Case Study-Chronic Tonsillitis

Case Study Of Chronic Tonsillitis Tumanguil,Jonalyn F. BSN408/Group32B Dhonna C. Cambe RN RM MAN Clinical Instructor

Patients Information Patient: P.E.D

DATE: 2/11/14

Age: 25 y/o Surgeon: Dr. Peter Jarin Anesthesiologist: Dr. Dominador Acosta Type Of Anesthesia: General Anesthesia Time of Operation: 12:20am Scrub Nurse: Luxy Joyce Viseral RN Circulating Nurse: Mark Patrick Bala RN

Operation: Tonsillectomy

Tonsillitis is a very common condition, most frequent in children aged 5 to 10years and young adults between 15 and 25 years.

Function of the Tonsils Both tonsils and adenoid are part of the Waldeyer ring, which is a ring of lymphoid tissue in the pharyngx. Lymphoid tissue in this ring provides defense against pathogens. The waldeyer ring is involved in the production of immunogloblins and thedevelopment of both B-cell and T-cell lymphocytes.

WHAT IS TONSILLITIS?

Tonsillitis is inflammation of the pharyngeal tonsils. The inflammation usually extends to the adenoid and lingual tonsils. Lingual tonsillitis refers to isolated inflammation of the lymphoid tissue at the tounge base.

There are 4 types of tonsillar disease: 1. acute tonsillitis 2. recurrent acute tonsillitis 3. chronic tonsillitis 4. obstructive tonsillar hyperplasia Patient P.E.D has been diagnose with Chronic Tonsillitis.

Chronic Tonsillitis

Clinical Features of Chronic Tonsillitis 1. Recurrent attacks of sore throat or acute tonsillitis. 2. Chronic irritation in throat with cough. 3. Bad taste in mouth and foul breath (halitosis) due to pus in crypts. 4 Thick speech, difficulty in swallowing and choking spells at night (when tonsils are large and obstructive) .

Complications 1. Peritonsillar abcess 2.Parapharyngeal abcess 3.Intratonsillar abcess 4.Tonsillar cyst 5.Focus of infection in rheumatic fever, acute glomerulonephritis, eye and skindisorders.

Examination 1. Tonsils may show varying degree of enlargement. Sometimes they meet in the midline (chronic parenchymatous type). 2. There may be yellowish beads of pus on the medial surface of tonsil (chronic follicular type). 3. Tonsils are small but pressure on the anterior pillar expresses frank pus or cheesy material (chronic fibroid type) . 4. Flushing of anterior pillars compared to the rest of

the pharyngeal mucosa is an important sign of chronic tonsillar infection . 5. Enlargement of Jugulodigastric lymph nodes is a reliable sign of chronic tonsillitis. During acute attacks,the nodes enlarge further and become tender.

Treatment 1. Conservative treatment consists of attention to general health, diet, treatment of co-existent infection of teeth, nose and sinuses. 2. Tonsillectomy is indicated when tonsils interfere with speech, deglutition and respiration or cause recurrent attacks. For the patient case Tonsillectomy is the chosen treatment for her condition.

Indications of tonsillectomy a. Absolute indications: 1. Enlarged tonsils that cause upper airway obstruction, severe dysphagia, sleepdisorders, or cardiopulmonary complications 2. Peritonsillar abcess that is unresponsive to medical management and drainagedocumented by surgeon, unless surgery is performed during acute stage 3. Tonsillitis resulting in febrile convulsions 4. Tonsils requiring biopsy to define tissue pathology

b. Relative Indications: 1. Persistent foul taste or breath due to chronic tonsillis that is not responsive that isnot responsive to medical history.

2. Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase-resistant antibiotics. 3. Unilateral tonsil hypertrophy that is presumed to be neoplastic. 4. Three or more tonsils infections per year despite adequate medical therapy.

What is a Tonsillectomy? A tonsillectomy is the surgical removal of the tonsils, glands in the throat that are meant to help fight infection. In some cases, the tonsils are large, or repeatedly become infected instead of fighting infection and must be removed. The tonsillectomy procedure is often combined with an adenoidectomy, which is the removal of an additional set of glands that are also in the throat. Tonsillectomies are most commonly performed on children, but adults do have the surgery, often when the tonsils are causing a breathing problem like sleep apnea.

Tonsillectomy Surgical Procedure In most cases, a tonsillectomy is an outpatient procedure, which allows the patient to go home once they are fully awake from surgery. The procedure is performed under general anesthesia, so the patient is asleep through the surgery, which is usually completed in less than an hour. Instead of the typical method of intubation, where a breathing tube is passed through the mouth into the airway, the patient is intubated nasally, with the tube inserted in the nose and down into the airway, keeping the mouth available for the surgical procedure. Once the patient is asleep, the surgery begins. An instrument is used to hold the mouth open, allowing the surgeon to work without the teeth in the way.

The tonsils are then cut away with a scalpel, a laser or a heated instrument. The bleeding is typically controlled by cauterizing the incision. If necessary, an adenoidectomy is also performed, using the same technique. Once the tonsils and potentially the adenoids are removed and the bleeding is controlled, the surgery is over. The anesthesiologist stops the anesthesia and gives a drug to help the patient wake. When the patient is awake enough to breath without assistance, the breathing tube is removed and the patient is taken to the PACU, or post anesthesia care unit, until they wake completely.

DIAGNOSIS: CHRONIC TONSILLITIS After Tonsillectomy