Tonsillitis

Subject: Medical and Surgical Nursing II (Theory)

Overview

Your tonsils, which are two lumps of tissue at the back of your throat, act as filters by snatching bacteria that might otherwise enter your airways and infect you. They also produce antibodies to ward off infection. But occasionally, an infection can even travel to the tonsils. Under the influence of bacteria or viruses, they enlarge and become inflamed, a condition known as tonsillitis. Tonsillitis is common, especially in children. The condition might occasionally appear or keep coming back. Both bacterial and viral infections can cause tonsillitis. A common cause is streptococcus (strep) bacteria. Some of the more common offenders are adenoviruses, influenzaviruses, Epstein-Barr viruses, parainfluenza viruses, etc. Inflammation and swelling are the main signs and symptoms of tonsillitis, and they can occasionally be so severe as to obstruct the airways. Lozenges and painkiller pills are used as tonsillitis treatments. Antibiotics, most frequently penicillin, are recommended if bacteria are the cause of the tonsillitis. Patients with penicillin allergies should take erythromycin. Topical anesthetics should frequently be used for tonsillitis patients in order to provide brief relief from the painful effects of inflamed tonsils. For this use, viscous lidocaine solutions are frequently given.

Tonsillitis

A virus or a bacterium can cause tonsillitis, an inflammation of the tonsils (usually the bacterium known as streptococcus- the same bacterium that causes "strep throat")

Types

  • Acute tonsillitis: It can either be bacterial or viral in origin.
  • Sun acute tonsillitis: It is caused by the bacterium Actinomyces.
  • Chronic tonsillitis: It can last for long periods if mot treated, is almost always bacterial

Causes:

Tonsillitis can be brought on by viral and bacterial illnesses. Streptococcus (strep) bacteria are a frequent cause. Other typical reasons include:

  • Adenoviruses
  • Influenzavirus
  • Epstein-Barr virus
  • Parainfluenza viruses
  • Enteroviruses
  • Herpes simplex virus

Symptoms:

  • Throat pain or tenderness
  • Redness of the tonsils
  • Tonsils with a white or yellow coating
  • Throat ulcers or painful blisters
  • Hoarseness or loss of voice
  • Headache
  • Loss of appetite
  • Ear pain
  • Swallowing issues or mouth breathing issues
  • Swollen glands in the neck or jaw area
  • Fever, chills
  • Bad breath

Diagnosis:

  • Physical exam
  • Throat swabs culture

Treatment:

  • Lozenges and painkiller pills are used as tonsillitis treatments.
  • Antibiotics, most frequently penicillin, are recommended if bacteria are the cause of the tonsillitis. Patients with penicillin allergies should take erythromycin.
  • Topical anesthetics should frequently be used for tonsillitis patients in order to provide brief relief from the painful effects of inflamed tonsils. For this use, viscous lidocaine solutions are frequently given.
  • Inflammation and edema can be reduced with the aid of ibuprofen or other analgesics, which can lessen pain and enable the patient to swallow liquids more quickly.
  • The type of virus that causes tonsillitis affects how long the sickness lasts. The average recovery time is one week, however some extremely unusual illnesses might persist up to two weeks.
  • Persistent issues may suggest tonsillectomy as a possible therapeutic option.
  • Additionally, gargling with a warm water and salt solution may lessen discomfort and swelling.

Care of patients after Tonsillectomy

surgical- Tonsillectomy One of the most common surgical procedures in the department of otolaryngology. To remove the tonsils from either side of the throat, a tonsillectomy is a common surgical surgery.

  • Indications for tonsillectomy
    • Recurrent acute tonsillitis
    • Peritonsillar abscess
    • Obstructive sleep apnea
    • Suspicion of neoplasm “ tumors”
  • Complication of Tonsillectomy
    • Bleeding
    • Infection
    • Pain
  • Postoperative nursing interventions
    • Always keep a full vision of patients, and expand your chest to ensure that your breathing is as healthy as possible.
    • Teach the patient to break apart secretion as much as possible to reduce nausea and vomiting.
    • Apply cool, humidified air as directed to reduce edema, increase comfort, and keep oxygen levels high.
    • Encourage dental hygiene
    • To reduce pain and postoperative bleeding, put an ice collar on.
    • Regular monitoring of vital indicators
    • To reduce the chance of infection, keep an eye on the patient's fever, administer prescribed antibiotics, and give them 2 liters of liquids each day.
    • To lessen the suffering
    • Track vital signs
    • Keep the patient in a relaxed position and switch it up sometimes.
    • Provide analgesics as directed
    • If pain relief with analgesia is insufficient, consult a doctor.
    • Any unexpected bleeding should be immediately reported to the anesthesiology staff.
    • Immediately report any obstruction to anesthesiology after checking the airway, and have oxygen and an Ambu bag on hand.
    • Check the patient's ability to swallow properly. Work together with the anesthesia and surgical staff to determine when it is necessary to administer steroids to reduce uvula swelling.

REFERENCE

Dhingra PL. Diseases of ear, nose, and throat. $th ed: Reed Elsevier India (P) Limited:2007

HealthLine. 2005. 2017 http://www.healthline.com/health/tonsillitis

MedicineNet. 1996. 2017 http://www.medicinenet.com/adenoids_and_tonsils/article.htm

Medscape. 1994. 2017 http://emedicine.medscape.com/article/871977-overview

Shrivastav R, Rakesh P. An illustrated Textbook of ear, nose, throat and head and neck surgery. 1st ed. Lalitpur Nepal: UPS publisher; 2008

Web MD. 2005. 2017 http://www.webmd.com/oral-health/guide/tonsillitis-symptoms-causes-and-treatments#1
Things to remember
  • Two masses of tissue at the back of your throat called tonsils serve as filters by capturing germs that may otherwise get into your airways and infect you.
  • Additionally, they create antibodies to fend off infection.
  • However, sometimes an infection spreads to the tonsils themselves. They expand and become inflamed under the influence of bacteria or viruses, a disease known as tonsillitis.
  • Tonsillitis is frequent, particularly in kids.
  • The condition may occasionally manifest or return repeatedly.
  • Tonsillitis can be brought on by viral and bacterial illnesses.
  • Streptococcus (strep) bacteria are a frequent cause. Adenoviruses, influenzaviruses, Epstein-Barr viruses, parainfluenza viruses, etc. are some other common causes.
  • Tonsillitis' primary symptoms are inflammation and swelling, which can occasionally be so severe as to block the airways.
  • Lozenges and painkiller pills are used as tonsillitis treatments.
  • Antibiotics, most frequently penicillin, are recommended if bacteria are the cause of the tonsillitis.
  • Patients with penicillin allergies should take erythromycin.
  • Topical anesthetics should frequently be used for tonsillitis patients in order to provide brief relief from the painful effects of inflamed tonsils.
  • For this use, viscous lidocaine solutions are frequently given.
Questions and Answers

Tonsils are two masses of tissue at the back of your throat that act as filters, trapping germs that would otherwise enter your airways and cause infection. They also generate antibodies to combat infection. However, the tonsils themselves can become infected. When bacteria or viruses overwhelm them, they swell and become inflamed, resulting in tonsillitis.

Acute tonsillitis: It can either be bacterial or viral in origin.

Sun acute tonsillitis: It is caused by the bacterium Actinomyces.

Chronic tonsillitis: It can last for long periods if mot treated, is almost always bacterial

The main symptoms of tonsillitis are inflammation and swelling of the tonsils, sometimes severe enough to block the airways. Other symptoms include:

  1. Throat discomfort or tenderness
  2. Tonsil inflammation
  3. Tonsils with a white or yellow coating
  4. Blisters or ulcers on the throat that are painful
  5. Hoarseness or voice loss
  6. Headache
  7. Appetite loss
  8. Ear ache
  9. Swallowing or breathing through the mouth is difficult.
  10. Neck or jaw glands that are swollen
  11. Fever and chills
  12. Breath that stinks

Preoperative management:

  • Careful history taking is needed to evaluate for the following:
  • Bleeding disorders or wish to avoid transfusion
  • Anesthesia intolerance
  • Obstructive sleep apnea
  • In patients with Down syndrome, order cervical spine images to evaluate for C1-C2 subluxation. Also, be aware of the possible underlying cardiac disease.
  • Sleep studies are recommended if the severity of the patient's symptoms is uncertain.
  • Regarding admission planning, insurance plans are increasingly disallowing inpatient admission for tonsillectomy or adenoidectomy. Children who should be admitted are those with obstructive sleep apnea, those with a significant comorbid diseases such as hypotonia or neuromotor delays, and those younger than 3 years.

Postoperative management:

  • Use liquid acetaminophen (Tylenol) with or without codeine for pain control. (The unwillingness of parents to give analgesics is associated with children's refusal to eat, which results in dehydration, weight loss, and local infection.)
  • Sutter et al conducted a study comparing scheduled postoperative opioid analgesia (acetaminophen and hydrocodone 167 mg/2.5 mg per 5 mL PO q4h for 3 d) with as needed (PRN) opioid analgesia in children aged 6-15 years undergoing outpatient tonsillectomy. Children in the scheduled-dose group received more analgesia compared with the PRN group (p < 0.0001). Children in the PRN group had higher pain intensity scores (p=0.017). Pain intensity scores were higher in the morning compared with the evening (p < 0.0001).[9]
  • Maintain good hydration.
  • The patient should eat an adequate diet. No evidence suggests that a special diet is required; however, soft foods are more easily swallowed than hard foods.
  • Administer antibiotics. Oral antibiotic use for the week after tonsillectomy is associated with improved outcomes in children.
  • Instruct the patient to avoid smoking.
  • Instruct the patient to avoid heavy lifting and exertion for 10 days.
  • Warn patients that pain will abate during the first 3-5 days then increase for 1-2 days before completely disappearing.
  • Most often, tonsillectomy is safely performed on an outpatient basis. Individuals who should not receive tonsillectomy as outpatients are those younger than 3 years, those with obstructive sleep apnea, those who live far away from the outpatient facility, those with Down syndrome, or those who have difficulty in complying with instructions.

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