TONSILLITIS

Prepared by: Charmaine Joy H. Velasco – BSN 3A

I. OBJECTIVES

At the end of the study, the student-nurse would be able to:

• know the anatomy and physiology of the body part or organ involved;
• know the disease, its different causes, specific signs and symptoms,
medical managements, and other complications;
• identify different nursing interventions that are applicable to the
condition; and
• apply the acquired knowledge to an actual situation.

II. INTRODUCTION

Client’s Profile

Name: Mr. X. Address: Zone 7A, Sua, Camaligan

Birthdate: December 10, 2985
Age: 24 y/o
Sex: Male
Civil Status: Single
Nationality: Filipino
Religion: Roman Catholic
Chief Complaint: Fever, Sore throat
Present Treatment: Self-medication
Past Treatment: None
Past Hospitalization: None
Allergies: None
Occupation: None

Patient’s History of Present Illness

Mr. X is a resident of Zone 7A, Sua, Camaligan, Camarines Sur. He has no

permanent job and he does sidelines to earn for a living and to earn for his family. He
spends his time mainly at home, doing some household chores. He reported drinking
coffee every morning. He denies smoking and drinking alcohol. On the night of June 24,
2005, he felt hot and experienced a sore throat. He thought of having tonsillitis. He
immediately took ALVEDON 500 mg.

III. GORDON’S FUNCTIONAL HEALTH PATTERN

1. Health Perception – Health Management Pattern

The patient’s health rating is 1. Due to his present condition, he cannot

perform ADLs by himself and he needs assistance by a caregiver or significant
other. He hasn’t gone yet to a professional health care personnel. He doesn’t use
tobacco, doesn’t drink alcoholic beverages, and doesn’t take any drugs for
abuse.

Objective

The patient is alert even though having a bad feeling. He is lying on bed
to promote rest. He communicates well and talks fine. He can move his different
parts of the body and he shows emotions by different facial expressions.
 PR: 78 bpm T (axillary): 38⁰ C
RR: 22 cpm BP (sitting): 110/90

2. Nutritional – Metabolic Pattern

Daily Food and Fluid Intake

He usually drinks coffee in the morning. For lunch and dinner, he eats
vegetables and rice. He often eats fish and seldom eats meat. He eats anything
available for snacks. He doesn’t have any food allergies. He drinks approximately
2L of water delivered by the water tank that roams in their barangay everyday.
He doesn’t experience difficulty chewing but at present, he is experiencing
difficulty swallowing due to his sore throat. His gums and tongue are not swollen
but his palatine tonsils are. He is not experiencing abdominal pain and he never
took laxatives and antacids. His skin, hair, and nail condition are good.

3. Elimination Pattern

Bowel Habits

His usual pattern is everyday, in the morning. He never takes laxatives

and antacids. He never used suppositories. His stool color is usually dark brown.
He never experienced pain during defecation.

Bladder Habits

He voids approximately 8 times per day. The usual color of his urine is
clear to yellow. He never experience pain during urination. He never experienced
wetting his bed upon waking up. Whenever he feels the urge to void, he always
does. He never experienced retention.

4. Activity – Exercise Pattern

Daily Activities

He takes a bath daily without anyone’s aid. He does cook and do the
household chores at times. He views ADLs as different forms of exercises. He
eats moderate meals during lunch and dinner. He doesn’t experience chest pain,
stiffness, and palpitations. He experiences headache at times when he’s tired or
if the weather is too hot. His illness at present resulted to limitation of his
activities to promote rest.

5. Sleep – Rest Pattern

His sleeping time usually starts at 9:00 PM and he wakes up at 6:00 or

7:00 in the morning. He does not have difficulty falling asleep. He does not use
any sleeping aids. Simply turning off the lights induces his sleep. He denies using
any sleeping medications. At present, he appears exhausted due to his illness.

6. Sexuality – Reproduction Pattern

He is single. He doesn’t have any live-in partner nor does have any
children.
 7. Sensory – Perceptual Pattern

He does not have any problems with hearing, taste, smell, and sensation.
He does not use any hearing and vision aids. He is currently feeling pain in the
throat due to the swelling of his palatine tonsils.

8. Cognitive Pattern

He is able to express himself well by verbalizing his feelings and showing

gestures and manifesting different facial expressions. He can recall recent and
remote memories. He is able to make decisions for himself. He shows behaviors
of a mature gentleman.

9. Role – Relationship Pattern

He is the second child in the family. He lives with his mother, siblings,
cousins, and nephews and nieces. He provides extra income for the family,
sometimes when he has a sideline. He does some household chores when he is
at home. His family communicates well since they all live in one house. His
relationship with them is quite good. His siblings are actually taking care of him
at present.

10. Self-perception – Self-concept Pattern

He believes that he is an average person who wants to provide his family

with a good living. He believes he is funny at times.

11. Coping – Stress Tolerance Pattern

His major stressors are problems with the family. Family and friends are
his support system. He sometimes watches TV to relax his mind or he just simply
listens to the silence.

12. Value – Belief Pattern

He believes that he is silent, simple, and has self-esteem. His goal is to

provide his family with a good living. His sources of hope are his family and
friends. He is a Roman Catholic. He sometimes goes to church at Sundays. Even
though he forgets to pray at night, he assures that he is still a devoted catholic.

IV. ANATOMY AND PHYSIOLOGY

The Tonsils
 Tonsils are part of the body’s lymphatic system. These are organs which are of
importance in the creation of the blood and they are organs which fulfill important
tasks: protection and detoxification of the body and elimination of matter which should
be eliminated. They also act as organs for the regulation of the activity of the entire
mucous membrane.

There are three groups of tonsils.

• The pharyngeal tonsils, or adenoids, are located near the internal

opening of the nasal cavity.
• The lingual tonsil is a rounded mass of tissue on the posterior surface of
the tongue.
• The palatine tonsils are located on each side of the posterior opening of
the oral cavity. They usually are the “tonsils” that many people are
referring to.

The work done by the tonsils is similar to that done by the lymph glands. By the
formation of new white blood corpuscles and by filtering the stream of the lymph, the
germs of disease, metabolic poisons, and the foreign bodies are arrested and are made
innocuous. Tonsils and glands fulfill the same function, but there is this difference: the
tonsils are not encapsulated in connective tissue. They can expand towards throat and
mouth and their special formation with deep indentures and clefts makes it possible for
the tonsil to get greatly enlarged if necessary. Foreign bodies, body toxins, and germs,
which have been carried into the tonsils by the lymph stream, can therefore be
eliminated by way of the mouth, and thus the body is ridded of noxious materials.

The lymph circulation is of great importance to our health and the flow of lymph
through the tonsils is one of the most important defensive mechanisms of the human
body. Good health requires that the tonsils should function properly. In adults, the
tonsils decrease in size and may eventually disappear.

Nature of the Disease

Tonsils are ovoid masses of lymphoid tissue that act as a filter against disease
organisms. However, they often become a site of infection, a condition known as
tonsillitis, and sometimes become enlarged. It is most commonly caused by group A
beta-hemolytic streptococcus. According to studies, this microorganism can be present
in certain kinds of foods such as fried foods, flesh foods, pickles, tea, coffee, sugar, white
flour, and all products that are made with sugar and white flour. There is no proof that
smoking contributes to its development but research shows that smoking weakens the
immune system.

Symptoms of tonsillitis include a severe sore throat which may be experienced as

a referred pain to the ears, painful and difficult swallowing, coughing, headache,
myalgia, fever, and chills. It is characterized by signs of red and swollen tonsils which
may have a purulent exudative coating of white patches or pus. Swelling of the eyes,
face, and neck may also occur.

Tonsillitis may be acute (having presence of white patches) or chronic (persistent

infection having no presence of white patches). In any form, it is more prevalent during
childhood since tonsil tissue tends to regress with age. It can occasionally become
serious. For example, infection may spread beyond the tonsil to form an abscess, which
is a localized collection of pus. An abscess that forms around an inflamed tonsil is known
as a peritonsillar abscess or quinsy. This almost always develops on one side only and
usually in adults rather than children. Another type of abscess, one that develops mainly
in young children, is a retropharyngeal (behind the throat) abscess. This usually causes
high fever and great difficulty in swallowing.

The most serious complication of tonsillitis is rheumatic fever, which often is

accompanied by rheumatic heart disease. Rheumatic fever develops only if the tonsillitis
is due to group A beta-hemolytic streptococcus. It also usually occurs only in children
who have had repeated infections that have not been adequately treated with
antibiotics.

Whether tonsillitis is caused by a viral or bacterial infection, home care strategies

can be made to provide comfort and promote better recovery. Encourage the person to
get plenty of sleep and to rest his or her voice. Plenty of water should be given to keep
the throat moist and prevent dehydration. Warm liquids (broth, caffeine-free tea, or
warm water with honey) and cold treats (ice pops) can soothe a sore throat. If the
person can gargle, a saltwater gargle of 1 teaspoon of table salt to 8 ounces of warm
water can also help soothe a sore throat. Have the person gargle the solution and then
spit it out. It is also important to avoid irritants. Keeping the home free from cigarette
smoke and cleaning products can help.

If tonsillitis is caused by a bacterial infection, the doctor will prescribe a course of

antibiotics. Penicillin taken by mouth for 10 days is the most common antibiotic
treatment prescribed for tonsillitis. If the person is allergic to penicillin, the doctor will
prescribe an alternative antibiotic such as erythromycin. The person must take the full
course of antibiotics as prescribed even if the symptoms go away completely. Failure to
take all of the medication as directed may result in the infection worsening or spreading
to other parts of the body.

If tonsillitis is caused by a virus, like Epstein-Barr virus or the Coxsackie virus, the
length of the illness depends on which virus is involved. Usually viral infection is self-
limiting; the body fights off the infection on its own within one week. However, some
rare viral infection resolves for up to two weeks.

If detected very early, peritonsillar or retropharyngeal abscesses can sometimes

be treated successfully with antibiotics. In most cases, however, surgery is required to
drain the abscess. Removal of the tonsils, called tonsillectomy or adenoidectomy, is
sometimes advised if frequent inflammation poses a threat to health. The lingual tonsil
becomes infected less often than the other tonsils and is more difficult to remove.

V. NURSING CARE PLAN

VI. INSIGHT
Date: June 24 – 25 & July 1 – 2, 2010 (Thursdays and Fridays)
Clinical Area: Sua, Camaligan, Camarines Sur
Clinical Instructor: Mr. Joel Nebres, RN, MAN

It wasn’t my first time to be assigned to one of the communities handled by

Universidad de Sta. Isabel. I can say that I am already confident doing my entire task in
the community than when I am in the hospital. My anxiety is already into its minimum.
But still I’m afraid I might do something wrong that could possibly harm or disappoint
my client. Thanks to Sir Joel because with him, I knew how to properly interact with the
people in the community. I didn’t just gain more confidence but I also learned a lot.

The first two days of our exposure was really tiring but at the same time, it was a
lot of fun. Walking under the heat of the sun at 9:00 AM was never part of my dreams.
But when we did the ocular survey on the first day, I realized that seeing the condition
of the community makes a community health nurse proud if he/she has seen a lot of
development, or determined if he/she has seen some problems in the community.
Proud because when you see that there is a positive change in a certain person or place,
you will feel that all your hardships were worth it, and determined because when you
recognize a negative matter, you will try to do your best to make it a better one. The
long walk was an experience I can never forget.

On the second day of our exposure, home visit was the task of the day. Again,
walking the long road is a part of it. I, together with one of my RLE group mates, was
assigned on the 7th zone of the barangay. I was really shy to walk wearing my CHN
uniform. I feel like everyone was staring at me. If I had the chance to, I would take it off
and change myself into someone that they can see as themselves. With what I felt
during that day, I kept into my mind this principle: in order for you to be part of the
community, you should be one of the people. I did the home visit well but one thing
that makes me uneasy is me having to talk with the residents in tagalog, and they
answer me back in bikol. I was really shy because I know it is my task to learn the
language but I just can’t speak using it. Maybe one of these days, months, or years, I
would learn how to speak with it properly.

The last two days of our exposure was mainly spent for reporting and paper
works. I reported about IMCI and I guess I did pretty well. Preparation is very important
in delivering a report. This skill can be applied to activities in the community, wherein
the community health nurse has to inform the people about matters in the community.
Paper works, especially those that have to be prepared by group, will not be easy if not
every member is participating. I was happy on the last day of our exposure because
even if we just stayed in the barangay hall of our school, our time was productive. We
almost finished all that we have to do and the best part is that the moment was spent
with the whole group.

With the four-day exposure and experience, I learned that establishing rapport is
really important in all aspects. It is for the reason that people will not work effectively if
they didn’t develop a good relationship with each other, especially in the case of a nurse
and a client. Being careful is the key for an effective nursing care. The client should
always be our center. For me, the best thing to bear in every student-nurse’s mind is
this: “Common sense does not require a RN license.” 