TONSILLITIS TREATMENT(SIGNS AND SYMPTOMS)
DEFINITION OF TONSILLITIS: Tonsillitis is an acute inflammation of the tonsillary glands and their crypts.
INCIDENCE: It is Commonest in childhood ; 5-8 years aged children and can occur in adult but not always. it can be chronic or acute.
ETIOLOGY: It is commonly viral in origin.
CAUSE: Streptococci infection
TYPES OF TONSILLITIS:
- Follicular Tonsillitis: This is the commonest type of tonsilitis and it is characterized by the presence pus in the crypts of the tonsil giving it an appearance of yellowish sports.
- Suppurative Tonsillitis: This occurs when the infections from the crypts spread to the surrounding organs producing a painful abscess called quinsy
- Superficial Tonsillitis: This is the mildest form of tonsillitis in case there is a general inflammation of the pharynx and tonsils.
- Vincent's Tonsillitis: This is called so because the causative organism is vincent's organism
- Other types of Tonsillitis: Maybe due to diphteria and syphilis and influenza
When the infective micro organism usually the B-haemolytic streptococci reaches the tonsils, it releases an enzyme called hyaluronidase which destroys the lymphoid tissue of the tonsil. It also releases fibrinolysin which also destroys fibrin.
The result is (a) Inflammation of the tonsils (b) death of lymphoid cells & tissues (c) Pus formation (d) pain and oedema of the tonsils and (e) fever due to the inflammatory reaction
CLINICAL MANIFESTATION OF TONSILLITIS (SIGN AND SYMPTOMS)
It could have a sudden onset accompanied by fever inability to swallow or refusal to swallow for fear of pain.
In every young children who may not be able to express themselves, they hold their neck very rigidly making it look like meningitis. There could be vomiting if the child is forced to eat some younger children still may complain of abdominal pain and when this is coupled with vomiting, the diagnosis maybe mistaken to Appenditis. The child may leave the mouth open and saliva dribble out with time the tongue become fured (coated) the lips cracked. The temperature maybe as high as 39.4oC or more.
ON EXAMINATION: The tonsils are found to be swollen and highly inflamed together with the upper cervical lymph node. Pus may actually be seen as exudates and can be wiped with a swab.
DIAGNOSIS: The confirmatory diagnostic information is through a throat swab with is sent for culture and sensitivity to isolate the causative organism and to determine the appropriate chemotherapeutic agents to be used that is the confirmatory test
CLINICAL MANAGEMENT OF TONSILLITIS
The child can be managed at home or in the hospital. If the child is seen in the hospital and is to be sent home with treatment, it is the nurses responsibility to explain the mode of administration of the drugs especially the analgesics, the anti-pyretic and the chemotherapeutic agent to the parents.
NURSING CARE OF THE HOSPITALIZED CHILD
In Tonsillitis treatment The child is kept separate until the result of the throat swab excludes any of the acute infection fever like diphtheria. If this is excluded, there is no need for barrier nursing.
All the same, the child should not be nursed near a child with Congenital Heart disease, Rheumatoid arthritis and nephritis or nephrotic syndrome. This is because Streptococci infection are very dangerous to this patient and may aggravate their condition.
THE NURSING NEED FOR TONSILLITIS TREATMENT
- Need for relieve of pain
- Need for rest
- Need for lowering of high temperature (control pyrexia)
- Need for Isolation
- Need for observation
- Need for oral hygiene
- Need for nutrition
- Need for administration of drugs
- Need for emotional support or psychological care or psychotherapy
MANAGEMENT OF TONSILLITIS
The condition can be managed both medically and surgically
In Tonsillitis treatment the followings drugs are used:
Drug Therapy: Benzyl Penicillin 75 to 150mg 6-hourly, Aspirin or Disprin 0.3g prn
Haematinic drug, Lozanges, oraldive , mouth wash. However medical treatment is by drug of choice based on culture and sensitivity test
Nursing Management in Tonsillitis treatment
- Need for relieve of pain: Give warm /compress / block icecream to suck to numb the area. Give aspirin gaggle if necessary or analgesic lastly cold or hot compress or ice block at affected area
- Need for lowering of temperature: Expose child, open windows, fan child but avoid chilling, tepid sponge child and give anti pyretic drug.
- Need for Observation: Because of increase in temperature vital signs are observed 4 hourly especially temperature which is taken per axilla. Appetite of child is observed as well as his general condition including his sputum
- Need for hygiene(Oral): Oral care as often as is necessary, bed bathing, maintaining clean environment like changing linings when dirty or soiled. Give sputum mug and educate on how to use pending on age of the child lastly give tissue paper for proper disposal .
- Need for Nutrition: Relieve pain with dysprin tablet or ice cream before diet, Give fluid diet rich in protein and vitamin. Give pea soup and jelly keep intake and output record as child feeds on fluids. Mainly much fluid in other to combat dehydration caused by pyrexia
- Need for administration of drug: Anti-pyretics, analgesic, antibiotics and haematinic
- Need for Psychological Care: Admission of the child with the mother and allowing the mother to accompany the child to the recovery room. Reassure and cuddle the child also reassure the mother, Try not to monopolize the child. Break the child's fear of pain.
- Need for rest: Child is to have rest in bed until pyrexia stop, restrict visitors to the innermost circle -the family. Avoid nose and noise and maintain peaceful and calm environment, dove tail nursing care, give mild sedative.
- Isolation: Patient is isolated in order not to cross infect others or anybody suffering from kidney disease or heart disease because streptococci infection is dangerous. Sputum should be discarded properly and disinfected with proper hand-washing.
Prognosis: If after treatment medically and it dosent subside, patient should be booked for tonsillectomy(removal of the tonsils)