatoes, broth, soups
P: 92 bpm and porridge
R: 22 cpm -soft diets are
recommended for the
BP: 95/70 client with dysphagia to
mmHg avoid irritating the
inflamed tonsils while
meeting the client’s
nutritional needs
Use cotton clothes
-cotton is a strong
water absorber helps

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absorb the sweat and to
make client
comfortable.
Wipe off the sweat of
the client.
Advice mother to make
a gargle with warm
water and salt.
- This relieves the
client’s sore throat
although this is only
short-lived.
Educate the mother
about the possible
causes of tonsillitis.
-The information will
be able to help in
preventing tonsillitis to
reoccur.
Dependent:
Administer antipyretic
medication every 4
hours.
-To reduce fever.
Follow the frequency of
medication because
temperature may rise
again due to infection
Advice the mother to

continue the prescribed
antibiotics by the doctor
even if symptoms
subside. (10 days)
- To completely destroy
the bacteria and
prevent resistance of
the bacteria from the
antibiotic.

identification
SUBJECTIVE: Acute After 1-2 hours SHORT INDEPENDENT: After 2 hours of
pain of nursing nursing intervention,

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“Halos maiyak related to intervention, the TERM: Establish rapport the client’s pain
siya sa sakit pag swelling client will -Effective scale decreased from
exhibit After 1-2 communication is the 8/10 to 5/10.
nilulunok nya of both
improvement in hours of foundation on which
ang kanyang tonsils as nursing
pagkain.” As evidenced comfort level a you can establish trust After 2 days of
report decreased intervention, with the client. This nursing intervention
verbalized by the by the client will
in pain from will build trust and the client will exhibit
client’s mother. presence exhibit
8/10 to 5/10. familiarity with the improvement in
of pain improvement
Pain scale: client that can make comfort improve
upon in comfort them feel more
8/10 swallowin level a report appetite from poor to
comfortable and be
g decreased in fair, appeared relax
more honest when
reddened pain from and the client can
talking you with about
OBJECTIVE and 8/10 to 6/10. eat properly without
their health.
V/S: enlarged the presence of pain
T: 37.5 0C LONG Monitor vital sign upon swallowing.
tonsils,
PR: 119 bpm TERM: -this will serve as the
weak in
RR: 22 cpm appearanc baseline data
At the end of
 Palpable e, crying, Goal was met.
2 days of Promote oral fluid
lymph node and nursing intake.
on the neck irritable. intervention
the client will -Without proper
 Weak in
exhibit nutrition and
appearance.
improvement hydration, the oral
 Crying in comfort mucosa is vulnerable
improve to protect deeper
 Irritable
appetite from tissues, muscle, nerve
poor to fair, and blood supplies
and will be from mechanical
able to eat insults, such as
properly trauma during
without the chewing, and also
presence of prevents the entry of
pain upon bacteria and some
swallowing. toxic substances into
the body.
Teach and
demonstrate deep
breathing
-it helps the client to
relax, it also reduces
muscle tension
thereby lit can lessen
the pain.
Encourage to do
diversional activities
such as watch tv,
playing gadgets or
listening to music

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COLLEGE OF NURSING
-These activities will
divert the attention of
the client and lessen
the pain felt by the
client.
Avoid giving sweets

and cold beverage to
the client.
- Bacteria proliferate
faster in sweet
environment.
DEPENDENT:
Administer analgesics,
as indicated by the
doctor’s order to
maximum dosage, as
needed.
–to maintain
“acceptable” level of
pain.
Advice the mother to
continue with the
prescribed antibiotics
as given by the
physician even if
symptoms subside.
- To completely
destroy the bacteria.
This also prevents the
resistance of the
bacteria from the
antibiotic.
Instruct the client’s

mother to gargle
bactidol as prescribed
-this will help to
decrease the presence
of bacteria on
pharynx area.

Identification

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COLLEGE OF NURSING
CHAPTER V
DRUG STUDY
Name of Mechanism Dosage Indication Contrain Adverse Nursing Responsibility
the drug of Action dication Effect
Generic Inhibition of For Hypersens CNS: Before:
Name: prostaglandi reducing itivity to Headache
6-12 Observe 12 rights of medication
n synthesis, fever and acetamino
Paracetamo years old:
primarily for the phen. Check that the client is not taking
l 5-10 ml
within the temporary CV: any medication containing
(1-2 tsp)
central relief of paracetamol
nervous minor Chest
Not
Brand system. The aches, pain, Educate the client’s mother:
intended
Name: predominant Frequen pains and dyspnea
for long- That the drug cannot be taken
influence on cy: discomfort
TEMPRA term use more than four times a day and it
Forte the TID- associated in clients cannot be taken for longer than
thermoregul with the with GI:
QID 10 days.
ation center common anemia or Hepatic
in the Stock on colds or with heart, During:
Classificati toxicity
hypothalam hand: flu. lung,
on: and Use medical syringe or soluble
us, enhances 250mg/5 kidney, failure, paracetamol mixed with a drink if
Analgesics heat and liver
mL jaundice the child refuse to take medicine
(Non- transfer. disease. through spoon or cup.
Opioid) &
Antipyretic Ensure that the client has taken
GU:
s the drug,
Acute
After:
kidney
failure, Advise the mother that do not use
renal other OTC preparation. Consult
tubular the physician first.
necrosis
Advise the mother that if
Hypersen symptoms persist for more than
sitivity three days, consult the
prescribing practitioner.
Rash,
fever Keep all paracetamol well out of
the reach of children

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COLLEGE OF NURSING
Name of the Mechanis Dosage Indication Contraind Adverse Nursing
drug m of ication Effect Responsibility
Action
Generic Erythromy Exact dose: Pertussis Contraindic Nausea, Before:
name: cin is a ated in
50mg Observe 12 rights
Erythromycin bacteriostat client with
of medication
ic Penicillin known vomiting,
antibiotic, allergic hypersensit Assess the
which Stock on hand: ivity to
Brand name: rheumatic fever physical site of
Erythrocin means it 50 mg/5mL prophylaxis erythromyc diarrhea, the client such as
prevents in, or any the site of
Classification the further other infection; skin
: macrolide growth of macrolide. color, lesions;,
Campylobacter stomach
antibiotics bacteria Erythromy hearing tests;
infection pain/cramp
rather than cin is ing, adventitious
directly contraindic sounds; GI
destroying Uncomplicated ated in output, bowel
it. This genital infection clients sounds, liver
loss of
action taking in evaluation;
appetite
occurs by terfenadine culture and
inhibiting , sensitivity tests of
Mycoplasma
protein astemizole infection,
pneumonia
synthesis. or urinalysis, LFTs
cisapride.
Monitor vital
signs especially
heart rate for
arrhythmias
Take oral drug on

an empty
stomach, 1 hour
before or 2–3
hours after meals,
with a full glass
of water.
During:

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COLLEGE OF NURSING
Ensure the client
is taking his
prescribed
medication as
ordered.
After:
The drug should
be taking only as
prescribed by the
physician. Do not
take more; take it
as the doctor’s
ordered.
Observe for signs

of adverse effects
eg. diarrhea,
vomiting, allergic
reactions.
Observe for any

changes of the
intake of drug that
may cause
changes in heart
rhythms. Contact
the doctor right
away if the client
has worsening
symptoms of
heart rhythm
problems, such as
fast, pounding, or
uneven heartbeat.

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COLLEGE OF NURSING
Name of the Mechanism Dosage Indications Contraindi Adverse Nursing
Drug of action cation reaction Responsibility
Before:
Generic Oral It is a Penicillin - Diarrhea
Name: Augmentin is suspensio combination hypersensiti Check the 12 rights
a prescription - nausea before
n: 30 penicillin- vity.
amoxicillin medicine used administering the
mg/kg/day class - abdominal medication
clavulanate to treat the antibacterial pain
symptoms of and beta-
many different Stock on - rash To minimize the
Brand Name: lactamase potential for
infections hand: 125
Augmentin inhibitor - urticaria gastrointestinal
caused by mg/5 mL
indicated in intolerance,
Classification: bacteria. the treatment - vomiting Augmentin should
of infections - anaphylaxis be taken at the start
Broad- due to of a meal.
spectrum susceptible
penicillin isolates of the During:
designated
bacteria Stay with the client
until the medicine
is taken
After:
Keep the medicine
out of reach of the
children
Check for any sign
of adverse effect.

(044) 600-3970
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www.neust.edu.ph
COLLEGE OF NURSING
CHAPTER VI
EVALUATION AND FINDINGS
After conducting all the study, we were able to appreciate more the essence of utilizing the
nursing process by providing clinical care and management for our client. The client’s condition;
Tonsillitis is an infection of the tonsils at the back of your throat. It is a common childhood
illness, but teenagers and adults can get it too. The nature of illness was concluded when the
medical biodata was scrutinized and analyze as the result of a higher probability of recurrent
sickness that may experience of the client. The student nurses acknowledge the feasible risk of
the disease that may encountered of the client’s internal structure; includes palatine tonsils and
the poles of tonsils that signalize the breaking down of its causes and identifying the overall
disease. However, it classified the needs of nursing intervention for the accessible eminence of
the treatment; to retrieve the wellness of physical structure of the client.
Since this infection is repetitive, Tonsillitis is an inflammation of the tonsils most
commonly caused by viral or bacterial infection. The crypts or pockets can form in the tonsils
where bacteria can store. Frequently, small, foul smelling stones are found within these crypts
that are made of high quantities of sulfur. These stones cause a symptom of a full throat or a
throat that has something caught in the back. Early diagnosis is an important factor in terms of
successful treatment process and to reduce the mortality rate. This study will benefit the nursing
students because it illustrates the importance of being aware of the difficulties in detections of
pneumonia in younger children and it also provides adequate knowledge that the nursing
students can use as a basis that will help to improve their skills on how to properly assess the
client in a real life situation.
Every client deserved the rightful care from their health providers. This rightful care will
only be achieved if their providers are equipped with proper knowledge, skills and attitude
essential for the management of fracture. Understanding the mechanism of acute tonsillitis as
well as the process of which the client is going through creates an opportunity for student nurses
to provide a holistic care and help the client to lessen the worries and fears.

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COLLEGE OF NURSING
RECOMMENDATION
From the foregone conclusions the following recommendations are drawn.
Medication
 Take the entire course of any prescribed medications. It's because taking them
regularly until the prescription is complete helps ensure that all of the illness-causing
bacteria are killed or prevented from multiplying.
Environment/Exercise
 Avoid irritants. Keep your home free from cigarette smoke and cleaning products that
can irritate the throat.
 Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a
sore throat, or sit with your child for several minutes in a steamy bathroom
Treatment
 Prepare a saltwater gargle. If your child can gargle, a saltwater gargle of 1/2 teaspoon
(2.5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a
sore throat. Have your child gargle the solution and then spit it out.
Health teaching
 Advise the client to get lots of rest. Resting will allow the body to fight off the viral or
bacterial infection.

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COLLEGE OF NURSING
OPD Check-up
 Keep all follow-up appointments. It’s important to have doctor monitor the clients
progress.
 Advised the parents to consult a physician. If the child had 3 times of tonsillitis in a
year, it may indicate recurrent tonsillitis which may lead to rheumatic heart disease
Diet
 Avoiding hard foods. For people with tonsillitis, eating hard or sharp foods can be
uncomfortable and even painful. Hard foods may scratch the throat, leading to further
irritation and inflammation.
 Provide adequate fluids. Give the child plenty of water to keep his or her throat moist
and prevent dehydration.
 Provide comforting foods and beverage. Warm liquids like broth, caffeine-free tea or
warm water with honey can soothe a sore throat.
Spiritual
 Encourage the client to read the Bible on a regular basis. so that his soul can be fed and
nurtured. Pray to God when you're feeling down, anxious, and hopeless

(044) 600-3970
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COLLEGE OF NURSING
REFERENCES:
CHAPTER I:
Introduction:
Mitchell, R. MD. (2021). Pediatric Tonsillitis - Children’s Health.
https://www.childrens.com/specialties-services/conditions/tonsillitis
ScienceDirect. (2008, November 1). Tonsillitis and sudden childhood death.

https://www.sciencedirect.com/science/article/abs/pii/S1752928X08000735
CHAPTER II:
Definition of the Case:
ScienceDirect. (2008, November 1). Tonsillitis and sudden childhood death.

https://www.sciencedirect.com/science/article/abs/pii/S1752928X08000735
Medical Management:
MedlinePlus. (2017, April 11). Tonsillitis.
https://medlineplus.gov/tonsillitis.html
Nursing Management:
Belleza, R. M. N. (2021, February 11). Tonsillitis and Adenoiditis.

https://nurseslabs.com/tonsillitis-adenoiditis/
Anatomy and Physiology:

Britannica, The Editors of Encyclopedia. (2020, November 30) Tonsil.
https://www.britannica.com/science/tonsil
Pathophysiology:
Hitt, M. E., Zoran, D. L. (2008) Handbook of Small Animal Practice (Fifth Edition)
https://www.sciencedirect.com/topics/immunology-and-microbiology/tonsillitis?
fbclid=IwAR19PnGAjBU06nT4tZUklZybRRBMqEgEBFim2DETd_fjU2nSFrAcF4DV1
ZI
Risk factors:

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COLLEGE OF NURSING
Mayo Clinic. Tonsillitis
https://www.mayoclinic.org/diseases-conditions/tonsillitis/symptoms-causes/syc-
20378479
Clinical Manifestation (Book-based)
Anderson, J. et al. (2020, August 10). Tonsillitis. NCBI.NLM.NIH.
https://www.ncbi.nlm.nih.gov/books/NBK544342/
CHAPTER III:
LABORATORY RESULTS:
Soma, A. (2020, October 28). Tonsillitis. Geeky Medics.
https://geekymedics.com/tonsillitis/
KidsHealth. Strep Test: Throat Culture

https://www.google.com/url?
sa=t&source=web&rct=j&url=https://kidshealth.org/en/parents/labtest11.html%23:~:text
%3DA%2520throat%2520culture%2520or%2520strep,fever%252C%2520abscesses
%252C%2520and
%2520pneumonia.&ved=2ahUKEwjbl_KU4PfvAhWXd94KHU45BQEQFjABegQIAxA
F&usg=AOvVaw0vUNmZ5o01m2sWbKwXaN1o
Lab Test Online. (2021, January 21). Strep Throat Test.

sa=t&source=web&rct=j&url=https://labtestsonline.org/test/strep-throat test%23:~:text
%3DStrep%2520tests%2520are%2520used%2520to,available%2520in
%252010%252D20%2520minutes.&ved=2ahUKEwi_18Hn4PfvAhWFE4gKHSKaCbU
QFjABegQIAxAF&usg=AOvVaw3sVNTyf3UNdvX35csHsF23&cshid=1618198310879
Dias, E. P. et al. (2009) Detection of Epstein-Barr virus in recurrent tonsillitis. Science

Direct.
sa=t&source=web&rct=j&url=https://www.sciencedirect.com/science/article/pii/S180886
9415308284&ved=2ahUKEwiskK_M4vfvAhWdyIsBHfzKCaQQFjAIegQIKBAF&usg=
AOvVaw15Qq75QHLdZ5pnERvYNwYS
Lab Test Online. (2021, March 24). Mononucleosis (Mono) Test.

sa=t&source=web&rct=j&url=https://labtestsonline.org/tests/mononucleosis-mono-
test&ved=2ahUKEwiskK_M4vfvAhWdyIsBHfzKCaQQFjAGegQIJxAF&usg=AOvVaw
309EQc9_gYn031MSO7IhD9

(044) 600-3970
No. (044) 600-3970
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www.neust.edu.ph
COLLEGE OF NURSING
Mayo Clinic. Tonsillitis.
https://www.mayoclinic.org/diseases-conditions/tonsillitis/diagnosis-treatment/drc-
20378483
Statpearls. Tonsillitis.
https://www.statpearls.com/ArticleLibrary/viewarticle/30256
Bassett Healthcare. (2020) Strep A Dipstick.

https://bassett.testcatalog.org/catalogs/191/files/8941
Drug study:
MNT Medical Network. (2019, May 17). Augmentin (amoxicillin/clavulanate
potassium). https://www.medicalnewstoday.com/articles/325154
Multum, C. (2020, August 7). Tempra Quicklets. Drugs.

sa=t&source=web&rct=j&url=https://www.drugs.com/mtm/tempra-
quicklets.html&ved=2ahUKEwikiZLzu5vwAhUxyIsBHZCnB6wQFjANegQIChAC&us
g=AOvVaw3KB-1tS9lx6NJWBStb-Fz3
MIMS. TEMPRA (Paracetamol).

sa=t&source=web&rct=j&url=https://www.mims.com/philippines/drug/info/tempra
%3Ftype
%3Dfull&ved=2ahUKEwikiZLzu5vwAhUxyIsBHZCnB6wQFjACegQIJhAC&usg=AO
vVaw13MZ_BiKlNH9Wjj2BQask2
Nursing Care Plan:

Kabigting, A. NCP (PEDIA Tonsillitis). SCRIBD.
sa=t&source=web&rct=j&url=https://www.scribd.com/doc/58854957/NCP-PEDIA-
Tonsillitis&ved=2ahUKEwjsy4C5u5vwAhW8LqYKHdD1B6AQFjABegQIBRAC&usg
=AOvVaw3eZrIQY6g16Kr8sQdlwVme&cshid=1619424791405
Wayne, G. (2017, September 24). Hyperthermia Nursing Care Plan. Nurseslabs.

sa=t&source=web&rct=j&url=https://nurseslabs.com/hyperthermia/&ved=2ahUKEwjXlt
3Ru5vwAhWpyosBHVeIBDEQFjACegQIERAC&usg=AOvVaw25-
ndUCEKizh61dgmW6WyB&cshid=1619424875166

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COLLEGE OF NURSING
Wayne, G. (2017, September 24). Impaired Swallowing (Dysphagia). Nurselabs
https://nurseslabs.com/impaired-swallowing/

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Case Presentation OF Acute Tonsillitis: Nueva Ecija University of Science and

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Republic of the Philippines

NUEVA ECIJA UNIVERSITY OF SCIENCE AND

Prepared by: BSN II-C

Datu, Beverly Jane L.

De Lara, Bianca Jesmine

Del Rosario, Trixie DC.

Domingo, Precious Mae

Transforming Communities through Science and Technology Contact No.Contact

II. Presenting Complaints……………………………………………..7

III. Family History……………………………………………………7

IV. History of Past Illness……………………………………………..7

VII. Drug History……………………………………………………..8

VIII. Admitting History ………………………………………………8

IX. Admitting Vital Signs…………………………………………..…8

X. Status of present Illness…………………………………………….9

X1. Physical Examination……………………………………………..9

Definition of the case…………………………………………………………12

Anatomy and physiology…………………………………………………….13

Pathophysiology (book-based) ………………………………………………15

Risk factors …………………………………………………………………..19

Medical management ………………………………………………………...19

Nursing management ………………………………………………………....20

Transforming Communities through Science and Technology Contact No.Contact

Nursing Care Plans ……………………………………………………………24

Drug study …………………………………………………………………….30

Evaluation and findings ……………………………………………………….35

Transforming Communities through Science and Technology Contact No.Contact

TABLES AND FIGURES CONTENT

Table 1. Physical Examinations…………………………………………………9

Table 2. Clinical Manifestation…………………………………………………..19

Table 3. CBC Test Result of the Client………………………………………………………………….22

Figure 1. Lymphatic system………………………………………………………13

Figure 2. Tonsil location…………………………………………………………..14

Figure 3. Pathophysiology (Book Based) …………………………………………15

Figure 4. Pathophysiology (Client-based) ………………………………………17

Transforming Communities through Science and Technology Contact No.Contact

1. Perform a head-to-toe assessment focusing on parts affected by the Acute Tonsillitis;

Transforming Communities through Science and Technology Contact No.Contact

Tonsillitis is most common in children and adolescents. The inflammation usually

Transforming Communities through Science and Technology Contact No.Contact

Age: 7 years old

Date of Birth: February 24, 2014

Place of Birth: Cabanatuan City

Address: Mabini St. Cabanatuan City

Date of Admission: April 7, 2021

Attending Physician: Dr. Y

Admitting Diagnosis: Dysphagia

Final Diagnosis: Acute Tonsillitis

II. Presenting Complaints

No family history of any diseases related to Tonsillitis.

IV. History of Past Illness

The client had fever due to common cold 1 month ago.

Birth Weight: 3.5 kg

Transforming Communities through Science and Technology Contact No.Contact

VII. Drug History

Generic Name: Paracetamol

Generic Name: Phenylephrine HCl + Chlorphenamine Maleate

IX. Admitting Vital Signs

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X. Status of present Illness

Few hours prior to admission, persistence of above condition, prompt to consult to

X1. Physical Examination

The client has a sign of