tonsillits

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