A tonsillectomy is the surgical removal of the tonsils, which are two pads of glandular (lymphatic) tissue on each side of the back of the throat. Tonsils help defend the body against infection which may enter through the nose or mouth. They are prone to inflammation and enlargement, which can lead to a condition called tonsillitis. A doctor usually suggests a tonsillectomy when tonsillitis is frequent and severe, or causes complications. Show
The operationA tonsillectomy is performed under general anaesthesia. The surgeon will use a special device to keep the mouth open so that they can see the tonsils during the surgery. The procedure takes approximately 45 to 60 minutes. This includes the anaesthetic, the operation and time spent in the recovery room. Your child will stay in hospital overnight for observations but should be able to go home the next morning if he/ she can eat and drink, swallow medicine, does not have any severe pain and is not bleeding from the nose or mouth. Note: There is a slight risk of bleeding within 14 days after discharge, so it is important to stay within 45 minutes of the Queensland Children’s Hospital during this time. Families from regional or remote areas should make suitable accommodation arrangements. Preparation for surgeryDo not give your child Aspirin for one week before the operation or two weeks after. Do not give ibuprofen (Nurofen®) for 72 hours before the operation. After the operationAll children react differently to surgery. They may cry, be distressed, be awake and alert, or very sleepy. Do not be alarmed as your child will settle after a short time. Your child will have either Intravenous Therapy (IV drip) or an IV cannula overnight. This will be removed the following morning once your child is tolerating foods and fluid. Pain reliefPain relief will be prescribed by the doctor after your child’s operation. Paracetamol and Oxycodone (a stronger prescription-only medicine) are commonly used for pain relief after tonsillectomy. Throat pain builds up for the first few days and is usually at its the worst around the fifth day after surgery. Pain and discomfort will usually then ease until the seventh or ninth day after surgery when some of the scab covering the tonsillectomy site falls off. After this there is a steady reduction in pain. Some children will experience a mild earache after a tonsillectomy. This is because the ears and the tonsils share the same nerve. It is important to provide your child with regular pain relief during their recovery. This includes waking them at night for one or two days after the surgery. Do not wait for your child to say they have pain or they may not take their medication and may not eat or drink, putting them at risk of bleeding and dehydration. Paracetamol can be given every four to six hours with a maximum of four doses per 24 hours or as directed. Paracetamol should be given regularly for the first 48 hours and then as required. If pain is not relieved by Paracetamol alone, Oxycodone can also be used. Oxycodone can be given every four to six hours, with a maximum of four doses per 24 hours. It is important for you and other carers to record the name of the medication, and the date and time you have given it to keep track of medication usage. Do NOT give your child Aspirin for two weeks after the operation. Ibuprofen may be given after the operation if advised by your child’s doctor. Do not give any other pain relief medicines without checking with your child’s doctor because some products may double-up with prescribed medication. Local anaesthetic lozenges can also be used by older children to supplement pain relief. When to seek urgent medical attentionContact your doctor or the hospital immediately if your child:
Food and drinkFor the first two hours after the operation, your child can have clear fluids (water, cordial, iceblock). When he/she is tolerating clear fluids your child may then have non- carbonated fluids (milk, ice-cream, custard). Children may refuse to drink fluids after the surgery because of throat pain but they must be encouraged to drink regularly (half a cup every hour) to avoid dehydration. Dehydration can lead to increased pain and also increase the chance of bleeding. Two hours after returning to the ward your child can eat regular meals. During the first eight hours after surgery your child may eat without too much discomfort due to the local anaesthetic used in the surgery. It is important to maintain your child’s fluid intake at home to prevent dehydration. Your child should also resume their normal diet as soon possible, although he/ she will probably be fussy about food at first. Any food is better than none in the first few days. Some foods (hot and/or spicy, acidic) may cause discomfort when eating so should be avoided for a few weeks. Chewing gum or chewy lollies will increase saliva production and help to reduce jaw stiffness. Mouth careBad breath is a normal part of the healing process. Drinking plenty of water will help reduce the odour and teeth should be brushed as normal. The site where the tonsils have been removed will turn yellow/white – this is also normal. ActivityYour child will need to stay home from school or childcare for two weeks and should avoid all sports and rough play. Encourage plenty of rest and quiet play or entertainment such as puzzles, reading and watching DVDs. Post-operative reviewA review of your child will be scheduled after the operation. This will be performed at an outpatient appointment or over the phone. If you have any concerns prior to the review, contact the hospital. Contact usEar, Nose and Throat Outpatients Department Clinical nurse Clinical nurse consultant Day surgery (4c) Hospital switchboard In an emergency, always call 000. If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week. What is the nursing management for post tonsillectomy patients?Keep the patient nil by mouth. Consider antiemetic if patient nauseated. Record estimated amount of blood loss (note that bleeding may be haemoptysis or haematemesis as children often swallow blood). Allow patient to sit upright, leaning forward to assist in keeping blood out of airway.
When caring for a child after a tonsillectomy the nurse would consider which has the most important nursing action?The most important concept after surgery is aggressive hydration. It is of utmost importance that over the first 10-14 days, the patient drink plenty of fluids—more than one would normally—to avoid dehydration. We believe that this lessens the risk of bleeding and potentially lessens the fever as well.
When caring for a child that has undergone a tonsillectomy?After this surgery, children should rest but may play inside after one or two days and may be outside after three or four days, if they feel up to it. Strenuous physical activity following surgery is discouraged. Children may return to school whenever comfortable; a week is average, but 10 days is not unusual.
What happens after tonsillectomy for kids?It is normal for your child to have a sore throat, ear pain, bad breath, voice changes and white patches in the throat after their surgery. These problems can happen for up to two weeks after tonsils and adenoids are removed. These things do not mean that there is an infection.
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Which is the most appropriate nursing intervention for a child after tonsillectomy
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