This document provides information about tonsillitis, including its definition, incidence, causes, risk factors, types, symptoms, treatment and complications. Tonsillitis is the inflammation and infection of the tonsils, most commonly caused by viruses or streptococcus bacteria. It occurs most in children ages 5-9 years old. Types of tonsillitis include acute, subacute, and chronic. Symptoms include sore throat, difficulty swallowing, and fever. Treatment involves antibiotics, pain medication, warm salt water gargles, and tonsillectomy for recurrent cases. Complications include peritonsillar abscess, cervical abscess or rheumatic fever if left untreated. With proper treatment, children usually recover fully from tons

2. TONSILLITIS
Prepared by:
Shiksha Khanal
BNS 2nd year
Roll no:29

3. General Objective

4. Table of content:
Introduction
Definition
Incidence
Etiology
Risk factor
Types
Pathophysiology
Clinical features
Diagnostic
evaluation
Prevention
Management
Complication
Prognosis

5. Introduction

6. Definition
Tonsillitis is the inflammation and infection
of tonsils, especially, the palatine (faucial)
tonsil

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.

13. Acute follicular tonsillitis
Infection spreads
into the crypts and
filled with purulent
material, presenting
as yellowish spots.

14. Acute parenchymatous tonsillitis
The tonsil is
uniformly enlarged
and red.

15. Acute membranous tonsillitis
Stage ahead of acute
follicular tonsillitis when
exudation from crypts
coalesces to form a
membrane on the surface
of tonsil.

16. 2) Sub-acute tonsillitis
It can last between 3weeks to 3months
is caused by the bacterium

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

18. Chronic follicular tonsillitis
Tonsillar crypts are
full of infected
cheesy material
which shows
yellowish spots.

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.

20. Chronic fibroid tonsillitis
Tonsils are small but infected with
history of repeated sore throats

21. Pathophysiology

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

24. Diagnostic evaluation

25. Prevention
Practice good hygiene
Avoid exposure to germs
Maintain a healthy diet
Hydration
Avoid irritants
Immunizations

26. Medical
manage-
ment

27. Tonsillectomy

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.

42. Complication
Chronic tonsillitis
Peritonsillar abscess
Parapharyngeal abscess
Cervical abscess
Rheumatic fever
Sub-acute bacterial endocarditis
Peritonsillar abscess

43. Complication contd…
Respiratory obstruction
 Septicemia
Tonsilloliths in chronic
tonsillitis
Tonsil stone

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.

48. Assignment

49. References:
Dhingra PL(2022).Disease of ear,nose,throat,head and neck
surgery.8th ed. RELX Pvt.Ltd.New delhi.India.pg.304-308
Uprety K.(2021).Child health nursing.3rd ed.Akshav
publication.ktmandu.pg.402-406
Sharna S.(2020).Lippincott manual of nursing practice.Wolters
publication.India.pg.1216-1219
Mandal GN.(2019).Text book of medical surgical nursing .6thed.
.Makalu publication.dillibazar.kathmandu.pg.1214-1218
Hockenberry M.Wilson D.(2018)Wong’s essential of pediatric
nursing.10th ed. RELX Pvt.Ltd. New delhi.India.pg.468-470