Tonsilitis B.M

TONSILITIS
BWALYA MUNJILI
(Msc. Nsg, Bsc. Nsg, RoTN, RN)
MUNJILI 1
Introduction
• A tonsil is a mass of lymphoid tissue comprised
particularly two small almond shaped bodies
situated one on each side of the pillar of the
forchette fauces
• It is covered by mucous membrane and its
surfaces fitted with follicles.
• The tonsils and adenoids are part of the lymphoid
tissues which arch the pharynx and are collectively
known as Waldeyer’s Ring.
Monday, April 22, 2024 2

Functions of tonsils
•They act as a barrier against infections

•They are necessary for antibody
production which fight bacteria in the
body
•Production of some blood cells

DEFINITION
•Tonsillitis is an inflammation of the tonsils
TYPES OF TONSILITIS
1.Acute tonsillitis
2.Chronic tonsillitis

Types Cont’d
•Acute tonsillitis: is an abrupt or sudden
inflammation of the palatine tonsils.
•Chronic tonsillitis: is an inflammation of the

tonsils which is recurrent between episodes of
acute tonsillitis in which the throat remains
uncomfortable
•. Tonsilectomy: is a surgical removal of the
tonsils.
Types of Tonsilittis
•Acute tonsillitis can either be bacterial

or viral in origin.
•Subacute tonsillitis is caused by the
bacterium Actinomyces.
•Chronic tonsillitis, which can last for
long periods if not treated, is mostly
caused by bacterial infection.

Incidence
•Tonsillitis is common in children

between 5 – 7 years age.

Predisposing factors
• Overcrowding
• Poor ventilation and housing
• Upper respiratory tract infection (URTIs)
• Seasons especially in winter and spring
• Infectious like diphtheria
• Age – young children are predisposed
because their immunities are often low and
are prone to infections
• Lowered immunity in general
•
Causes
•Beta haemolytic streptococcus
•Pneumococcus
•Staphylococcus
•Echo Virus causes meningitis and
respiratory infection
•Adenovirus serotype viii
•Influenza virus
•Diphtheriae
•Treponema pallidum
Signs and symptoms
•Enlarged lymph nodes due to the immune

response as the defense mechanism try to fight
the infection.
•Dysphagia – may be as a result of swollen tonsils
and involvement of the trigeminal nerve
•Fever as a result of circulating microorganisms
and toxins in the blood.
•Sore throat due to ulceration in the depth of
crypts

Signs and symptoms Cont’d
•Malaise due to the systemic infection in
the body
•Difficulties in opening the mouth
(trismus) due to inflammation process
•Excessive salivation due to pain and
inflammation of tonsils
•Hyperaemic tonsils with swelling due to
the inflammatory process
•Yellowish exudates drainage draining
from the crypts.
MANAGEMENT
•Investigation and diagnostic tests

•Clinical picture or presentation may
reveal swollen tonsils and enlarged
swollen lymph nodes
•Throat culture may determine the
infecting organism
•White blood cell count usually reveals
leucocytosis
Non pharmacological treatment
•Bed rest especially in the acute stage is

very important and advised
•Advise taking a lot of fluids by mouth
•Saline gaggles
•An ice collar may be applied to the neck
to relieve pain
•A bland diet is highly recommended
especially in the acute stage.

Medical treament
•Antibiotics such as oral penicillin e.g.

Pen V 500mg 6 hourly orally for 10 days
or Benzathine Penicillin 2.4mega units
intramuscularly stat
•Analgesics e.g. Aspirin for pain
•Steroids e.g. Prednisolone to suppress
the inflammatory process (not
recommended for the immune
compromised)
•Indications
TONSILETOMY
•Recurrent acute Tonsilitis
•If a patient has had more than 4 attacks
of genuine tonsilitis acute in nature per
year for several years,
•A Quinsy (Abscess)

Indications Continued
•For Histologye.g If one tonsil is

abnormally larger or harder than the
other can be removed for histology
•Rheumatic Fever and Acute
Glomerulanephritis
•If a patient has had quinsy, he is likely to
get another one unless the tonsils are
removed.
POST OPERATIVE NURSING CARE
•
• Aims
• To prevent haemorrhage
• To promote quick recovery
• To maintain a patent airway
• To prevent asphyxia from inhaled blood and secretions

• Environment
• The patient is put in a clean room to prevent
infection.
• There has to be oxygen supply in case of an
emergency.
• A trolley with resuscitative equipment and
emergency drugs, an emesis bowl for
expectoration of mucus and blood should be
available.
• Position
• The patient is put in lateral position with the
head turned on one side to facilitate
drainage of secretions from the mouth and
pharynx.
• The head should be on a dressed/covered
mackintosh to prevent soiling of linen.

• Observations
• The patient needs constant observation for the
first 12 hours.
• Ensure observation of pulse rate and blood
pressure to be done half hourly to detect early
any bleeding.
• Observe for the swallowing reflex & bleeding
and the doctor should be informed
immediately.
• Temperature should be observed to rule out
infection.
• If the patient is vomiting observe the colour of
the vomitus because he may be vomiting blood.

• Hygiene
• If the patient is vomiting, an emesis bowl so
that he can help himself to prevent vomiting
on the floor.
• If there is excessive salivation, a clean dry
cloth or swab can be used to wipe the
mouth.
• Throat gaggling with antiseptic solution or
normal saline for at least 10 days after meals
should be encouraged.
• Nutrition
• When gag reflex has returned, he will be
allowed to drink water
• avoiding milk products which coat the
throat causing frequent throat cleaning and
increasing risk of bleeding. Taking fluids
prevents stiffness of muscles.
• In the morning after operation a light diet is
provided and a normal diet thereafter.
• The acid of fruits and fruit juices causes
considerable pain and so should be avoided.
• Advice on discharge
• Before discharge the patient or his parents
are provided with written instructions on
home care. They are told to expect a white
scab to form in the throat between the 3rd
and 4th day post operatively and to report
bleeding, ear discomfort or that lasts longer
than 3 days.
• Avoid spicy irritating foods and milk products
as they coat the mucous membrane.
• Frequently following tonsilectomy avoid
strenuous exercise Activities contraindicated
because there is a risk of bleeding include
sneezing, coughing the throat and vigorous
nose blowing etc to be avoided.
• Prevention of anxiety; blood swallowed
during surgery may cause the patient to be
tarry for a day or so following tonsilectomy,
he may be told this is expected.
Complications
•Peritonsilar abscess (Quinsy); this is situated
near the tonsils and lead to septicaemia.
• Chronic tonsillitis resulting from acute
tonsillitis
•Rheumatic heart disease which can eventually
lead to heart failure
•Recurrent otitis media
•Acute nephritis

Post OP Complications of Tonsilectomy
1. Haemorrage
2. Infection
3. Aspiration
4. Otitis media
5. Respiratory tract infections
6. Neurogenic Shock
7. Hypovolaemic shock

Post-operative care
• Pain following the procedure is significant and may
include a hospital stay. Recovery can take from 10 up
to 20 days, during which narcotic analgesics are
typically prescribed. Patients are encouraged to
maintain diet of liquid and very soft foods for several
days following surgery. Rough textured, acidic or
spicy foods may be irritating and should be avoided.
Proper hydration is very important during this time,
since dehydration can increase throat pain, leading
to a vicious cycle of poor fluid intake.

POST OP CONT…….
• At some point, most commonly 7–11 days after the surgery (but occasionally as
long as two weeks (14 days) after), bleeding can occur when scabs begin
sloughing off from the surgical sites. The overall risk of bleeding is approximately
1%–2% higher in adults. Approximately 3% of adult patients develop significant
bleeding at this time. The bleeding might naturally stop quickly or else mild
intervention (e.g., gargling cold water) could be needed (but ask the doctor
before gargling because it might bruise the area of the skin that has been
cauterized). Otherwise, a surgeon must repair the bleeding immediately by
cauterization, which presents all the risks associated with emergency surgery
(primarily the administration of anesthesia particularly on a patient whose
stomach may not be empty).

Complications
1. Haemorrage
2. Infection
3. Aspiration
4. Otitis media
5. Respiratory tract infections
6. Neurogenic Shock
7. Hypovolaemic shock

IEC
1. Oral hygiene to prevent infection

2. Drug compliance
3. Report back to the hospital if any complications
4. High protein diet to enhance healing
5. Avoid over crowded place to avoid risk of upper respiratory
infections
6. When cold keep the child warm to prevent URTI
7. Avoid dust areas as the dust irritate the airway leading to
coughing which can lead to damage of blood vessels on the
operated area

Tonsilitis B.M

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TONSILITIS

Monday, April 22, 2024 2

•They act as a barrier against infections

Monday, April 22, 2024 3

•Tonsillitis is an inflammation of the tonsils

Monday, April 22, 2024 4

•Chronic tonsillitis: is an inflammation of the

•Acute tonsillitis can either be bacterial

Monday, April 22, 2024 7

•Tonsillitis is common in children

Monday, April 22, 2024 8

•Enlarged lymph nodes due to the immune

Monday, April 22, 2024 11

•Investigation and diagnostic tests

•Bed rest especially in the acute stage is

Monday, April 22, 2024 14

•Antibiotics such as oral penicillin e.g.

Monday, April 22, 2024 16

•For Histologye.g If one tonsil is

Monday, April 22, 2024 18

Monday, April 22, 2024 20

Monday, April 22, 2024 21

Monday, April 22, 2024 26

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Monday, April 22, 2024 30

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Monday, April 22, 2024 32

1. Oral hygiene to prevent infection

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