Angelite Nurses

1. General information
1. Inflammation of tonsils often as a result of a viral or bacterial pharyngitis
2. 10%-15% caused by group A beta-hemolytic streptococci
2. Medical management
1. Comfort measures and symptomatic relief
2. Antibiotics for bacterial infection, usually penicillin or erythromycin
3. Surgery: removal of tonsils/adenoids if necessary
3. Assessment findings
1. Enlarged, red tonsils; fever
2. Sore throat, difficulty swallowing, mouth breathing, snoring
3. White patches of exudate on tonsillar pillars, enlarged cervical lymph nodes
4. Nursing interventions
1. Provide soft or liquid diet.
2. Use cool-mist vaporizer.
3. Administer salt water gargles, throat lozenges.
4. Administer analgesics (acetaminophen) as ordered.
5. Administer antibiotics as ordered; stress to parents importance of completing entire course of medication.

Tonsillectomy

1. General information
1. One of the most common operations performed on children
2. Indications for tonsillectomy include recurrent tonsillitis, peritonsillar abscess, airway or esophageal obstruction
3. Indications for adenoidectomy include nasal obstruction due to hypertrophy
2. Nursing interventions: preoperative
1. Make pre-op preparation age-appropriate; child enters the hospital feeling well and will leave with a very sore throat.
2. Obtain baseline bleeding and clotting times.
3. Check for any loose teeth.
3. Nursing interventions: postoperative
1. Position on side or abdomen to facilitate drainage of secretions.
2. Avoid suctioning if possible; if not, be especially careful to avoid trauma to surgical site.
3. Provide ice collar/analgesia for pain.
4. Observe for hemorrhage; signs may include frequent swallowing, increased pulse, vomiting bright red blood (vomiting old dried blood or pink-tinged emesis is normal).
5. Offer clear, cool, noncitrus, nonred fluids when awake and alert.
6. Provide client teaching and discharge planning concerning
1. Need to maintain adequate fluid and food intake and to avoid spicy and irritating foods
2. Quiet activity for a few days
3. Need to avoid coughing, mouth gargles
4. Chewing gum (but not Aspergum): can help relieve pain and difficulty swallowing and aids in diminishing bad breath
5. Mild analgesics for pain
6. Signs and symptoms of bleeding and need to report to physician