Tonsillitis
Mr. Shantinath,
D. Sajane.
Lecturer in Peadiatric
Nursing, Shree Gomatesh Education Society, Ankali
*Corresponding Author’s Email: shantinath.sajane@gmail.com
ABSTRACT:
Tonsils are the two lymph nodes located on
each side of the back of your throat. They function as a defense mechanism,
helping to prevent infection from entering the rest of your body. When the
tonsils themselves become infected, the condition is called tonsillitis. The
most common cause is viral infection and the second most common cause is
bacterial infection of which the predominant is Group A β-hemolytic
streptococcus (GABHS), which causes strep
throat. It shows signs and symptoms of pain, red swollen tonsils sore throat
and so on. Swollen tonsils may cause difficulty breathing, which can lead to
disturbed sleep. Tonsillitis that is left untreated can result in the infection
spreading to the area behind the tonsils or to the surrounding tissue. Symptoms
of tonsillitis caused by a bacterial infection usually improve a few days after
you begin taking antibiotics.
KEYWORDS: Conflict resolution styles, Nursing Professionals.
INTRODUCTION:
Tonsils are the two lymph
nodes located on each side of the back of your throat. They function as a
defense mechanism, helping to prevent infection from entering the rest of our
body. When the tonsils themselves become infected, the condition is called
tonsillitis. Tonsillitis can occur
at any age and is a common childhood ailment. It is most often diagnosed in
children from preschool age through their mid teens. Symptoms include a sore
throat, swollen tonsils, and fever. This
condition can be caused by a variety of common viruses and bacteria and is contagious.
If left untreated, tonsillitis caused by strep throat (Streptococcus
bacteria) can lead to serious complications. Tonsillitis is easily diagnosed and treated. Symptoms usually
fully resolve within seven to 10 days.1
Definition:
Tonsillitis is inflammation of the tonsils most commonly caused by viral or bacterial
infection. Symptoms may include sore
throat and fever. When caused by a bacterium belonging
to the group a streptococcus, it
is typically referred to as strep
throat. The overwhelming majority of people recover completely, with or without
medication. In 40%, symptoms will resolve in three days, and within one week in
85% of people, regardless of whether streptococcal infection is present or not.2
Causes
of Tonsillitis:
The most common cause is viral infection
and includes:
·
Adenovirus, rhinovirus, influenza, corona virus,
and respiratory syncytial
virus.
·
It can
also be caused by Epstein-Barr virus, herpes simplex virus, cytomegalovirus, or HIV. The
second most common cause is bacterial infection of which the predominant is :
·
Group
A β-hemolytic streptococcus (GABHS), which causes strep throat.3
·
Less
common bacterial causes include: Staphylococcus aureus (including methicillin
resistant Staphylococcus aureus or MRSA),4
Streptococcus pneumoniae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Bordetella pertussis, Fusobacterium sp., Corynebacterium
diphtheriae, Treponema
pallidum, and Neisseria
gonorrhoeae.3
·
Anaerobic
bacteria have been implicated in
tonsillitis and a possible role in the acute inflammatory process is supported
by several clinical and scientific observations.5
Sometimes, tonsillitis is caused by an infection of spirochaeta and treponema, in this case called Vincent's angina or Plaut-Vincent
angina.6
Pathophysiology:
Under normal circumstances, as viruses and
bacteria enter the body through the nose and mouth, they are filtered in the tonsils. Within
the tonsils, white blood cells of the immune system destroy the viruses or
bacteria by producing inflammatory cytokines like phospholipase A2, which also lead to fever. The infection may also be present in the throat and
surrounding areas, causing inflammation of the pharynx.7
Illustration comparing normal tonsil anatomy and tonsillitis
Common
signs and symptoms:
·
Sore throat
·
Red,
swollen tonsils
·
Pain when
swallowing
·
High temperature
(fever)
·
Coughing
·
Headache
·
Tiredness
·
Chills
·
A
general sense of feeling unwell (malaise)
·
White pus-filled spots on the tonsils
·
Swollen
lymph nodes (glands) in the neck
·
Pain in
the ears or neck
·
Weight
loss
·
Difficulty
ingesting and swallowing meal/liquid intake
·
Not able
to sleep well
Less
common symptoms include:
·
Nausea
·
Fatigue
·
Stomach
ache
·
Vomiting
·
Furry tongue
·
Bad breath
(halitosis)
·
Voice changes
·
Difficulty
opening the mouth (trismus
)
·
Loss of appetite
·
Anxiety/fear
of choking 3
In cases of
acute tonsillitis, the surface of the tonsil may be bright red and with visible
white areas or streaks of pus.8
Incidence:
Tonsillitis occurs in up to 10% of the population
frequently due to episodes of tonsillitis.9
Diagnosis:
·
The diagnosis of GABHS tonsillitis can be confirmed
by culture of samples obtained by swabbing both tonsillar
surfaces and the posterior pharyngeal wall and plating them on sheep blood agar medium. The isolation rate might be
increased by incubating the cultures under anaerobic conditions and using selective growth media. A single throat
culture has a sensitivity of 90%-95% for the detection of GABHS (which means
that GABHS is actually present 5%-10% of the time culture suggests that it is
absent). This small percentage of false-negative results is part of the
characteristics of the tests used but are also possible if the patient has
received antibiotics prior to testing.
·
Identification requires 24 to 48 hours by culture but
rapid screening tests (10–60 minutes), which have a sensitivity of 85-90%, are
available. Older antigen tests detect the surface Lancefield group A
carbohydrate. Newer tests identify GABHS serotypes using nucleic acid (DNA)
probes or polymerase chain
reaction. Bacterial culture may need
to be performed in cases of a negative rapid streptococcal test.10
·
True infection with GABHS, rather than colonization,
is defined arbitrarily as the presence of >10 colonies of GABHS per blood
agar plate. However, this method is difficult to implement because of the
overlap between carriers and infected patients. An increase in antistreptolysin
O (ASO) streptococcal antibody titer 3–6 weeks following the acute infection
can provide retrospective evidence of GABHS infection 11 and is
considered definitive proof of GABHS infection.
·
Increased values of secreted phospholipase
A2 and altered fatty acid metabolism12 in patients with tonsillitis may have
diagnostic utility.
Treatment:
Treatments to
reduce the discomfort from tonsillitis include:3
·
Pain relief, anti-inflammatory, fever reducing
medications (paracetamol/acetaminophen
and/or ibuprofen).
·
Sore throat relief (warm salt water gargle, lozenges,
dissolved aspirin gargle (aspirin is an anti inflammatory, do not take any
other anti inflammatory drugs with this method), and warm/hot liquids).
·
If the tonsillitis is caused by group A streptococcus, then antibiotics are useful with penicillin or amoxicillin being primary choices.13
·
Cephalosporin’s and macrolides
are considered good alternatives to penicillin in the acute state.14
·
A macrolide such
as erythromycin is used for people allergic to penicillin.
Individuals who fail penicillin therapy may respond to treatment effective
against beta-lactamase producing bacteria15 such as clindamycin or amoxicillin-clavulanate.
Aerobic and anaerobic beta lactamase producing
bacteria that reside in the tonsillar tissues can
"shield" group A streptococcus from penicillins.16
·
When tonsillitis is caused by a virus, the length of
illness depends on which virus is involved. Usually, a complete recovery is
made within one week; however, symptoms may last for up to two weeks.
·
Chronic cases
may be treated with tonsillectomy
(surgical removal of tonsils) as a choice for treatment.17
Prognosis:
Since the
advent of penicillin in the Complications may rarely include dehydration and
kidney failure due to difficulty swallowing, blocked airways due to
inflammation, and pharyngitis due
to the spread of infection.3 an abscess may develop lateral to the tonsil during an
infection, typically several days after the onset of tonsillitis. This is
termed a peritonsillar abscess (or quinsy). Rarely, the infection may
spread beyond the tonsil resulting in inflammation and infection of the internal jugular vein giving rise to a spreading septicemia infection (Lemierre's
syndrome). In chronic/recurrent cases (generally defined as seven episodes of
tonsillitis in the preceding year, five episodes in each of the preceding two
years or three episodes in each of the preceding three years),19 or in acute cases where the palatine
tonsils become so swollen that swallowing is impaired, a tonsillectomy can be performed to remove the tonsils.
Patients whose tonsils have been removed are still protected from infection by
the rest of their immune system. 1940s, a major preoccupation in the treatment
of streptococcal tonsillitis has been the prevention of rheumatic fever, and its major effects on
the nervous system (Sydenham's chorea) and heart. Recent evidence would suggest
that the rheumatogenic strains of group A beta
hemolytic strep have become markedly less prevalent and are now only present in
small pockets such as in Salt Lake City.18 This brings into question the
rationale for treating tonsillitis as a means of preventing rheumatic fever.
Complications:
In strep throat, very rarely diseases like rheumatic fever or glomerulonephritis can
occur. These complications are extremely rare in developed nations but remain a
significant problem in poorer nations. Tonsillitis
associated with strep throat, if untreated, is hypothesized to lead to pediatric
autoimmune neuropsychiatric disorders associated with streptococcal infections
(PANDAS).20
Tonsillitis
is highly contagious. To decrease the odds of getting tonsillitis, stay away
from people who have active infections. Hands should be washed often,
especially after coming into contact with someone who has a sore throat, is
coughing, or is sneezing. If the individual has the tonsillitis, he or she must
stay away from others until they are no longer contagious.1
The client
should be advised to do the following:1
·
Drink plenty of fluids.
·
Get lots of rest.
·
Gargle with warm salt water several times a day.
·
Use throat lozenges. (Throat lozenges can be a
choking hazard for very young children).
·
Use a humidifier to moisten the air in home.
·
Avoid smoke.
·
Use over-the-counter pain medications, such as
acetaminophen and ibuprofen. (Aspirin can be dangerous for children. Always
check with doctor before giving aspirin to children).
Nursing
Assessment for Acute Tonsillitis:21
Medical
history factors associated with the occurrence of tonsillitis as well as
supporting the bio-psycho-socio-spiritual. Circulatory: Palpitations,
headache at the time of a change in position, drop in blood pressure, bradycardia, and body felt cold, pale extremities
appearance. Elimination: Changes in the pattern of elimination (incontinence
uri/Alvi), abdominal
distension, bowel sounds disappearance.
Activity /
rest:
There is a decrease
in activity due to body weakness, loss of sensation or pareses / plegia, tiredness, difficulty in recuperating from muscle
spasms and pain or spasm. The reduced level of consciousness, decreased muscle
strength, general body weakness.
Nutrition and
fluids:
Anorexia,
nausea, vomiting due to increased ICP (intracranial pressure), impaired
swallowing, and loss of sensation on the tongue.
Nerves system: Dizziness /
syncope, headache, decreased visual field wider / blurred vision, decreased
touch sensation, especially in the face and extremities. Mental status coma, kelmahan in the extremities, facial muscles paradise,
aphasia, dilated pupils, decreased hearing.
Comfort: Tense facial expressions, headache, restlessness.
Breathing: Shortened breath, inability to breathe, apnea, apnea onset period in
breathing patterns.
Security: Fluctuations of temperature in the room.
Psychology: Denial,
disbelief, anguish, fear, anxiety.
Nursing
Diagnosis and Interventions for Acute Tonsillitis:
1. Ineffective breathing pattern related to tissue damage or trauma to
the respiratory center. Goal: The patient demonstrated the ability to perform
adequately the respiratory blood gas results show stable and good as well as
the loss of signs of respiratory distress.
Interventions:
1.
Clear the airway patent (keep the head position in a
state parallel to the spine / as Indicated).
2.
Perform suction if necessary.
3.
Assess the function of the respiratory system.
4.
Assess the patient's ability to perform cough/
discharging effort.
5.
Observation of vital signs before and after the
action.
6.
Observation for signs of respiratory distress (skin
becomes pale / cyanosis).
7.
Collaboration with therapists in the provision of
physiotherapy.
2. Impaired physical mobility related to neuromuscular weakness in the
extremities.
Goal: Patients showed an increased ability to perform physical activity.
Interventions:
1.
Assess the patient's ability to perform the activity.
2.
Teach the patient about the range of motion that can
still be done.
3.
Perform active and passive exercises at extremities
to prevent stiffness and muscle atrophy.
4.
Instruct the patient to take a straight position.
5.
Assist patients in performing ROM gradually according
to ability.
6.
Collaboration in the provision antispasmodic or
relaxant if necessary.
7.
Observation of the patient's ability to perform the
activity.
3. Ineffective Cerebral Tissue Perfusion related to the brain, bleeding in the
brain.
Goal: The patient showed an increase in awareness, cognitive and sensory
function. Interventions:
1.
Assess neurologic status and note the changes.
2.
Give the patient supine position.
3.
Collaboration in the provision of oxygenation.
4.
Observation level of consciousness, vital signs.
4. Acute pain related to physical trauma.
Goal: The patient expresses pain is reduced and shows a relaxed and calm
state.
Interventions:
1.
Assess the level or degree of pain felt by the
patient using a scale.
2.
Help the patient in finding factor in precipitation
of pain felt.
3.
Create a quiet environment.
4.
Teach and demonstration to patients about several
ways to do relaxation techniques.
5.
Collaboration in the provision of appropriate
indications.
5. Impaired
verbal communication related to the effects of damage to the area to talk to
the cerebral hemispheres:
Goal: The patient was able to communicate to meet their basic needs and showed
improvement in their communication capabilities.
Interventions:
1.
Do a personal communication with the patient (often
but short and easy to understand).
2.
Create an atmosphere of acceptance of the changes
experienced by the patient.
3.
Instruct patients to improve communication
techniques.
4.
Use non-verbal communication techniques.
5.
Collaboration in the implementation of speech
therapy.
6.
Observation of the patient's ability to communicate
both verbally and non-verbally.
6.
Self-concept Disturbance related to a change of perception.
Goal: The patient showed improvement in the ability to accept the
circumstances.
Interventions:
1.
Assess the patient's degree of self-concept change.
2.
Mentor and listen to patient complaints.
3.
Give support to actions that are positive.
4.
Assess the patient's ability to rest (sleep).
5.
Observation of the patient's ability to receive
state.
CONCLUSION:
Swollen
tonsils may cause difficulty breathing, which can lead to disturbed sleep.
Tonsillitis that is left untreated can result in the infection spreading to the
area behind the tonsils or to the surrounding tissue. If tonsillitis is caused
by a strep throat infection that is not treated or does not go away, it could
lead to rheumatic fever (inflammation of the heart, joints, and other tissues),
or to post-streptococcal glomerulonephritis
(inflammation of the kidneys). Symptoms of tonsillitis caused by a bacterial
infection usually improve a few days after the initiation of antibiotic
therapy. Strep throat is considered contagious until the individual is with
antibiotics for a 24-hour period. Tonsillitis generally resolves completely
within seven to 10 days.
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http://nursing-care-plan.blogspot.com/2014/02/acute-tonsillitis-6-nursing-diagnosis.html