TONSILLITIS in child.pptx,tonsillits, toncelectomy, nursing

tonsillits

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

2. General Objective

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

4. Introduction

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

6. 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 .

7. 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)

8. Etiology It is caused by either a virus or a bacteria Usually the streptococcus bacterium ( hemolytic streptococcus most common ) Others: Staphylococci, pneumococci, H Influenza

9. 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

10. Types of tonsillitis Acute tonsillitis : It is classified into : Acute catarrhal or superficial tonsillitis Acute follicular tonsillitis Acute parenchymatous tonsillitis Acute membranous tonsillitis

11. Acute catarrhal or superficial tonsillitis It is a part of generalized pharyngitis and is mostly seen in viral infections.

12. Acute follicular tonsillitis I nfection spreads into the crypts and filled with purulent material, presenting as yellowish spots.

13. Acute parenchymatous tonsillitis The tonsil is uniformly enlarged and red.

14. Acute membranous tonsillitis S tage ahead of acute follicular tonsillitis when exudation from crypts coalesces to form a membrane on the surface of tonsil.

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

16. 3) Chronic tonsillitis It can last for long periods if not treated and is almost always bacterial. C omplication of acute tonsillitis. It is classified into : Chronic follicular tonsillitis Chronic parenchymatous tonsillitis Chronic fibroid tonsillitis

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

18. Chronic parenchymatous tonsillitis H yperplasia 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 .

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

20. Pathophysiology

21. Clinical features Acute tonsillitis Sore throat Difficulty in swallowing Fever: vary from 38 to 40C Earache Constitutional symptoms Foetid breath and tongue is coasted

22. 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

23. Diagnostic evaluation

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

25. Medical manage- ment

26. Tonsillectomy

27. 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

28. 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 .

29. 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.

30. 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

31. 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 S alt water gargles three to four times a day. A mouth wash with plain water after every feed.

32. Post-op care contd … 5) Analgesics and antiemetic A nalgesics 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 S uitable antibiotic can be given orally or by injection for a week.

33. 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

34. 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 .

35. 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.

36. 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.

37. Have a suction equipment available at the bedside. Teach breathing exercises to promotes lung expansion. Administer medications as prescribed: antibiotics

38. 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 .

39. 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.

40. 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. N ormal temperature maintained.

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

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

43. 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.

44. 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.

45. Assignment

46. References: Dhingra PL(2022).Disease of ear,nose,throat,head and neck surgery.8 th ed. RELX Pvt.Ltd.New delhi.India.pg.304-308 Uprety K.(2021).Child health nursing.3 rd 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 .6 th ed. .Makalu publication.dillibazar.kathmandu.pg.1214-1218 Hockenberry M.Wilson D.(2018)Wong’s essential of pediatric nursing.10 th ed. RELX Pvt.Ltd . New delhi.India.pg.468-470