7. Incidence
According to a study published in the journal
Pediatrics in 2019,(UK) the incidence of
tonsillitis in children under 15 years old is
approximately 40 per 1,000 person-years.
The incidence is highest in children aged 5 to
9 years old, and decreases with age.
8. There is research in Egypt that indicates 15-30%
of sore throats in children and 5-10% sore throats
in adults are bacterial tonsillitis((Michael Gibson
C., Luk B.S. Tonsillitis Epidemiology and
Demographics)
9. Etiology
It is caused by either a virus or a bacteria
Usually the streptococcus bacterium
(hemolytic streptococcus most common)
Others: Staphylococci, pneumococci, H
Influenza
10. Risk factor
Ingestion of cold or infected food stuff
Low immunity and resistance (mostly affect
school going children rare in infant and above
50 years of age)
Upper respiratory tract infection
Pollution and ill-ventilated environment
Residual tonsillar tissue left post-tonsillectomy
11. Types of tonsillitis
1) Acute tonsillitis:
It is classified into:
Acute catarrhal or superficial tonsillitis
Acute follicular tonsillitis
Acute parenchymatous tonsillitis
Acute membranous tonsillitis
12. Acute catarrhal or superficial tonsillitis
It is a part of generalized pharyngitis and is
mostly seen in viral infections.
15. Acute membranous tonsillitis
Stage ahead of acute
follicular tonsillitis when
exudation from crypts
coalesces to form a
membrane on the surface
of tonsil.
17. 3) Chronic tonsillitis
It can last for long periods if not treated
and is almost always bacterial.
Complication of acute tonsillitis. It is
classified into:
Chronic follicular tonsillitis
Chronic parenchymatous tonsillitis
Chronic fibroid tonsillitis
19. Chronic parenchymatous tonsillitis
Hyperplasia of lymphoid tissue.
Tonsils are very much enlarged and
may interfere with speech,
deglutition and respiration.Attacks
of sleep apnoea may occur.
Long standing cases develop
features of cor-pulmonale.
22. Clinical features
Acute tonsillitis
Sore throat
Difficulty in swallowing
Fever: vary from 38 to 40C
Earache
Constitutional symptoms
Foetid breath and tongue is coasted
23. Clinical features contd…
Chronic tonsillitis
Recurrent attacks of sore throat or acute tonsillitis.
Chronic irritation in throat with cough.
Bad taste mouth and foul breath
Thick speech, difficulty in swallowing and choking
spells at night
28. Surgical management
Tonsillectomy:
Tonsillectomy is a surgical procedure in which
both palatine tonsils are fully removed.
The procedure is mainly performed for recurrent
tonsillitis, throat infections and obstructive sleep
apnea .
Tonsillectomy is not performed until 3 to 4 years
of age
29. Preoperative nursing care
A complete history is taken.
Take written informed consent.
Send and collect lab test report timely.
Informed parents of any problem are on lab test
report.
Prepare child physically as per need such as keep nil
per orally, bath, administer pre-operative medication,
bowel and bladder preparation etc.
30. Pre-op care contd…
Psychological preparation of child by giving
a simple explanation about hospital routine,
permit child to try on operating room and
show the operating room and recovery areas
as appropriate age.
Encourage parent to remain with child.
31. Post operative nursing care
1) Provide immediate general post-operative care:
vital sign, intake and output, pain medication,
monitoring of bleeding
2) Maintain airway ventilation and circulation:
Position child on abdomen or side lying to facilitate
drainage.
Discourage coughing, clearing throat, blowing nose
32. Post-op care contd…
3) Diet:
When fully recovered from anesthesia, patient is
permitted to take cold liquid diet . Sucking of ice
cubes gives relief of pain and controlled
bleeding.
4) Oral hygiene
Salt water gargles three to four times a day.
A mouth wash with plain water after every feed.
33. Post-op care contd…
5) Analgesics and antiemetic
Analgesics like paracetamol can be given.
Avoid aspirin and ibuprofen as it can cause
bleeding.
Antiemetic such as ondansetron may be
administered if nausea vomiting present.
6) Antibiotics
Suitable antibiotic can be given orally or by
injection for a week.
34. Nursing Management of tonsillitis and
tonsillectomy
Assessment
Collection of subjective and objective data
History taking and physical examination
Assess for sign and symptoms
Assess laboratory reports
35. Nursing diagnosis
Risk for Ineffective Airway Clearance related to
postoperative swelling and pain, as evidenced by
noisy breathing, restlessness, and decreased
oxygen saturation levels.
Acute Pain related to inflammation and swelling
of the tonsils, as evidenced by facial grimacing.
36. Diagnosis contd…
Alter body temperature related to infection
and inflammation as evidenced by high body
temperature.
Deficient Knowledge related to the diagnosis
and treatment of tonsillitis/tonsillectomy, as
evidenced by frequent questions by patient's
caregiver.
37. Nursing interventions
To maintain patent airway
Assess for signs and symptoms of inadequate
oxygenation to identify early signs of hypoxia
Place the patient prone or side-lying position
Discourage the intake of milk, ice cream, and
pudding. However, post tonsillectomy patient
should start diet from cold food like cold milk or
ice cream.
38. Have a suction equipment available at the
bedside.
Teach breathing exercises to promotes lung
expansion.
Administer medications as prescribed:
antibiotics
39. To relieve pain
Assess pain using appropriate pain scale.
Observe patient for nonverbal indications of pain.
Gargling and rinsing with warm salt water can
help sooth a sore throat and pain.
Avoid hot and spicy food it aggravate the pain.
Suggest diversional activity.
Administer pain medications as prescribed .
40. To maintain normal temperature
Administering antipyretic medications as prescribed.
Encouraging to maintain proper hydration and nutrition.
Tepid sponging
Monitoring for signs of complications such as dehydration,
seizures, or confusion, and intervening promptly if needed.
41. Evaluation
Patent airway maintained as demonstrated by
normal respiratory rate and rhythm and clear
breath sounds.
Decreased level of pain and patient appear more
relaxed/comfortable.
Normal temperature maintained.
44. Prognosis
The prognosis of tonsillitis in children can vary
depending on the underlying cause, the severity of
the infection, and the child's overall health.
45. If left untreated or improperly managed, tonsillitis
in children can lead to complications.
With appropriate treatment, most children with
tonsillitis have a good prognosis and can recover
fully without any long-term complications.
