TONSILLECTOMY/ADENOIDECTOMY
A. Indications for surgery
1. Recurrent tonsillitis, peritonsillar abscess
2. Airway or esophageal obstruction
B. Nursing Diagnoses Related to Tonsillectomy/Adenoidectomy
• Risk for injury
• Deficient fluid volume
• Acute pain
• Deficient knowledge (parent)
• Risk for ineffective airway clearance
• Anxiety
C. Preoperative interventions
1. Bleeding and clotting times to assure safety because hemorrhage is a common complication
2. Assess the child for infection; surgery is not done during an acute episode.
3. Prepare child for surgery in ways appropriate to age.
D. Postoperative interventions
1. Position child prone or side-lying to facilitate drainage of secretions.
2. Do not suction unless absolutely necessary; suctioning removes clots forming at the surgical site.
3. Provide ice collar for pain; medicate as ordered.
4. Observe for signs of hemorrhage: biggest risk is first 48 hours and five to seven days after surgery
a. Frequent swallowing; child complains of “trickle in throat”
b. Persistent, bright red emesis
c. Oozing from suture line
d. Tachycardia and signs of shock 5. 5. Acetaminophen for pain (no aspirin); involve child/parent in pain assessment
6. Diet
a. Cool, clear, noncitrus, nonred fluids when awake and alert
b. No milk products at first because milk increases mucus in throat
c. Fluids essential
d. Advance diet as tolerated: no roughage, acidic foods, milk products; progress from
soft to bland to regular
7. Usually same day surgery or may be hospitalized overnight
8. Activity
a. Keep child quiet for several days.
b. Child may return to school one to two weeks after surgery.
c. Scab falls off in 7 to 10 days; instruct parents to watch for bleeding and call physician if any questions.
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