Tonslitis

OM VERMA
ASSISTANT PROFESSOR
MEDICAL - SURGICAL NURSING
GRACIOUS COLLEGE OF NURSING ABHANPUR

1. RELIANCE INSTITUTE OF NURSING
DHAMTARI
SUBJECT: MEDICAL SURGICAL
NURSING
TOPIC : TONSILLITIS
OM VERMA
Msc lecturer
Medical surgical nursing

2. CONTENTCONTENT
•INTRODUCTION
•DEFINITION
•TYPES
•ANATOMY & PHYSIOLOGY
•ETILOGY
•PATHOPHYSIOLOGY
•CLINICAL FEATURES
•DIAGNOSTIC EVALUATION
•MEDICAL MANAGEMENT
•SURGICAL MANAGEMENT
•NURSING MANAGEMENT
•DIET MANAGEMENT
•COMPLICATION

3. INTRODUCTIONINTRODUCTION
THE TONSILS ARE COMPOSED OF LYMPATIC THE TONSILS ARE COMPOSED OF LYMPATIC
TISSUE & ARE SITUATED ON EACH SIDE TISSUE & ARE SITUATED ON EACH SIDE
OF THE OROPHARYNX.THEY FREQUENTLY OF THE OROPHARYNX.THEY FREQUENTLY
SERVED AS THE SITE OF ACUTE SERVED AS THE SITE OF ACUTE
INFECTION.INFECTION.
GROUP A GROUP A
STREPTOCOCCUS IS THE MOST COMMON STREPTOCOCCUS IS THE MOST COMMON
ORGANISM ASSOCIATED. ORGANISM ASSOCIATED.

4. DEFINITION
TONSILLITIS IS SIMPLY DEFINES AS THE
SWELLING OF THE TONSIL WHICH ARE
LOCATED IN THE THROAT TOWARDS THE
BACK OF THE MOUTH.
TONSILLITIS THE INFECTION OF
INFLAMMATION OF THE TONSIL.THE
TONSIL ARE THE BALL OF THE LYMPATIC
TISSUES ON BOTH SIDE OF THE
THROAT.THEY ARE THE PART OF IMMUNE
SYSTEM WHICH HELP THE BODY TO FIGHT
AGAINST INFECTION.

5. CONT….CONT….

TONSILITIS IS AN INFECTION & SWELLING TONSILITIS IS AN INFECTION & SWELLING
OF THE TONSIL. THE TONSIL ARE LYMPH OF THE TONSIL. THE TONSIL ARE LYMPH
NODE & OVAL SHAPE MASK OF LYMPH NODE & OVAL SHAPE MASK OF LYMPH
GLAND TISSUES LOCATED ON THE BOTH GLAND TISSUES LOCATED ON THE BOTH
SIDE OF THE THROAT. THAT ARE THE PART SIDE OF THE THROAT. THAT ARE THE PART
OF THE BODY IMMUNE SYSTEM.OF THE BODY IMMUNE SYSTEM.

6. TYPESTYPES
•ACUTE TONSILLITIS.
•CHRONIC TONSILLITIS.

7. ANATOMY AND PHYSIOLOGY

8. ETIOLOGYETIOLOGY
•PRIMARY INFECTION OF THE TONSIL.
•OCCUR AS A SECONDORY INFECTION OR AS A
RESULT OF INFECTION OF THE URI.
•VIRAL INFECTION OR BACTERIAL INFECTION.
•POOR ORODENTAL HYGIENE MAY CAUSE IN
INFLAMMATION OF THE TONSIL.
•POOR NUTRITIONAL STATUS.
•OTITIS MEDIA

9. PATHOPHYSILOGYPATHOPHYSILOGY
DUE TO ANY ETIOLOGICAL FACTORSDUE TO ANY ETIOLOGICAL FACTORS
INFECTION CAUSED BY BACTERIAL OR VIRAL INFECTION CAUSED BY BACTERIAL OR VIRAL
ORGANISMORGANISM
TONSIL BECOME INFLAMMEDTONSIL BECOME INFLAMMED
HYPEREMIA & EDEMA WITH CONVERSION OF HYPEREMIA & EDEMA WITH CONVERSION OF
LYMPHOID FOLLICLE INTO SMALL ABCESSLYMPHOID FOLLICLE INTO SMALL ABCESS
DISCHARGE INTO CRYPTDISCHARGE INTO CRYPT
AIRWAY OBSTRUCTION DECREASE APPETITE & AIRWAY OBSTRUCTION DECREASE APPETITE &
PAIN PAIN

10. CLINICAL FEATURESCLINICAL FEATURES
SYMPTOMS:SYMPTOMS:
FEVER WHICH IS ALWAYS HIGH GRADE.FEVER WHICH IS ALWAYS HIGH GRADE.
GENERELISED MALAISE & BODY ACHE.GENERELISED MALAISE & BODY ACHE.
ODYNOPHAGIA (PAIN DURING ODYNOPHAGIA (PAIN DURING
SWALLOWING).SWALLOWING).
DRY MOUTH.DRY MOUTH.
SORE THROAT.SORE THROAT.

11. Cont………Cont………
•SIGNS:SIGNS:
•CONGESTED & EDEMATOUS TONSIL.CONGESTED & EDEMATOUS TONSIL.
•TONSILS MAY BE DIFFUSELY TONSILS MAY BE DIFFUSELY
SWOLLEN IN PARENCHYMATOUS SWOLLEN IN PARENCHYMATOUS
TONSILLITIS.TONSILLITIS.
•CRYPTS CAN BE SEEN FILLED WITH CRYPTS CAN BE SEEN FILLED WITH
PUS WITH SWOLLEN FOLLICLES IN PUS WITH SWOLLEN FOLLICLES IN
FOLLICULR TONSILITIS.FOLLICULR TONSILITIS.
•EXAMINATION OF THE NECK CAN EXAMINATION OF THE NECK CAN
REVEAL ENLARGED AND TENDER REVEAL ENLARGED AND TENDER
JUGULO-DIGASTIC LYMPHNODES. JUGULO-DIGASTIC LYMPHNODES.

12. 
COMPLETE BLOOD PICTURE INCLUDING:
* HEMOGLOBIN.
* ESR.
* PLATELET COUNT.
* PERIPHERAL SMEAR.
CLOTTING & PROTHROMBIN TIME.
 BLOOD GROUPING.
ASO titer
THROAT SWAB FOR CULTURE.
X-RAY CHEST
ECG MAY BE REQUIRED IN ELDERLY PATIENT.
NASAL ENDOSCOPY TO RULE OUT THE ADENOID
HYPERTROPHY.
EVALUATION OF RENAL & CARDIAC FUNCTION IF
RHEUMATIC DISEASE IS SUSPECTED.

14. MEDICAL MANAGEMENTMEDICAL MANAGEMENT

IF THE SYMPTOMS ARE SEVERE AND IF MEMBRANE IS IF THE SYMPTOMS ARE SEVERE AND IF MEMBRANE IS
PRESENT, IT IS NECESSARY TO HOSPITALISED THE PRESENT, IT IS NECESSARY TO HOSPITALISED THE
PATIENT.PATIENT.

PENICILLIN IS THE DRUG OF CHOICE USUALLY PENICILLIN IS THE DRUG OF CHOICE USUALLY
SPECIALLY FOR STREPTOCOCCUS INFECTION.SPECIALLY FOR STREPTOCOCCUS INFECTION.

ERYTHROMYCIN SHOULD BE PREFFERED IN PATIENT ERYTHROMYCIN SHOULD BE PREFFERED IN PATIENT
SENSITIVE TO PENICILLIN GROUP OF ANTIBIOTIC.SENSITIVE TO PENICILLIN GROUP OF ANTIBIOTIC.

INJECTABLE PENICILLIN LIKE CRYSTALLINE PENICILLIN INJECTABLE PENICILLIN LIKE CRYSTALLINE PENICILLIN
& CO-AMOXYCLAV SHOULD BE GIVEN IN SEVERE & CO-AMOXYCLAV SHOULD BE GIVEN IN SEVERE
CASES.CASES.

MOST OF THE PATIENT RESPOND TO THE ANTIBIOTIC.MOST OF THE PATIENT RESPOND TO THE ANTIBIOTIC.

ANTISEPTIC GARGLES AND THROAT LOZENGES MAY BE ANTISEPTIC GARGLES AND THROAT LOZENGES MAY BE
GIVEN.GIVEN.

PARACETAMOL/NIMESULIDE FOR FEVER.PARACETAMOL/NIMESULIDE FOR FEVER.

ANTI-INFLAMMATORY FOR PAIN AND INFLAMMATION. ANTI-INFLAMMATORY FOR PAIN AND INFLAMMATION.

15. SURGICAL MANAGEMENTSURGICAL MANAGEMENT

TONSILLECTOMYTONSILLECTOMY

METHOD OF SURGERY:METHOD OF SURGERY:
* DISSECTION* DISSECTION
* GUILLOTINE* GUILLOTINE
* ELECTRO CAUTERY* ELECTRO CAUTERY
* CRYO SURGERY* CRYO SURGERY
* LASER * LASER
PRE MEDICATION: PRE MEDICATION:
* ANTIBIOTIC* ANTIBIOTIC
* ATROPINE* ATROPINE
* ANTI EMETIC* ANTI EMETIC
* SEDATIVE* SEDATIVE

16. COMPLICATION OF SURGERYCOMPLICATION OF SURGERY

HAEMORRHAGEHAEMORRHAGE

REACTION TO ANAESTHESIAREACTION TO ANAESTHESIA

OTITIS MEDIAOTITIS MEDIA

BACTERIMIABACTERIMIA

17. NURSING
MANAGEMENT
•ASSSESSMENT
* History taking
* Physical examination
* Nutritional status
* Skin condition
* Personal hygiene
* Anxiety level
* Knowledge level

18. NURSING DIAGNOSIS:NURSING DIAGNOSIS:
RISK FOR DEFICIENT FLUID VOLUME RISK FOR DEFICIENT FLUID VOLUME
RELATED TO REDUCED INTAKE POST-RELATED TO REDUCED INTAKE POST-
OPERATIVELY & BLOOD LOSSOPERATIVELY & BLOOD LOSS
INEFFECTIVE AIRWAY CLEARENCE INEFFECTIVE AIRWAY CLEARENCE
RELATED TO PAIN & EFFECTS OF RELATED TO PAIN & EFFECTS OF
ANAESTHESIA ANAESTHESIA
ANXIETY OF THE PATIENT RELATED TO ANXIETY OF THE PATIENT RELATED TO
CONCEPT OF SURGERY CONCEPT OF SURGERY
FEAR RELATED TO PAINFULL PROCEDURE FEAR RELATED TO PAINFULL PROCEDURE
& UNFAMILIAR ENVIRONMENT.& UNFAMILIAR ENVIRONMENT.
ACUTE PAIN RELATED TO SURGICAL ACUTE PAIN RELATED TO SURGICAL
INCISSIONINCISSION

19. DIET MANAGEMENTDIET MANAGEMENT
►A liquid or soft diet is give during acute A liquid or soft diet is give during acute
stage of disease.stage of disease.
►Diet is give depending on the patients Diet is give depending on the patients
swallowing condition.swallowing condition.
►In severe condition fluid may be administer In severe condition fluid may be administer
intravenously.intravenously.
►The patient also encourage to drink as The patient also encourage to drink as
much as possible(2-3L/day)much as possible(2-3L/day)
► Milk & milk product should be provided.Milk & milk product should be provided.
►Avoid spicy food & food with high roughageAvoid spicy food & food with high roughage
►Gelatinous food are acceptable.Gelatinous food are acceptable.

20. CONT…..
•DAILY REQUIREMENT OF TONSILITIS PATIENTS:
Total calories : 2700-2800 Kcal
Protein : 35 gm
Carbohydrate : 485-500 gm
Fat : 25-30 gm
VITAMIN A: 3000 IU

21. COMPLICATION
PULMONORY HTN
RESPIRATORY FAILURE
PERI TONSILLAR ABSCESS
DYSPHAGIA

22. HEALTH EDUCATION
INSTRUCT THE PATIENT TO TAKE REST.
EDUCATE ABOUT WARM SALINE ANTISEPTIC GARGLING
INSRUCT THE PATIENT TO TAKE DRUG THERAPY & ITS
IMPORTANCE.
INSTRUCT THE PATIENT TO TAKE BED REST WITH
INCREASED FLUID INTAKE DURING FEVER.
EDUCATE THE PATIENT TO MINIMIZE EXPOSURE TO
POLLUTANTS BY WEARING FACE MASK
INSTRUCT THE PATIENT TO AVOID THE USE OF
ALCOHOL , TOBACCO, & THE SECOND HAND SMOKE.
AVOID COUGHING AND HAWKING.
VOICE REST.
INSTRUCT THE PATIENT TO MAINTAIN PROPER ORAL
HYGEINE.
PROVIDE SEMISOLID OR LIQUID DIET TO THE PATIENT.
PATIENT WITH SURGERY SHOULD BE PROVIDED ICE
CREAMS & COLD DRINKS.