TONSILITIS
Tonsils are located anteriorly to the oro pharynx on the either side and
adenoids are mass of lymphoid tissue
located in the nasopharynx posteriorly. This is inflammation of the tonsils. It
is acute and chronic in nature.
ACUTE TONSILITIS
Acute infection of tonsils occur as a
result of pharyngitis.
Etiology:
Beta-Hemolytic streptococcus is
the most important causative organism. H. influenza type-B is also responsible.
Nursery school and dormitories favor the spreads of infection.
Signs
and Symptoms:
·
Usually,
the onset is abrupt with shivering and pain in the throat which may radiate to
the ears.
·
Swallowing
in painful as the palatine enlarges meeting at the midline obstructing the
passage of food and air.
·
Solid
foods are refused but drinks are tolerated.
·
Convulsion
may occur in younger children.
·
Later
the tonsils looks markedly red and congested.
·
Eustachian
tube may be blocked resulting in otitis media.
Treatment
and nursing management:-
·
Rest
in bed and isolation from other children is important.
·
If
dysphasia is marked, paracetamol syrup may be given.
·
Analgesic
lozenges may be given in early stages.
·
Antibiotics may be given according to the physician’s
order.
·
Gargling
may be of some use in soothing the palatal and
pharyngeal muscles.
·
Common
salt, one tea spoon to a cup or one tablets of aspirin added to a glass of warn
water , on 10% potassium chlorade or sodium bicarbonate may be used.
·
The
child needs more fluids. He need to be kept warm.
·
Soft
diet is given in early stage.
CHRONIC TONSILITIS
The occurrences of tonsillitis
decrease with age complete resolution after a single attack of tonsillitis is
usual.
Signs
and Symptoms:
·
Recurrent
persistent sore throat,
·
Swallowing
and breathing difficulties.
·
Shows
no eagerness to play.
·
Loss
of appetite and cyclical vomiting.
·
Halitosis.
·
Occasional
abdominal pain.
·
Voice
may become thick.
·
A
sense of dryness and irritation in the throat.
·
Rarely
Dyspnea, chronic hypoxemia and pulmonary hypertension are observed.
·
In
some cases nocturnal enuresis can be attributed to chronic tonsillitis.
Treatment
and Nursing Management:
The Only
definite indications for tonsillectomy are-
1)
Peri
tonsilar abscess (quinsy) and
2)
Retro
tonsilar abscess.
Pre-Operative
Care:
·
Parents
are instructed about the type of surgery to be done on the child and about the
general anesthesia.
·
Since
these children are of an age, when the first teeth are loosened and may fall
out, these may be removed by the physician before anesthesia is given to prevent
aspiration.
·
Bleeding
and clotting time and other routine laboratory tests are obtained on the day
before surgery is scheduled.
·
Patient
should be assessed for other respiratory function.
Post-operative
Nursing Management:
·
Upon
return from the operation room, the child is placed in a prone or side lying
position to facilitate drainage of secretions and prevent aspiration of vomits.
·
Constant
observation continues until the child is fully awake.
·
For
several hour thereafter, the child is frequently monitored for pulse rate and
quality, degree of restlessness, frequency of swallowing and vomiting. These
observations may indicate hemorrhage.
·
If
bleeding occurs in the post operative period, the child is returned to the
operating room for re catheterization.
·
Chipped
ice may be given when he child awakens, increased fluid intake is encouraged.
·
Synthetic
fruit juices are given at first and later natural fruit juices.
·
Gradually
semisolids are given.
·
A
mild analgesic may make the child more comfortable and facilitates fluid
intake.
·
Parents
are involved in the care of the child.
·
Children
should be allowed to get out of the bed
and play when they feel to be ready for play.
Home
Care Management tonsillitis:
·
Be
away from other children.
·
Adequate
rest.
·
Amore
amount of fluid intake.
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