Foundation University

COLLEGE OF NURSING
Dumaguete City

WARD CLASS
Hemorrhoids, Hemorrhoidectomy
Tonsillitis, Tonsillectomy

Submitted to:
Mr. Kenneth Joe R. Corales, LPT, RN

Submitted by:
CABALLO, Cloie Alexi K.
DAUG, Jenessel Ann P.
DINAWANAO, Ramona B.
FUTALAN, Ruby Jane A.
Purpose: The purpose of this study is to provide students with comprehensive knowledge on Hemorrhoids, Hemorrhoidectomy
Tonsillitis, Tonsillectomy. By the end of the discussion, participants will be able to define the said disease, its overview, clinical manifestations, assessment
and diagnostic findings and medical and surgical management.
Goal: The goal of this study is to equip nursing students with the necessary knowledge on Hemorrhoids, Hemorrhoidectomy
Tonsillitis, Tonsillectomy along with its overview, clinical manifestations, assessment and diagnostic findings and medical and surgical management.

METHOD TIME METHOD OF

OBJECTIVES CONTENT OUTLINE OF ALLOTTED RESOURCES EVALUATION
INSTRUC
TION

1. Give an I. Overview and Clinical Lecture and 20 minutes Hemorrhoids: symptoms, Question and Answer
overview on Manifestations of Hemorrhoids and presentation causes, and treatment.
Hemorrhoids, hemorrhoidectomy (2001, December 31). 1. Define the
Hemorrhoidecto WebMD. following:
my. Hemorrhoids are swollen veins, Hemorrhoids
https://www.webmd.com/
similar to varicose veins, in the lowest and
digestive-disorders/under
2. Understand the part of your rectum and anus. Hemorrhoidecto
clinical Sometimes, the walls of these blood Lecture and 20 minutes
standing-hemorrhoids-bas my
manifestations vessels stretch so thin that the veins presentation ics
of Hemorrhoids. bulge and get irritated, especially 2. What are the
when you poop. You might also hear Hyperarts, R. M.-. (n.d.). clinical
them called piles. Department of Surgery - manifestations
3. Discuss the Hemorrhoidectomy. of
medical and Hemorrhoids aren't serious, but they https://surgery.ucsf.edu/c Hemorrhoids?
surgical can cause unpleasant symptoms. Lecture and 20 minutes onditions--procedures/he
management of They're one of the most common presentation morrhoidectomy.aspx#:~: 3. What are the
Hemorrhoids causes of rectal bleeding. They often medical and
text=A%20hemorrhoidect
go away on their own. Treatments can surgical
omy%20is%20surgery%2
4. Discuss the also help. management of
appropriate
0to,the%20greatest%20ra Hemorrhoids?
 nursing Types of Hemorrhoids te%20of%20complication
management for Lecture and 20 minutes s. 4. What is the
Hemorrhoids Internal hemorrhoids - These are so presentation appropriate
far inside your rectum that you can't Rnpedia. (2017). nursing
5. Ask the usually see or feel them. They don't management for
Hemorrhoids Nursing
participants generally hurt because you have few Hemorrhoids?
Care Plan &
questions to pain-sensing nerves there.
gauge their Lecture and 20 minutes
management. RNpedia.
understanding of External hemorrhoids - You get presentation https://www.rnpedia.com/
the diseases.. these under the skin around your anus, nursing-notes/medical-sur
where there are many more gical-nursing-notes/hemo
pain-sensing nerves. rrhoids/

Prolapsed hemorrhoids - These

happen when an internal hemorrhoid
stretches down so far that it bulges
outside your anal opening. They
usually go back inside your body on
their own. Even if they don't, they can
often be gently pushed back into
place.

Thrombosed hemorrhoids - A blood

clot can turn an external hemorrhoid
purple or blue. This is called a
thrombosis or a thrombosed
hemorrhoid.

Signs and Symptoms of

Hemorrhoids
Internal hemorrhoids may have no
symptoms at all. You might notice
blood on your poop, on toilet paper
after you wipe, or in the toilet bowl.

Prolapsed hemorrhoid symptoms

might include:
> Pain, especially when defecating
> Moist bumps that look pinker than
the surrounding area
External hemorrhoid symptoms may
include:
> Pain while sitting or at other times
> Bleeding
> Itching
> Swelling

Thrombosed hemorrhoid symptoms

may include:
> Serious pain
> Itching
> Bleeding

Causes

Pressure building up in your lower

rectum can affect blood flow and
make the veins there swell. That may
happen because of:

> Pushing when you defecate

> Straining when you do something
that's physically hard, like lifting
something heavy
> Extra weight, like obesity
> Pregnancy, when your growing
uterus presses on your veins
> A diet low in fiber
> Anal sex

You may get hemorrhoids when you

have constipation or diarrhea that
doesn't clear up. Coughing, sneezing,
and vomiting could make them worse.

Risk Factors

Genetics - You may be more likely to

get hemorrhoids if other family
members, like your parents, had them.
Age - Older people may be more
likely to get them because tissues in
the anal area tend to grow weaker as
you age.
Pregnancy - Pregnancy raises your
risk in a couple of ways. The weight
of the fetus puts extra pressure on
your rectum. You're more prone to
constipation, too.
Too much sitting - A mostly
sedentary lifestyle, or a job in which
you have to sit for long stretches, also
raises your risk. When you don't move
around a lot, blood can pool in your
anal area and put pressure on the
blood vessels there.

Hemorrhoidectomy - is a surgical
procedure done to remove internal or
external hemorrhoids that are
extensive or severe. Surgical
hemorrhoidectomy is the most
effective treatment for hemorrhoids,
though it is associated with the
greatest rate of complications.

Types of hemorrhoidectomies and

related procedures performed
during surgery:

Closed Hemorrhoidectomy - most

commonly used to treat internal
hemorrhoids; consists of the excision
of hemorrhoidal bundles using a sharp
instrument, such as a scalpel, scissors,
electrocautery, or even laser followed
by complete wound closure with
absorbable suture

Open Hemorrhoidectomy -
hemorrhoidal tissue is excised in the
same manner as in a closed procedure,
but here the incision is left open
Stapled Hemorrhoidectomy
(Procedure for Prolapse and
Hemorrhoids - PPH) - newest
addition to the armamentarium of
surgical internal hemorrhoid
procedures. It has several aliases,
including Longo's procedure, the
procedure for prolapse and
hemorrhoids (PPH, Ethicon
Endo-surgery, Inc., Cincinnati, OH),
stapled circumferential mucosectomy,
and circular stapler hemorrhoidopexy

Rubber band Ligation - A rubber

band is placed around the base of the
hemorrhoid inside the rectum. The
band cuts off circulation, and the
hemorrhoid withers away within a few
days.

Lateral Internal Sphincterotomy -

or opening of the inner anal sphincter
muscle is sometimes performed
during hemorrhoidectomy in patients
with high resting sphincter pressures.
It is hypothesized to reduce
postoperative pain. It is not used in
most cases.
II. Assessment and Diagnostic
Findings

Physical exam - anus and rectum will

be checked to check for lumps,
swelling, irritation, or other problems.
Digital rectal exam - physician will
apply lubrication, and insert a finger
into your rectum to check muscle tone
and feel for tenderness, lumps, or
other problems.

To diagnose internal hemorrhoids or

rule out other conditions, you might
need a more thorough test, including:

Anoscopy - a short plastic tube called

an anoscope will be used to look into
the anal canal
Sigmoidoscopy - inspection of the
lower colon with a flexible lighted
tube called a sigmoidoscope; tube
may be used to collect tissue for
further tests
Colonoscopy - inspection of the large
intestine with a long, flexible tube
called a colonoscope; tube may be
used to collect tissue for further tests

III. Medical and Surgical

Management
Nonsurgical Treatments
Over-the-counter creams, pads, and
suppositories temporarily ease pain,
swelling, and itching. Most contain
ingredients like lidocaine,
hydrocortisone, or witch hazel.

May also be treated with:

Rubber band ligation: A small
rubber band placed around the base of
a hemorrhoid cuts off blood supply to
the vein.
Electrocoagulation: An electric
current stops blood flow to a
hemorrhoid.
Infrared coagulation: A small probe
inserted into the rectum transmits heat
to get rid of the hemorrhoid.
Sclerotherapy: A chemical injected
into the swollen vein destroys
hemorrhoid tissue.

Surgical Treatments
Hemorrhoidectomy: Surgery
removes large external hemorrhoids or
prolapsed internal ones.
Hemorrhoid stapling: A stapling
instrument removes an internal
hemorrhoid. Or it pulls a prolapsed
internal hemorrhoid back inside of
your anus and holds it there.

IV. Nursing Management

● After thrombosis or surgery,

assist with frequent
repositioning using pillow
support for comfort.
● Provide analgesics, warm sitz
baths, or warm compresses to
reduce pain and
inflammation.
● Apply witch-hazel dressing to
perianal area or anal creams
or suppositories, if ordered, to
relieve discomfort.
● Observe anal area
postoperatively for drainage
and bleeding.
● Administer stool softener or
laxative to assist with bowel
movements soon after
surgery, to reduce risk of
stricture.
● Teach anal hygiene and
measures to control moisture
to prevent itching.
● Encourage the patient to
exercise regularly, follow a
high fiber diet, and have an
 adequate fluid intake (8 to 10
glasses per day) to avoid
straining and constipation,
which predisposes to
hemorrhoid formation.
● Discourage regular use of
laxatives; firm, soft stools
dilate the anal canal and
decrease stricture formation
after surgery.
● Tell patient to expect a
foul-smelling discharge for 7
to 10 days after
cryodestruction.
● Determine the patient’s
normal bowel habits and
identify predisposing factors
to educate patient about
preventing recurrence of
symptoms.
Objectives Content Outline Method of Time Allotted Resources Method of
instruction Evaluation
s

1. Give an Lecture and 10 mins Question and

What is tonsillitis? presentation https://www.mayoclin Answer:
overview of
tonsillitis and Tonsillitis is an infection or ic.org/tests-procedure
s/tonsillectomy/about 1. Define the
tonsillectomy inflammation of the tonsils . following:
/pac-20395141
The tonsils are balls of Tonsillitis
lymph tissue on both sides of https://my.clevelandcl and
the throat, above and behind inic.org/health/treatm tonsillectomy
the tongue. They are part of ents/15605-tonsillect .
the immune system, which omy 2. What are the
clinical
helps the body fight
https://www.entkidsa manifestation
infection. s of
dults.com/pediatric-e
There are three types: nt/tonsils-and-tonsille tonsillitis?
ctomy/ 3. What are the
medical and
● Acute tonsillitis. surgical
These symptoms treatments of
tonsillitis?
usually last 3 or 4
4. What are the
days but can last up appropriate
to 2 weeks. nursing
● Recurrent management
for tonsillitis?
tonsillitis. This is
when you get
tonsillitis several
times in a year.
● Chronic tonsillitis.
This is when you
 have a long-term
tonsil infection.

What is tonsillectomy?
Lecture and 10 mins
presentation
Tonsillectomy is defined as
the surgical excision of the
palatine tonsils. Although a
long-practiced procedure,
tonsillectomy is still a
common operation and
considered one of the most
common major surgical
procedure performed in
children.

Tonsillitis Symptoms:
The main symptoms of
tonsillitis are inflamed and
swollen tonsils, sometimes
severe enough to make it
hard to breathe through your
mouth. Other symptoms
include:

● Throat pain or
tenderness
● Fever
● Red tonsils
 ● A white or yellow
coating on your
tonsils
● Painful blisters or
ulcers on your throat
● Headache
● Loss of appetite
● Ear pain
● Trouble swallowing
● Swollen glands in
your neck or jaw
● Fever and chills
● Bad breath
● A scratchy or
muffled voice
● Stiff neck

Tonsillitis Causes
2. Understand Bacterial and viral infections
the clinical cause tonsillitis. A common Lecture and 10 mins
manifestation presentation
cause is Streptococcus
s of tonsillitis (strep) bacteria, which can
also cause strep throat. Other
3. Discuss the common causes include:
medical and
surgical
treatments of ● Adenoviruses
tonsillitis ● Influenza virus
● Epstein-Barr virus
● Parainfluenza
4. Discuss the viruses
appropriate ● Enteroviruses
nursing ● Herpes simplex virus
management
for tonsillitis
II. ASSESSMENT AND Lecture and 10 mins
5. Ask DIAGNOSTIC FINDINGS presentation
participants
questions to
evaluate their ● Examine the
answers. patient's throat for
redness, swelling or
white spots on their
tonsils.
● Ask about other
symptoms that the
patient had, such as
a fever, cough, runny
nose, rash or
stomachache.
● Look in the patient's
ears and nose for
other signs of
infection.
● Feel the sides of the
patient's neck to see
if their lymph nodes
are swollen and
tender.
III. Medical and Surgical Lecture and 10 mins
Management presentation

Healthcare providers treat

bacterial tonsillitis (strep
throat) with antibiotic
medications. Antibiotics
require a prescription. You
usually take antibiotics orally
(by mouth) for about 10
days. The most common
antibiotics for strep throat
are:

● Penicillin.
● Clindamycin.
● Cephalosporin.

It’s very important to follow

your healthcare provider’s
instructions and take the full
course of antibiotics, even if
you’re feeling better after a
couple of days. You must
finish the antibiotics so the
infection doesn’t come back,
get worse or spread to
another part of your body.
Tonsillectomy procedure

There are several different

ways to remove tonsil, these
are the following:

● “cold knife (steel)

dissection.” In this
case, your surgeon
removes your tonsils
with a scalpel.
● Cauterization
involves burning
away the tissues.
● Ultrasonic vibration
(using sound waves)
is also used in some
tonsillectomy
procedures.

Tonsillectomies usually take

about a half hour.No matter
what surgical method your
doctor chooses, you’ll be
asleep with a general
anesthetic. You won’t be
aware of the surgery or feel
any pain. When you wake up
after the tonsillectomy,
you’ll be in a recovery room.
Medical staff will monitor
your blood pressure and
heart rate as you wake up.

IV. NURSING
MANAGEMENT Lecture and 10 mins
presentation

● Advise patient to
take pain
medications as
directed by their
surgeon or the
hospital staff.
● Encourage patients
to drink enough
fluids. It's important
to get plenty of
fluids after surgery
to avoid
dehydration.
● Educate patient on
the appropriate foods
to eat post-op.Bland
foods that are easy to
swallow are the best
choices immediately
after surgery.
● Promote enough rest
periods.
● Position patient with
head elevated on 2-3
pillows for 3-4 days
to help decrease
swelling.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Altered comfort: Short term goals: Independent: Short term:

The patient Pain related to At the end of my 8 1. Encourage 1. To maintain After 8 hours of
verbalized, “Sakit difficulty in hours nursing care, patients to soft stools to nursing care, the
kaayo ilingkod ug defecation as patient will be able increase fluid avoid patient was able to
ikalibang.” evidenced by pain to report decrease intake and eat straining report decrease of
➢ Pain Scale of scale of 7/10 and of pain as foods rich in during pain as evidenced by:
7/10 facial grimace. evidenced by: fiber. defecation. ● Goal met.
● Absence of 2. Eating small 2. To promote Patient
Objectives: restlessness and frequent more showed
➢ Restlessness ● Absence of meals. efficient absence of
➢ Facial facial 3. Avoid eating metabolism. restlessness
grimace grimace spicy food. 3. To prevent ● Goal met.
➢ Guarding ● Absence of 4. Encourage irritating the Patient
behavior guarding patient to do lining of the showed an
behavior perineal care stomach and absence of
5. Provide a intestine. facial
Long Term Goals: “donut cushion” 4. To provide grimace.
At the end of my 2 for the patient to comfort and ● Goal met.
days nursing care, sit on if needed. proper Patient
patient will be able hygiene showed
to report decrease 5. Donut absence of
of pain as cushions can guarding
evidenced by: help remove behavior.
● Report pressure from
decreased hemorrhoids; Long Term Goals:
of pain with caution on After 2 days of
a pain scale the nursing care, patient
of 3/10 occurrence of was able to report
from a Dependent: pressure decrease of pain as
scale of 6. Encourage and areas. evidenced by:
7/10 instruct patient ● Goal met.
● Identifying to apply Patient
measures to prescribed 6. To reduce reported
decrease analgesic and control decreased
 pain or topical pain pain with a
discomfort medication pain scale of
during properly. 3/10 from a
defecation. 7. Encourage scale of 7/10.
patient to do sitz ● Goal met.
bath as needed Patient
identified
7. To relieve measures to
pain and decrease pain
itching or discomfort
during
defecating.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired Skin Short term goals: Independent: Short term goals:
The patient Integrity related After 8 hours of 1. Instruct patient 1. Hemorrhoids After 8 hours of
verbalized “katol to scratching or nursing care, the and/or family are caused by nursing care, the
kaayo ang palibot trauma caused patient will have regarding causes straining, patient had improved
sa akoang by itching and improved skin of hemorrhoids, heavy lifting, skin integrity as
gawsanan ug irritation as integrity as methods of obesity, evidenced by:
hugaw, nasamad evidenced by evidenced by: avoiding pregnancy, ● Goal met.
nalang ug kinatol” the patient’s ● Absence of hemorrhoids, and and any Patient had
complaint of discomfort treatments that can activity that absence of
Objective: itching and the ● Absence of be performed. distends discomfort
➢ Presence of presence of facial 2. Instruct patient rectal veins ● Goal met.
discomfort hemorrhoidal grimace and/or family in and causes Patient had
➢ Facial bleeding. dietary them to absence of
grimace Long term goals: management. prolapse. facial
➢ Hemorrhoi After 2 days of 3. Encourage patient 2. Increasing grimace
dal nursing care, the to do sitz bath bulk, fiber,
bleeding patient will have 4. Provide a “donut and fluids, Long Term Goals:
noted improved skin cushion” for the and eating After 2 days of
around integrity as evidenced patient to sit on if fruits and nursing care, the
lower by: needed. vegetables patient had improved
rectum ● Verbalization can help by skin integrity as
of decreased maintaining evidenced by:
itching and soft stools to ● Goal met.
irritation avoid Patient
● Absence of straining at verbalized
hemorrhoidal bowel decreased
bleeding movements. itching and
around lower 3. To relieve irritation
rectum. pain, ● Goal met.
itchiness and Patient had
irritation an absence of
4. Donut hemorrhoidal
cushions can bleeding
help remove around the
pressure from lower rectum.
hemorrhoids;
caution on
the
occurrence of
pressure
areas.

5. Helps relieve
Dependent: pain by
5. Administer stool avoiding the
softeners as passage of
ordered. hard fecal
6. Administer topical material.
 medication as 6. Reduces
ordered. swelling,
pain, and/or
itching in
order to make
the patient
more
comfortable.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

“Mahadlok ko Risk for imbalanced After 8 hours of Independent: After 8 hours of

mokaon kay basin nutrition related nursing care, the 1. Assess the 1. To obtain nursing care, the
gahi akong tae unya hemorrhoidal pain as patient will have a patient’s baseline data patient had a
sakit ikalibang”, as evidenced by fear of balanced nutrition as bowel of patient’s balanced nutrition as
verbalized by the eating. evidenced by: patterns and elimination evidenced by:
patient. ● Eating document the pattern ● Goal met.
adequate frequency, 2. To have Patient ate
Objective: amount of consistency, adequate adequate
● Lethargic food and ease of nutrients in amount of
● Facial ● Absence of bowel the body and food
grimace lethargy movements. to prevent ● Goal met.
noted ● Absence of 2. Encourage straining Patient had
● Presence of facial the patient to bowel absence of
discomfort grimace increase movements lethargy
● Absence of dietary fiber ● Goal met.
discomfort intake by Patient had
consuming absence of
fruits, facial
vegetables, grimace
whole grains, ● Goal met.
and legumes. Patient had
3. Instruct the an absence of
patient to discomfort.
drink an
adequate 3. To soften
amount of stools
fluids,
particularly
water.
4. Advise the
patient to
engage in
regular 4. To promote
physical bowel
activity, such motility.
as walking or
exercise

Dependent:

5. Administer
stool
softeners as
ordered.
5. To help
relieve pain
by avoiding
Collaborative: the passage
of hard
6. Collaborate stools.
with a
registered
dietitian 6. to develop a
fiber-rich
meal plan
and provide
education on
maintaining
healthy
bowel habits.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Altered comfort: Short term goals: Independent: Short term goals:
“Sakit kaayo itulon Pain related to After 8 hours of 1. Encourage 1. To prevent After 8 hours of
bisan ug laway”, as inflammation of nursing care, the patient to throat from nursing care, the
verbalized by the tonsils as evidenced patient will report increase drying out patient was able to
patient. by patient’s decrease of pain as fluid intake 2. To reduce report decreased pain
➢ Pain scale of verbalization of pain evidenced by: 2. Elevate the effort in as evidenced by:
7/10 and facial grimace ● Absence of head of the breathing ● Goal met.
facial bed and 3. To provide Patient had
Objective: grimace position optimal absence of
➢ Reddened ● Verbalization patient to a comfort to facial
and swollen of decreased Semi the patient grimace
tonsils pain when fowler’s 4. To prevent ● Goal met.
➢ Facial swallowing position tonsils from Patient
grimace 3. Place the bleeding verbalized
noted Long term goals: patient in a decreased
➢ V/S of: T: After 2 days of complete bed pain when
38.5 C; nursing care, the rest during swallowing
RR:23 cpm patient will report severe Long Term Goals:
decrease of pain as episodes of After 2 days of
evidenced by: pain nursing care, the
● Absence of 4. Avoid hot, patient was able to
reddened and spicy, and report decreased pain
swollen coarse foods. as evidenced by:
tonsils ● Goal met.
● Pain scale of Dependent: Patient had
3/10 5. Administer absence of
● Decreased analgesics as reddened and
temperature prescribed 5. To help swollen
to 37 C and 6. Administer lessen/relieve tonsils
RR within antibiotics as pain ● Goal met.
established ordered. 6. To serve as Patient
limits first line reported pain
 therapy to a 3/10
prevent ● Goal met.
bacterial Patient’s vital
infection signs were in
established
limits.

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Impaired swallowing Short term goals: Independent: Short term goals:
“Maglisod ko ug related to swollen After 8 hours of 1. Place patient 1. To facilitate After 8 hours of
tulon kay sakit kaayo tonsils as evidenced nursing care, the in an upright swallowing nursing care, the
inig tulon”, as by patient’s patient will have an position and to patient had improved
verbalized by the verbalization of pain improved swallowing during and prevent risk swallowing as
patient. upon swallowing as evidenced by: after feeding of aspiration evidenced by:
● Absence of 2. Provide oral 2. To prevent ● Absence of
Objective: facial care dry mouth facial
➢ Reddened grimace 3. Serve food at 3. To prevent grimace
and swollen ● Absence of customary the trigger of ● Absence of
tonsils discomfort temperature increased discomfort
➢ Presence of Long term goals: and water swollen Long term goals:
facial After 2 days of always tonsils After 2 days of
grimace nursing care, the chilled 4. To prevent nursing care, the
➢ Presence of patient will have 4. Encourage throat from patient had improved
discomfort improved swallowing increased drying out swallowing as
as evidenced by: fluid intake which may evidenced by:
● Verbalization 5. Avoid hard lead to pain ● Goal met.
of decreased coarse foods upon Patient
of pain upon swallowing verbalized
swallowing 5. To prevent decreased of
● Absence of the throat pain upon
reddened and Dependent: from swallowing
 swollen 6. Administer bleeding ● Goal met.
tonsils analgesics as 6. To help Patient had
prescribed relieved pain absence of
and reddened and
discomfort. swollen
tonsils

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Risk for imbalanced After 8 hours of Independent: After 8 hours of

“Mahadlok ko nutrition related to nursing care, the 1. Encourage 1. To prevent nursing care, the
mokaon kay di nako inflamed tonsils as patient will have patient to throat from patient had a
kaya ang kasakit inig evidenced by imbalanced nutrition increase fluid drying out balanced nutrition as
tulon”, as verbalized verbalization of pain as evidenced by: intake evidenced by:
by the patient. ● Eating 2. Provide oral 2. To prevent ● Goal met.
➢ Pain scale of adequate care infection and Patient ate
6/10 amount of 3. Serve food at dry mouth adequate
food customary 3. To prevent amount of
Objective: ● Reported temperature the trigger of food
➢ Lethargic pain scale of and water increased ● Goal met.
➢ Restlessness 3/10 always swollen Patient
➢ Pale skin ● Absence of chilled tonsils reported pain
lethargy 4. Monitor food 4. To evaluate if scale a 3/10
● Absence if intake patient had ● Goal met.
restlessness 5. Avoid hard, enough food Patient had
● Skin is coarse food intake an absence of
normal in 5. To prevent lethargy abd
color the throat restlessness
from ● Goal met.
bleeding Patient’s skin
6. To help is normal in
Collaborative: maintain color.
6. Collaborate enough
with nutrients
registered needed by the
dietitian body.