Tonsillitis
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Outline
Overview
- Inflammation and infection of tonsils most often caused by viral or bacterial infection.
Nursing Points
General
- Tonsils
- Lymphoid tissue located in the pharynx
- Protect respiratory tract from pathogens
- Larger in children as a protective mechanism against illness
- Causes
- Viral
- Bacterial
- Group A strep = “Strep throat”
Assessment
- Sore throat
- Red, swollen tonsils (covered in white exudate)
- Pain when swallowing
- Fever
- Foul smelling breath
- Nose blocked so breathing through mouth
Therapeutic Management
- Throat swab
- Viral Tonsillitis
- Self-limiting
- Supportive treatment
- Bacterial -Group A strep
- Antibiotics
- Surgical removal of tonsils and adenoids
- For frequent tonsillitis and obstructive sleep apnea
- Post operatively
- Monitor airway
- Continuous pulse ox
- Position in side lying position
- To prevent aspiration
- Excessive drooling may indicate airway edema
- Assess for bleeding
- Visualize throat with pen light
- Frequent swallowing may be a sign of bleeding
- Inspect all secretions & vomit for signs of fresh bleeding
- Protect operative site
- Avoid sharp, crunchy foods
- Tortilla chips
- Don’t use a straw or allow the child to put objects in mouth
- Avoid routine suctioning
- Avoid sharp, crunchy foods
- Provide pain management
- Acetaminophen
- Opioids
- Start clear liquid or soft diet
- Avoid red foods
- Avoid foods that decrease ability to clear secretions
- Milk products (milk, ice cream, pudding)
- Monitor airway
Nursing Concepts
- Infection Control
- Fluid and Electrolyte Balance
- Comfort
Patient Education
- Post-op dietary restrictions
- Signs of bleeding
- Postoperative hemorrhage can occur up to 14 days after surgery
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References:
Hockenberry, M., Wilson, D. & Rodgers, C. (2017). Wong’s essentials of pediatric nursing (10th ed.) St. Louis, MO: Elsevier Limited.
Lissauer, T. & Carroll, W. (2018). Illustrated textbook of pediatrics (5th ed.) Europe: Elsevier Limited.
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Transcript
Hey everyone, in this lesson we are going to talk about tonsillitis. Now, tonsillitis is very straightforward so we’re just going to quickly go over it. We’re going to spend most of our time talking about nursing care following a tonsillectomy.
So, tonsillitis is when the tonsils on the sides of the throat, here and here, become inflamed and infected. Kids are more prone to this infection because their tonsils tend to be larger than adults. Most of the time the cause is viral, but another common cause is Group A strep, which we call Strep Throat.
In your nursing assessment the main symptom will be sore throat. Sometimes this can be so bad that the kid has difficulty with eating and drinking so in severe situations they may become dehydrated.
If you take a look at the throat it will probably be red and swollen and there may be white spots or white exudate as well.
The child will probably have a fever and feel pretty crummy as well. And it’s not uncommon for them to have really bad breath!
Management should really start with a throat swab because this is going to tell us if the cause is bacterial. If it’s viral treatment is primarily supportive, so giving antipyretics and analgesics like acetaminophen. If the cause is bacterial they will need antibiotic treatment.
Kids who have a lot of episodes of tonsillitis may be candidates for a tonsillectomy and adenoidectomy. This procedure is also done for kids with sleep apnea. It’s a really common procedure so we’re gonna take a few minutes to talk about nursing care for for this!
So, T&A’s are common and pretty straightforward but there are actually some life threatening complications that can occur so we’ve got to be on our toes looking out for them!
The first thing we have to do is monitor for airway obstruction. They’ve just had surgery on their throat so if the edema from this becomes severe enough, it can block the airway. So keep an eye on their respiratory status. The major symptom to look for here is excessive drooling. If you note this, let the provider know straightaway!
Your next priority is to assess for signs of bleeding. The red flag symptom here is excessive swallowing. If they are bleeding, the blood will be draining down the back of their throat causing them to swallow a lot. Another symptom would be bright red blood in their vomit.
Protecting the operative site is important to help prevent bleeding. This means no straws and no sharp, crunchy foods like doritos! They should be on a clear liquid diet or a soft diet to start with.
This is actually a pretty painful procedure. Kids handle it a lot better than adults do but they will still have a lot of pain. Most will be given opioids for the first day or so. Remember kids have a tough time telling us when something hurts so a lot of times acetaminophen will be scheduled for the first 24 hours or so to make sure they don’t become dehydrated!
Dehydration is the next major complication to be on the lookout for. It can be a real battle to get fluids and medications into these kids but it’s super important. So offering small amounts via syringe to start with is usually the best option! Popsicles usually go over pretty well too!
Your priority nursing concepts for a pediatric patient with tonsillitis or post-tonsillectomy are Infection control, fluid and electrolyte balance and comfort.
Okay so let’s review your major takeaway points for this lesson! Tonsillitis is when tonsils become infected. The cause is usually viral, but sometimes can be caused by bacteria like Group A strep. If it’s bacterial the child will need antibiotics.
Kids with frequent episodes of tonsillitis or sleep apnea may need to have a tonsillectomy. During post-op care your top priorities are to assess for airway obstruction and bleeding. The primary symptoms of these two things are excessive drooling for airway obstruction or excessive swallowing for a hemorrhage.
It’s also very important to manage their pain so they can keep fluids down and prevent dehydration.
And remember parents need to be aware of these complications too! Because bleeding can occur up to 14 days after surgery.
That’s it for our lesson on Tonsillitis. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!
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