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 Clients Profile Name: Mr. X. Birthdate: December 10, 2985 Age: 24 y/o Sex: Male Civil Status: Single Nationality: Filipino Religion: Roman Catholic Address: Zone 7A, Sua, Camaligan Chief Complaint: Fever, Sore throat Present Treatment: Selfmedication Past Treatment: None Past Hospitalization: None Allergies: None Occupation: None

Patients 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. GORDONS FUNCTIONAL HEALTH PATTERN 1. Health Perception Health Management Pattern The patients 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 hasnt gone yet to a professional health care personnel. He doesnt use tobacco, doesnt drink alcoholic beverages, and doesnt 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 RR: 22 cpm T (axillary): 38 C 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 doesnt have any food allergies. He drinks approximately 2L of water delivered by the water tank that roams in their barangay everyday. He doesnt 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 anyones 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 doesnt experience chest pain, stiffness, and palpitations. He experiences headache at times when hes 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 doesnt 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 bodys 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 internal opening of the nasal cavity. The lingual tonsil is a rounded mass of tissue on posterior surface of the tongue. The palatine tonsils are located on each side of posterior opening of the oral cavity. They usually are tonsils that many people are referring to. the the the the

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 betahemolytic 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 wasnt 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 Im 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 didnt 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 cant 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 didnt 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-nurses mind is this: Common sense does not require a RN license.