Tonsillitis slideshare for medical students

complete and detail information about tonsillits , that is the inflammation of the tonsils ,present in the oral cavity , disease of oral cavity contains introduction, definition, types, causes, risk factors,pathophysiology , treatment , medical management, nursing management, nurses role, patient teaching sign and symptoms , drug therapy, diet management,

1. TONSILLITIS SUBMITTED TO Mrs Mamta toppo Associated professor college of nursing RIMS RANCHI Submitted by : Munmun raj Roll no -07 Basic b.sc nursing 3 rd year

2. contents TONSIL FUNCTION OF TONSIL TONSILLITIS CAUSE TYPE OF TONSILLITIS SIGN AND SYMPTOMS COMPLICATION DIAGNOSIS PATHOPHYSIOLOGY MEDICAL MANNAGEMENT SUGICAL MANAGEMEMENT NURSING MANAGEMENT PREVENTION RECENT RESEARCH SUMMARY BIBILIOGRAPHY

3. THE TONSILS Tonsils are two masses of tissue at the back side of throat ; its function is to defend the body against toxic substance that are found in blood . An anatomically the tonsils are classified based on their location into: – pal atine Nasopharyngeal ( “adenoid”) Lingual Tubal tonsils Generally the palatine tonsils reffered to as the tonsils.

4. Waldeyer ring The lymphoid tissues surrounding opening into respiratory and digestive system forms a ring. The lateral part is formed by palatine tonsils and tubal tonsil around the auditory tube opening The upper part is formed by pharyngeal tonsils on the roof of the nasopharynx The lower part – lingual tonsil on the posterior 1/3 of tongue.

5. WHAT IS THE DIAGRAM GIVEN BELOW?

6. QUIZ

7. Function of tonsils Immunity Antibodies formation Lymphocyte formation Barrier to infection

8. QUIZ

9. TONSILLITIS Tonsillitis is defined as an inflammation of the tonsils and characterized by sore throat and fever

10. QIUZ

11. CAUSE Bacterial and viral infection can cause tonsillitis through droplet infection. A common cause is beta-haemolytic streptococci bacteria. Other common cause include:- Adenoviruses Influenza virus Epstein –Barr virus Corona virus Enteroviruses Herpes simplex virus

12. QUIZE 1.Which is the most common bacterial pathogen causing tonsillitis ? Beta haemolytic streptococci Alpha haemolytic streptococci herps simplex virus

13. TYPE OF TONSILLITIS Tonsillitis is often labelled as acute , sub-acute, or chronic. Acute tonsillitis tend to be bacterial or viral in nature. Sub-acute tonsillitis is cause by the bacterium Actinomyces . Chronic tonsillitis last for long time and is caused by bacteria. ACUTE TONSILLITIS SUB ACUTE CHRONIC TONSILLITIS

14. ACUTE TONSILLITIS Acute infection of the tonsils involving the surface epithelium crypts and lymphoid tissue Acute superficial tonsillitis Acute parenchymatous tonsillitis Acute membranous tonsillitis Acute follicular tonsillitis

15. Acute superficial tonsillitis When tonsils are inflamed as part of the generalised infection of the oropharyngeal mucosa it is called acute superficial tonsillitis and also called catarrhal tonsillitis.

16. Acute follicular tonsillitis In acute follicular infection spread into the crypts – filled with purulent material – yellowish spots at the openings.

17. Acute parenchymatous Uniformly enlarge and erythematous with exudates, Edema of uvula and soft palate

18. Acute membranous Some times from the crypts may coalesce to form a membrane over the surface of tonsil, giving rise to clinical picture of membranous tonsillitis.

19. SIGNS OF ACUTE TONSILLITIS Tonsil appear congested and swollen - yellowish spots – follicular -whitish membrane – membranous - red and enlarged – parenchymatous Hyperemia of pillars, uvula, soft palate Halitosis, impeded movements of palate and increased secretion. Enlarge and tender jugulodigastric nodes.

20. Symptoms of acute tonsilLitis Sore throat - raw sensation in the throat. Refusal to eat due to odynophagia. Earache – either referred pain from the tonsil or due to acute otitis media. Voice become thick and muffled Jugulodigastric nodes are enlarged and painful. Fever, may be associated with chills and rigor, headache , tachycardia .

21. QUIZ

22. Sub acute tonsilLitis Sub-acute tonsillitis (which can last between 3week and 3 month ) is caused by the acntinomyces bacterium.

23. Chronic tonsillitis Chronic tonsillitis is a persistent infection of the tonsil and can cause tonsil s tone. AETIOLOGY Complication of acute sinusitis Subclinical infection of tonsil. Chronic infection of sinuses or teeth

24. Type of chronic tonsillitis Chronic follicular tonsillitis Chronic fibroid tonsilitis Chronic parenchymatous tonsillitis

25. Chronic follicular tonsillitis Tonsillar crypts are full of cheesy material resulting in yellow spots on the surface .

26. Chronic parenchymatous tonsillitis Tonsils are very much enlarged almost touching each other and may interfere with speech diglutition and respiration long standing cases may develop pulmonary hypertension

27. Cronic fibroid tonsillitis Tonsil are small but infected, with history of repeated sore throats

28. SIGNS OF CHRONIC TONSILLITS Appearance :hypertrophied, congested- chronic parenchymatous; small, fibrotic with cheesy debris-chronic follicular squeezing; pus oozes out-should be distinguished from lymphatic fluid of normal tonsils Enlarged jugulodigastric nodes Retention cysts; yellowish swellings filled with yellow liquid and debris

29. Symptom of chronic tonsillitis Recurrent throat pain Cough Halitosis and bad taste in the mouth Quiescent phase; discomfort, irritation, pain; asymptomatic

30. COMPLICATION Chronic tonsillitis- incomplete resolution of acute tonsillitis Peritonsillar abscess Parapharyngeal abscess A cute otitis media- recurrent attacks Cervical abscess due to suppuration of jugulodigastric nodes. Rheumatic fever – groupA ,B – hemolytic streptococci. Substance bacterial endocarditis (patient with valvular heart disease) – streptococcus viridans . Tonsillar cyst Tonsiolith Retropharyngeal abscess.

31. PATHOPHYSIOLOGY

32. DIAGNOSIS THROAT SWAB (strep test )- this is used to get a sample of the secretion from the back of the throat. MONOSPOT TEST ;a blood test can detect certain antibodies ,which can help confirm that a persons symptoms are due to mononucleosis. EPSTEIN-BARR VIRUS ANTIBODIES if a mono spot test test is negative ,antibodies in the blood against EBV might help diagnose mononucleosis. BLOOD TEST – this primarily includes a complete blood count (CBC) which is done to confirm the presence of infection.

33. MEDICAL MANAFGEMENT Antibiotic are used to treat acute tonsillitis .penicillin being most commonly used . In addition , the patient is instructed to minimize bed rest and increase adequate amount of fluid intake. Saline through irrigation or gargles may relives the discomfort. Ibuprofen or other analgesic can help to decrease edema and inflammation.

34. Which drugs are used for patient to patient allergic to penicillin ? Erythromycin Clarithromycin Ciprofloxacin Both A and B

35. QUIZ

36. SURGICAL MANAGEMENT Surgical removal of the tonsils (TONSILLECTOMY ) and adenoids(ADENOIDECTOMY) is collectively called( TONSILLOADENECTOMY”)

37. INDICATION OF TONSILLOADECTOMY Recurrent episodes of acute or chronic tonsillitis . Tonsillar or adenoid hypertrophy causing obstruction of a airway and impaired swallowing. Resolution of a peri tonsillar abscess. Repeated ear problems related to eustachian tube obstruction. Sinus complication.

38. NURSING MANAGEMENT OF THE TONSILLECTOMY After tonsillectomy, place the client in a lateral decubitus position until the client awake and alert . Monitoring vital sign , haemorrhage is the most serious complication. Start oral feeding if once recovery from anesthesia . Pain is the first 7 to 10 post operative days this can usually controlled with liquid Tylenol (acetaminophen) or Tylenol with coden

39. Cont … Avoid medication containing aspirin ,ibuprofen or other inflammatory medication for 2 weeks . FEVER- A low grade fever following surgery may occur and should be treated with Tylenol (acetaminophen)while a children have fever they should play quietly or remain in bed. ICE COLLAR-gently lay the ice bag on the front of neck . BLEEDING- most bleeding is minor and you may only see a little coting of blood on the tongue. Put your child into bed , sitting upright and place an ice collar on the neck .and watch for spitting ,coughing , or vomiting of blood.

40. quiz

41. QUIZ

42. QUIZ

43. Nursing management Promoting airway clearance Provide side lying or prone position to facilitate safe drainage of secretion Suctioning if necessary should be done to avoid trauma to the surgical site Maintaining fluid volume Inspect throat to the surgical site discourage the child from coughing , clearing the throat , blowing the nose and using straws. Encourage children to take any fluids Cittrous juice and brown or red fluid should be avoided Relieving pain Administer analgesic Promote oral fluid intake

44. Recent reserch in india

45. Study of common bacterial isolate in acute tonsillitis in india Dr GD Manajan,Dr Mayur Ingale professor ,Assistant professor department of ENT ,p Dr D Y Patil medical college , pimpri , pune ABSTRACT ; tonsil is a common condition encountered in the ENT out patient department of every hospital .1 out of every 10 children visiting the ENT OPD suffer from acute tonsillitis Material or method- our perspective observational study was carried out in the otorhinolaryngology department in a medical college hospital and research centre the period of study was from june 2015 to august 2015 Randomized throat swabs were collected from 50 patient visiting the ENT OPD. A certified of approval of the institutional ethics committee was obtained before commencing the study . Aninfor med consent was obtained from every patient who was a part of this study before commencing the study .

46. result Out of 50 patient from whom the throat swabs were collected and analysed , 45 were positive for staphylococcus aureus pyogenes while the other was positive for beta haemolytic streptococci CONCLUSION Staphylococcus aureus appear to be the main causative agent in the pathogenesis of acute tonsillitis in our area with a prevalence of about 90 percent (40/50 positive isolates)

47. SUMMARY Tonsillitis is an infection of the tonsils, the small masses of glandular tissue at the back of the throat . Tonsillitis most commonly affects children between the ages of one and five years Tonsillitis is usually not serious unless a rare complication known as a tonsillar abscess develops. This is a collection of pus just behind the tonsils. Obstruction to breathing by enlarged tonsils may cause snoring and disturbed sleep Tonsillitis caused by bacteria is treated with antibiotics. Virul tonsillitis does not respond to antibiotics. Tonsillectomy is performed for significant airway obstruction or in cases of recurring or serious infection.

48. EVALUATION WHAT Is waldeyer s ring? Define tonsillitis ? What are the type of acute tonsillitis ? What are the sign and symptoms of tonsillitis ? What are the diagnostic evaluation of tonsillitis? Explain Tonsillectomy ? What is electrosurgical tonsillectomy? Explain pathophysiology of tonsillitis? What are the nursing management of tonsillitis? Is tonsillitis is contagious? Discuss some Home Remedies for tonsillitis?

49. bibliography Ansari javed ,a text book of medical surgical nursing- II , pv publication,page no;-107-109 , Brunner and suddarth , text book of medical surgical nursing vol -II south Asian edition , wolters Kluwer, page no;-499-503 www.Wikipedia.com

50. Thanku