Tonsils and adenoids are the first line of defense as part of the immune system. They trap bacteria before it is able to enter the body.  Once infected they can obstruct the airway or the individual may experience recurring infections. The two common problems affecting these areas are recurrent infection and enlargement.

 

 

Tonsillitis

  • •Redder than normal tonsils
  • •A white or yellow coating on the tonsils
  • •A slight voice change due to swelling
  • •Sore throat, sometimes accompanied by ear pain.
  • •Uncomfortable or painful swallowing
  • •Swollen lymph nodes (glands) in the neck
  • •Fever
  • Bad breath

 

Retrieved from https://www.youtube.com/watch?v=_DNM039pUXE

 

Enlarged tonsils/adenoids

  • Swollen glands in the neck
  • •Breathing through the mouth instead of the nose most of the time
  • •Nose sounds “blocked” when the person speaks
  • •Chronic runny nose
  • •Noisy breathing during the day
  • •Recurrent ear infections
  • •Snoring at night
  • Restlessness during sleep, pauses in breathing for a few seconds at night (may indicate sleep apnea).

 

Treatment

  • steroids ( dexamethasone),
  • NSAIDs (ibuprofen)
  • betalactam antibiotics (penicillin or cefuroxime)
  • surgery: tonsillectomy and adenoidectomy

 

Tonsillectomy and Adenoidectomy

Indications for surgery:

  • recurrent tonsillistis and otitis media
  • airway obstruction from enlargement

 

 

Treatment complications

  • Bleeding (may happen during surgery, immediately after surgery, or at home)
  • Dehydration
  • Fever
  • Difficulty breathing (swelling of the area around the surgery)

 

Post op haemorrhage can occur within 24 hrs after surgery and between days 5-10 due to sloughing of tissue. Monitor for excessive swallowing, bright red blood in vomit, restless, tachycardia, pallor

 

Nursing considerations

  • Assess swallowing
  • Assess the bleeding by mouth
  • Assess pain
  • Evaluate airway clearance.
  • Encourage fluids (not red fluid)
  • Side positioning allows secretions to drain from the mouth
  • Monitor for infection
  • Encourage bed rest

 

 

Test your knowledge here http://www.nursingentrance.org/2016/04/post-tonsillectomy-bleeding-nclex-1-5.html

 

 

References

American Academy of Otolaryngology. (2017). Tonsils and adenoids. Retrieved from http://www.entnet.org/content/tonsils-and-adenoids

Saxton, D., Nugent, P., & Pelikan, P. (2003). Mosby’s comprehensive review of nursing for NCLEX-RN (2nd ed). St Louis, MO: Mosby.

Stelter, K. (2014). Tonsillitis and sore throat in children. GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery, 13(07). doi: 10.3205/cto000110

 

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