TONSILLITIS

Definition of tonsillitis

Tonsillitis is an inflammation of the

tonsils.
Tonsillitis is when your tonsils
become inflamed, infected and
swollen.
Tonsils are 2 large lumps of tissue in
the back of child's throat.
They help to protect body against
infection.
Incidence rate

Usually occur among

children age between 5 to
10 years old.
 Types of tonsillitis
a) Acute tonsillitis
Is an infection of the tonsils caused by
one of several possible types of
bacteria or viruses.

b)Chronic tonsillitis
Is an enlargement of the glands due to
repeated inflammation of the tonsils.
It is also known as recurrent tonsillitis.
 Causes of tonsillitis
Tonsillitis may be caused by a
bacterial or a viral infection.
Viruses that cause a cold or the flu
may cause viral tonsillitis in children.
A virus that causes mononucleosis
(mono) may also lead to tonsillitis.
Group A streptococcus is the most
common type of bacteria that cause
tonsillitis.
 Tonsillitis can spread from an
infected person to others through
coughing, sneezing, or touching.
The germs can spread through
kissing or sharing food and drinks.
Germs spread easily in schools and
daycare centers and between family
members at home.
Clinical manifestations
of tonsillitis
Fever, headache, chills
Red, swollen tonsils
Difficulty in swallowing (dysphagia)
A general sense of feeling unwell (malaise)
White patches or pus-filled spots on the
tonsils
Swollen lymph nodes (glands) in the neck
Sore throat and pain spread to ears or neck
Dryness of mouth and throat
Hoarseness of voice
 How is tonsillitis diagnosed?

1) Examination of the throat

) Tonsil appear red, swollen and are
coated with white spot or patches or
pus seen on the tonsil
2) Take a throat swab for culture and
sensitivity to determine the type of
microorganism so that proper
antibiotic will be given
3) Palpate the neck to feel for enlarge
lymph node and whether patient
feel the pain
4) Blood tests may be done to see if
your child has an infection caused
by bacteria or a virus.
) Total white blood count (TWBC)
the white blood cell usually normal
or low for viral infection and
) Elevated (or leucocytosis) for
bacterial infection
 Complication of
tonsillitis
Peritonsillar abscess (Quincy)
Is a localize accumulation of pus in the
peritonsillar tissues that pushes one of the
tonsils toward the uvula.
Progressive inflammation and suppuration
may extend to directly involve the soft
palate, the lateral wall of the pharynx and
the base of the tongue.
Peritonsillar abscess usually result from
Group A beta-hemolytic streptococcus.
 Peritonsillar abscess
Clinical manifestations :
Similar to tonsillitis but more severe. For
example ; high fever with malaise,
headache, anorexia and insomnia
Dysphagia (difficulty in swallowing)
Dribbling of saliva due to severe pain
and cannot swallow saliva
Trismus may occur (prolonged tonic
spasm of the jaw muscle)
 Complication of peritonsillar
abscess :
Airway obstruction

Diagnostic procedure in
peritonsillar abscess :
Needle aspiration is use for diagnostic
purposes as well as for treatment
for diagnostic purposes, the fluid
aspirated will be send to the laboratory
for culture and sensitivity
 Treatment of peritonsillar abscess :
Either done by incision and drainage or
by using needle aspiration
Patient is placed in a sitting position
that enable to drain pus and blood
Antibiotic and analgesic is given as
prescribed by doctor to destroy
microorganism and to relief pain
Encourage patient to drink more fluids
as tolerated to prevent dehydration
Pus is aspirated through a widebore needle from the right
peritonsillar abscess.
An additional incision will be made to drain any other pus
pockets.
Treatment and nursing care
given to tonsillitis patient
1) Advice patient to rest in bed to hasten
recovery
2) Advice patient to drink plenty of water
3) Encourage patient to take nutritious soft
diet to build up immune system
4) Monitor patient body temperature every
two hourly to ensure patient fever has
subside
5) If patient still having fever and symptom
not relief , inform doctor
6) Conservative treatment :
) Give antibiotic as prescribed by doctor for
10 to 14 days if tonsillitis caused by Group
A beta-hemolytic streptococcus
) Give analgesic such as Ibuprofen as
prescribed by doctor to reduce
inflammation and edema to reduce
symptom like dysphagia
) Give Lozenges as prescribed by doctor to
give a soothing effect and relief sore throat
7) If conservative treatment is not effective
then doctor will recommend surgery -
Tonsillectomy
 Health education to
patients mother (if patient
is a child)
1) To raise body immune system
) Ensure child has enough rest and sleep
to hasten recovery
) Advice patients mother to let child take
antibiotic as prescribed by doctor and
avoid stop taking antibiotic although
fever gas subsided
) Give patient vitamin C to build up body
resistant
2) Encourage patient to take plenty of
water to prevent dehydration,
reduced temperature and removal
of toxin trough urine
3) Advice patients mother to
encourage child to take soft diet or
liquid diet if child complain of sore
throat
4) Advice patients mother to observe
child if symptoms not relief then
she must bring her child to see
doctor immediately
5) Advice mother to avoid bringing her
child to overcrowded area to
prevent infection spread to other
people
6) If child is schooling, advice mother
to inform school teacher that patient
is on tonsillitis treatment
7) Advice mother to bring her child for
regular follow up as scheduled by
doctor
TONSILLECTOMY
 What is
tonsillectomy?

Tonsillectomy is the
removal of tonsil
through surgery
Indication for
tonsillectomy

1) Chronic tonsillitis
2) Hypertrophy tonsil
3) Peritonsillar abscess
4) Tonsillitis recurrent
Preparation before
tonsillectomy
1) Explain to patients parents about the
purpose of tonsillectomy
2) Explain to patients parents about the
care given for patient post operatively.
For example :
) Position patient semi prone when
patient is not conscious yet post
anesthesia to allow flow of secretion
through mouth
) When patient is conscious, allow
patient to sit up
) Patient will be starve after surgery
 Observation will be done more
closely after surgery between 24 to
48hours
Patient will feel pain at the operation
wound after surgery and analgesic
will be given to relief pain as
prescribed by doctor
3) Obtain consent from parents by the
doctor
4) Take blood specimen as ordered by
doctor to monitor Hb and TWBC
 Preparation on the
operation day
1) Encourage childs mother to bath
her child and wear OT gown
2) Encourage child to empty the
bladder
3) Check OT checklist to determine
all the preparation has done
4) Check to make sure correct patient is
send to the operation theatre by
asking patients parents to mention
their child name and check with the
child ID band same with the name in
the childs bed head ticket
5) Take vital sign of the child as baseline
data and to detect any abnormalities
6) Give premedication as prescribed by
doctor to reduce childs anxiety
 Post tonsillectomy care
1) To maintain a clear airway
) Lie patient in a semi prone position to
allow secretion to flow out
) Use tissue paper to wipe off the
secretion from patients mouth
Do not do suction to prevent trauma to
the tonsils
) When patient is conscious, sit up the
patient to prevent hypostatic
pneumonia
2) To detect bleeding of the
operation wound
) Take vital signs of the patient every
15minutes for one hour,30minutes
for one hour and hourly until patient
condition stable
) Observe for secretion flowing out of
patients mouth whether there is
any blood
) Observe whether patient has shown
sign of frequent swallowing. If there
3) To reduce pain at the wound site
) Give analgesic for example injection
Pethidine as prescribed by doctor
) Give Dequadine Lozenges to
soothen the throat and relief pain
) Give saline gargle to clean the
operation wound
) Give syrup Paracetamol or Brufen as
prescribed by doctor to reduce pain
4) Nutrition
) Patient is nil orally until fully conscious
) When patient is fully conscious, allow
patient to take sips of water and observe
patient is able to swallow.
) If patient is able to swallow and no vomiting
occur then slowly increase fluid intake
) For Dr. Gopalan and Dr. NgHH patient
allow patient to take tonsillar diet . Normal
diet is allow several days after surgery as
ordered by doctor
) for Dr. Neil S patient allow normal diet
after patient conscious
5) Observation
) Check vital signs of the patient every
15minutes for one hour,30minutes for
one hour and hourly until patient
condition stable
) Check the respiration rate, rhythm
whether having stridor respiration (if it
happens means laryngeal spasm has
occur as a result of injury to the vocal
cord during operation
) Observe whether patient is able to pass
urine after post operative
 Complications of post
tonsillectomy
Hemorrhage
Types of hemorrhage :
a) Primary hemorrhage bleeding
occur after operation may be due to
suture (catgut) is loosen
b) Reactionary hemorrhage bleeding
occur after first 24 hours
c) Secondary hemorrhage - bleeding
occur after 4 to 5 days as a result of
infection