TONSILLITIS

I. Introduction
Tonsillitis
Tonsillitis is inflammation of the tonsils. It's usually caused by a viral infection
or, less commonly, a bacterial infection.
Causes:
Bacterial and viral infections can cause tonsillitis. A common cause is
Streptococcus (strep) bacteria. Other common causes include:
o

Adenoviruses

Influenza virus

Parainfluenza viruses

Enteroviruses

Herpes simplex virus

Epstein-Barr virus (mononucleosis)

Herpes simplex virus

HIV

Bacteria

Group A beta-hemolytic streptococci (GABHS)

Neisseria gonorrhoeae

Haemophilus influenzae type b

Mycoplasma

Chlamydia pneumoniae

Fungal infections

Parasitic infections

Cigarette smoke

Clinical manifestation:
o

Throat pain or tenderness

Redness of the tonsils

A white or yellow coating on the tonsils

Painful blisters or ulcers on the throat

Hoarseness or loss of voice

Headache

Loss of appetite

Ear pain

Difficulty swallowing or breathing through the mouth

Swollen glands in the neck or jaw area

Fever, chills

Bad breath

In children, symptoms may also include:

o

Nausea

Vomiting

Abdominal pain

Statistics:
Tonsillitis usually occurs in children between 4 and 7 years of age. It is rare in
those under 2 or over 40.
Assessment :
o

Age, level of consciousness, antopometri, vital signs.

Breathing.

Difficulty breathing, coughing.

Medical management:
tonsillitis is largely supportive and focuses on maintaining adequate
hydration and caloric intake and controlling pain and fever. Inability to
maintain adequate oral caloric and fluid intake may require IV hydration,
antibiotics,

and

pain

control.

Home

intravenous

therapy

under

the

supervision of qualified home health providers or the independent oral intake

ability of patients ensures hydration. Intravenous corticosteroids may be
administered to reduce pharyngeal edema.
Airway obstruction may require management by placing a nasal airway
device, using intravenous corticosteroids, and administering humidified
oxygen. Observe the patient in a monitored setting until the airway
obstruction is clearly resolving.
Surgical Management:
Tonsillectomy is indicated for individuals who have experienced more
than 6 episodes of streptococcal pharyngitis (confirmed by positive culture) in
1 year, 5 episodes in 2 consecutive years, or 3 or more infections of tonsils
and/or adenoids per year for 3 years in a row despite adequate medical
therapy, or chronic or recurrent tonsillitis associated with the streptococcal
carrier state that has not responded to beta-lactamaseresistant antibiotics.

II. OBJECTIVES
At the end of the study, the I would be able to:
o

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.

III.NURSING HISTORY
Clients Profile
Name: W.A
Birthdate:

Chief
December

25,

2004

Complaint:

Fever,

Sore

throat
Present

Treatment:

Age: 10 y/o

medication

Sex: Female

Past Treatment: None

Civil Status: Single

Past Hospitalization: None

Nationality: Saudi

Allergies: None

Religion: Muslim

Occupation: None

Self-

Address: Al-Jamaa Dist.

Patients History of Present Illness
Miss. W.A is a resident of Al-Jamaa Dis. She is a student. She spends
her time mainly at home. She reported drinking soda usually. She do not
drink alcohol or smoke. On the night of March 6, 2015, she felt hot and
experienced a sore throat. She thought of having tonsillitis. She immediately
took FEVADOL 5mg.

IIII. GORDONS FUNCTIONAL HEALTH PATTERN

1. Health Perception Health Management Pattern

The patients health rating is 1. Due to her present condition,
she cannot perform ADLs by herself and she needs assistance by a
caregiver or significant other. She hasnt gone yet to a professional
health care personnel.
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: 65 bpm

T (oral): 37 C

RR: 19 cpm

BP (lying): 80/65

2. Nutritional Metabolic Pattern

Daily Food and Fluid Intake
She usually drinks soda. For lunch, she eats vegetables and
rice , for dinner , she eats fast food. She often eats fish and seldom
eats meat. She eats anything available for snacks. She doesnt have
any food allergies. She drinks approximately 1L of water. she doesnt
experience difficulty chewing but at present, she is experiencing
difficulty swallowing due to her sore throat. Her gums and tongue are
not swollen but her palatine tonsils are. She is not experiencing
abdominal pain and she never took laxatives and antacids. Her skin,
hair, and nail condition are good.
3. Elimination Pattern
Bowel Habits
Her usual pattern is everyday, in the morning. She never takes
laxatives and antacids. She used suppositories. Her stool color is
usually dark brown. She never experienced pain during defecation.
Bladder Habits
She voids approximately 8 times per day. The usual color of her
urine is clear to yellow. She never experience pain during urination.
She never experienced wetting her bed upon waking up. Whenever she
feels the urge to void, she always does. She never experienced
retention.

4. Activity Exercise Pattern

Daily Activities
She takes a bath daily without anyones aid. She eats moderate
meals during lunch and dinner. She doesnt experience chest pain,
stiffness, and palpitations. Her illness at present resulted to limitation
of her activities to promote rest.

5. Sleep Rest Pattern

Her sleeping time usually starts at 9:00 PM and he wakes up at
5:00 or 6:00 in the morning. She does not have difficulty falling asleep.
She does not use any sleeping aids. She denies using any sleeping
medications. At present, she appears a little bit exhausted due to her
illness.
6. Sexuality Reproduction Pattern
She is single, She still young.
7. Sensory Perceptual Pattern
She does not have any problems with hearing, taste, smell, and
sensation. She does not use any hearing and vision aids. She is
currently feeling pain in the throat due to the swelling of her palatine
tonsils.
8. Cognitive Pattern
She is able to express herself well by verbalizing hes feelings
and showing gestures and manifesting different facial expressions. She
can recall recent and remote memories. She is partially able to make
decisions for herself. She shows behaviors of a mature kid.
9. Role Relationship Pattern
She is the fifth child in the family. She lives with her parents,
siblings, cousins, and nephews and nieces. Her family communicates
well since they all live in one house. Her relationship with them is quite
good. her mother and siblings are actually taking care of her at
present.
10.

Self-perception Self-concept Pattern

She believes that she is a dreamer kid who wants to provide her

family with a good living. She believes he is funny at times.

11.

Coping Stress Tolerance Pattern

Her major stressors are problems with the school. Family and
friends are his support system. She watches cartoons

to relax her

mind or she just simply listens to the Quran.

12.

Value Belief Pattern

She believes that she is silent, simple, and has self-esteem. Her

goal is to provide her family with a good living by being a doctor. Her
sources of hope are Allah and her family and friends. She is a Muslim.
She prays and sometimes so go to the prayer with her mother

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 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: April 6 7 & 2015 (Monday and Tuesday)
Clinical Area: Al-Jadaani Hospital
Clinical Instructor: Jessica Saldana, RN, MAN
It was my first time to be assigned to a hospital. I can say that I am
already confident doing my entire task. 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 Mrs. Jessica

because with her, 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. 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, I was really shy to do vital signs to
male clients. I feel like everyone was staring at me. If I had the chance to, I
would explain everything we do to them. 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 rooms visit well but one thing that
makes me uneasy is me having to talk with the non-Arab non-English clients,
and they answer me back in Pakistani. I was really shy because I know it is
my task to get the information 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 day of our exposure was mainly spent for reporting and paper
works. I reported about hypercreatininemia and I guess I did pretty well. We
almost finished all that we have to do and the best part is that the moment
was spent with my 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.