2.4 : Tonsillitis II: Management

This lesson will focus on the different treatment options for managing tonsillitis, which typically depend on the cause and severity.

• Acute viral tonsillitis treatment usually involves outpatient supportive management, including analgesia (acetaminophen) and oral hydration, corticosteroids (dexamethasone), salt-water gargles, and rest.

• Bacterial tonsillitis is typically treated with penicillin as the primary choice, although cephalosporins can also be effective. Antibiotic therapy with azithromycin or cephalosporins provides a comparable alternative to penicillin treatment for patients with a penicillin allergy.

• Recurrent tonsillitis is generally identified as five or more tonsillitis episodes in one year. Treatment may be surgical, including tonsillectomy.

During postoperative care, nurses need to keep the following in mind.

Close monitoring of patients is crucial during the immediate postoperative and recovery periods due to the potential risk of bleeding. Postoperative nursing interventions include

• Positioning the patient in a prone position with their head turned to the side. This positioning facilitates drainage from the mouth and pharynx.

• Applying an ice collar to the neck.

• Providing a basin and tissues for the expectoration of blood and mucus.

Vigilant monitoring for postoperative complications, such as fever, throat pain, ear pain, and bleeding, is essential. Additionally, patients are advised to minimize talking and coughing, as these activities may cause throat pain.

Patient education includes instructing the patient about the use of liquid acetaminophen with or without codeine for pain control and explaining that the pain will subside during the first 3 to 5 days.

Instruct the patient to seek immediate medical attention if they experience any of the following:

• Excessive or bright red bleeding

• Difficulty breathing

• Severe pain not relieved by medication

• Persistent nausea or vomiting

• A fever higher than 101°F

Advise taking the entire course of prescribed antibiotics and maintaining good hydration.

Dietary guidelines suggest having soft foods, as they are more easily swallowed than hard foods, and avoiding spicy, hot, acidic, or rough foods. Restrict milk and milk products because they make removing mucus more difficult for some patients. The patient is instructed to refrain from vigorous tooth brushing or gargling, as these activities may result in bleeding.

Furthermore, it is recommended that the patient refrain from smoking and heavy lifting or strenuous activities for ten days. This precaution is crucial to minimize bleeding risk and alleviate post-surgical pain and discomfort.