Nursing care of the child undergoing a tonsillectomy

James and Nelson: Chapter 21 (pg.493-494)

Assessment: Preoperative period

Medical history
o Allergy symptoms, difficulty swallowing, airway obstruction
o Bleeding history (bc tonsils are in vascular area)
Assessed for active infection (fever, WBC count) and redness and presence of exudate in the throat
Pain in throat or ears
Lab results
o Prothrombin time
o Partial prothrombin time
o Platelet count
o H&H
Checked for loose teeth (risk for aspiration)
Complete and current medication list

Assessment: postoperative period

Right after surgery, check for bleeding and the ability to swallow secretions
o Post op hemorrhage is the most serious and life-threatening complication of this procedure
o Clinical manifestations:
Frequent swallowing, restlessness, a fast and thread pulse or bright red vomit
If bleeding occurs; they will go back to surgery to re-cauterize
Rate and quality of respirations, breath sounds
Vitals
Interventions:
o Prone or side-lying position to promote drainage
o No straws or forks
o Coffee ground vomit is common antiemetics are given as ordered to throat pain from retching
o If vomiting occurs, keep NPO for 30 min. and then resume clear liquids
o Non-aspirin analgesics (Tylenol) are given as ordered (Q4hrs. for the first 24 hrs.)
Avoid giving red PO meds; could be mistaken for blood
o Increase fluid intake
o Ice collar
provide clear, cool liquids when the child is fully awake
o avoid citrus, carbonated, and extremely hot or cold drinks
o milk/milk products coat the throat and cause the need to clear the throat worsening the pain and
increasing the risk for bleeding
adequate fluid intake promotes healing and maintains hydration

Safety Alert
Checking for post-op bleeding is the MOST important because the operative site is not easily seen, the nurse
should check for:
o Excessive swallowing
o pulse and Bp
o signs of fresh bleeding in the back of the throat
o vomiting bright red blood
o restlessness that does not seem to be associated with pain

Teaching the family

Encourage your child to participate only in quiet activities for 1 week after surgery.
Encourage abundant liquid intake. Avoid citrus juices, which irritate the throat, for 10 days.
Avoid red liquids, which will give the appearance of blood if your child vomits.
Add full liquids (cream soups, gelatin, puddings, and other soups) on the second day and soft foods (mashed
potatoes, soft cereals, eggs) as your child tolerates them. Avoid rough or scratchy foods (bacon, chips, popcorn),
citrus foods, or spicy foods for 3 weeks.
Encourage your child to chew and swallow because this exercise pharyngeal muscles and promotes healing.
Do not give your child any straws, forks, or sharp pointed toys that could be put in the mouth.
Use acetaminophen for pain relief; your child may have a prescription for acetaminophen with codeine for sore
throat. Do not use aspirin or any medicine containing aspirin because it might affect the clotting time of the blood.
Pain should not persist past the first week. Notify your physician if pain persists.
Discourage your child from coughing, clearing the throat, or gargling.
 Bad mouth odor is normal and may be relieved by drinking more liquids.
Earache and slight fever are common.
Call your physician for any bleeding, persistent earache, or fever greater than 101 F (38.3 C).
Bleeding caused by tissue sloughing during the healing process can occur 7 to 10 days after surgery. Such
bleeding requires immediate medical attention.
To protect your child from catching a cold, keep the child away from crowds for 2 weeks.
Your child may return to school when directed by the physician, usually in about 10 days.
Bring your child for a follow-up appointment in 1 to 2 weeks.