Tonsils are defined as the masses of lymphatic tissue that are located in the depressions of the mucous membranes of the fauces (constricted opening, leading from the mouth to the oral pharynx) and pharynx. The tonsils act as a filter to protect the body from bacterial invasion via the oral cavity and also to produce white blood cells. Tonsillitis is generally referred to as an inflammation of a tonsil, particularly a faucial tonsil. Acute tonsillitis is considered acute pharyngitis. When tonsillar involvement is severe, the term tonsillopharyngitis or tonsillitis is used; when the involvement is minor, the term nasopharyngitis is used. Nearly all children have at least one episode of tonsillitis during their childhood.
Viral infection is the leading cause of nasopharyngitis. Adenovirus is the most common infecting agent, but other viruses include enteroviruses, herpes virus, and Epstein-Barr virus. A nonviral cause is Mycoplasma pneumoniae. Bacterial causes include group A beta-hemolytic streptococci (GABHS), Neisseria gonorrheae, and Corynebacterium diphtheriae.
Nursing care plan assessment and physical examination
Usually, the symptoms of viral tonsillitis have a gradual onset. Elicit a description of the history and progression of the signs and symptoms. Expect that the predominant symptom is rhinorrhea (a runny nose), which is the key symptom. Ask parents if the child also demonstrates other common symptoms: sore throat, dysphagia, mild cough, hoarseness, and a low-grade fever. Ask if any members of the household have had a cold or upper respiratory infection. Bacterial infections have an abrupt onset without rhinorrhea. Generally, parents will describe fever, weakness, sore throat, dysphagia, nausea, abdominal discomfort, and vomiting. Children with viral and bacterial infections will have symptoms that reflect the infecting organism.
The parents and child will be apprehensive. Assess the parents’ ability to cope with the acute situation and intervene as appropriate. Note that many children are treated at home rather than in the hospital; your teaching plan may need to consider home rather than hospital management.
Nursing care plan primary nursing diagnosis: Pain related to inflammation and infection of the throat and tonsils.
Nursing care plan intervention and treatment plan
The aim of treatment for a viral infection is to provide supportive care. Usually, fever and sore throat pain can be managed with over-the-counter analgesia. Antibiotic therapy is appropriate for bacterial infections. Allow the child to get rest and provide adequate fluid intake. If the child continues to have symptoms in spite of appropriate antibiotic therapy after cultures and sensitivities, the child may represent a “treatment failure” and may need a different antibiotic. If a relapse occurs, a second course of antibiotics may be needed and a family member may be a carrier.
Chronic tonsillitis occurs in children with recurrent throat infections (seven in the past year or five in each of the past 2 years). Tonsillectomy and adenoidectomy decrease the incidence of these problems during childhood, although those who do not have surgery also have a decreased incidence of infection as well. Current recommendations generally encourage physicians to avoid surgery in most cases. The decision to remove the tonsils relates directly to hypertrophy, obstruction, and chronic infection.
Children should be allowed to rest as much as possible to conserve their energy; organize your interventions to limit disturbances. Provide age-appropriate activities. Crying increases the child’s difficulty in breathing and should be limited if possible by comfort measures and the presence of the parents; parents should be allowed to hold and comfort the child as much as possible. Provide adequate hydration to liquefy secretions and to replace fluid loss from increased sensible loss (increased respirations and fever). The child might also have a decreased fluid intake during the illness. Apply lubricant or ointment around the child’s mouth and lips to
decrease the irritation from secretions and mouth breathing.
Nursing care plan discharge and home health care guidelines
Most children will be managed at home. Caregivers need to understand the rationale for all medications. If the child has a viral infection, explain to the parents why an antibiotic is not indicated. If the child has a bacterial infection, make sure the parents understand the importance of taking the entire prescription and to report new onset of symptoms if they occur. Reassure parents that frequent infections are not unusual, but if the infections persist, they need to report them to a healthcare provider.