NURS 680A Week 4 : Tonsillitis Essay
Tonsils are composed of lymphatic tissue and play a crucial defense role against inhaled or ingested pathogens by dispensing the initial immunological barrier to these insults. Tonsilitis refers to the inflammation of the palatine tonsils, a condition commonly affecting school-going children (Anderson & Paterek, 2022).In the United States, approximately 2% of ambulatory patient visits are due to tonsillitis. The purpose of this paper is to discuss a case scenario of a patient with tonsillitis I read about and highlight the importance of understanding tonsillitis as a graduate nurse as well as the guidelines for treatment.
The Case Scenario
M.A is a 13-year-old female patient, who presented to the emergency department with a two-day history of sore throat and dysphagia to solids. She had associated headache, general blood malaise, and nausea but no cough or any other associated respiratory symptom. Her mother reported that she had multiple similar episodes in the past year, always alleviated by taking antibiotics. On examination, she had a fever of 38°C, with tender cervical lymph nodes. Her tonsils were inflamed, hypertrophied with a whitish membrane. Subsequently, a throat swab was for culture and sensitivity. She was treated with a seven-day course of penicillin, and Four days later the swab result confirmed the presence of group A β hemolytic streptococcus which was sensitive to penicillin. Nine days after the initial consultation M.A returned complaining of continuing symptoms of sore throat and requesting further antibiotics. She still had inflamed tonsils but with no exudate; her cervical lymphadenopathy had persisted. Given her positive throat swab, she was given a further course of penicillin. Serology for infectious mononucleosis was negative. A subsequent consultation confirmed that her sore throat had settled two days after the second consultation.
The patient in the above case scenario had acute tonsillitis. Acute tonsillitis below the age of 5 years and in young adults is mostly viral while it is mostly bacterial in children aged 5 to 15 years. Viral causes include adenovirus, respiratory syncytial virus, rhinovirus, coronavirus, and parainfluenza virus. Group A β hemolytic streptococcus is the most common bacterial cause and may be primary or secondary to viral infection. Other bacterial causes include staphylococci, pneumococci, and H. influenza (Haidara et al., 2019). In the United States, bacterial tonsillitis commonly occurs in winter and spring.
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Clinically, a patient with tonsillitis is usually a school-going child who presents with a sore throat, difficulty in swallowing, fever, ear pain, or constitutional symptoms such as headache, general body aches, malaise, vomiting, and constipation. Physical examination usually reveals inflamed, swollen tonsillitis with yellowish spots of purulent exudates, and or a whitish membrane. Occasionally, the tonsils may be grossly enlarged that they almost meet in the midline with edematous uvula and soft palate. Additional features include fetid breath and enlarged tender jugulodigastric lymph nodes.
According to Zaman et al. (2021), the diagnosis of acute tonsillitis is primarily clinical.Further evaluation includes risk stratification by scoring systems such as modified Centor score, rapid antigen testing, and or throat culture. Modified Centor score has five parameters i.e., age, exudate/swelling on tonsils, tender/swollen anterior cervical lymph nodes, temperature>38°C, and cough with each finding scoring onepoint (Zaman et al., 2021). The patient in our case scenario scored four, following which she had a throat culture and empiric antibiotic therapy started.
Guidelines to Use to Develop a Treatment Plan
For the majority of patients, tonsillitis is usually a self-limiting infection. However, the Infectious Diseases Society of America (IDSA) guidelines recommend the following management of tonsillitis: (1) Patient with confirmed GAS tonsillitis to be treated for 10 days with the appropriate antibiotic. (2) Penicillin or amoxicillin is the drug of choice. (3) First-generation cephalosporin, clindamycin, or macrolides can be used in the case of penicillin allergy. (4) No role for corticosteroid therapy. (5) Acetaminophen or NSAID for local pain and fever. (6) Tonsillectomy is reserved for recurrent infections defined as 7 episodes in the past year, 5 episodes per year in the past 2 years, and three episodes per year in the past three years (Zaman et al., 2021). Finally, the patient should be adequately hydrated. Complications of acute tonsillitis include peritonsillar abscesses, chronic tonsillitis, rheumatic fever, acute otitis media, acute glomerulonephritis, subacute bacterial endocarditis, and parapharyngeal/cervical abscess.
Acute tonsillitis is an essential topic for graduate nursing students for several reasons. Firstly, knowledge about this topic will enable graduate nursing students to educate and enlighten their patients concerning the likely cause and appropriate treatment options. Secondly, the graduate nursing students will be in a stronger position to promptly pick this condition in the outpatient setting thus preventing the complications of delayed diagnosis and treatment. Furthermore, knowledge and expertise in the diagnosis and management of tonsillitis increase interprofessional collaboration especially with pharmacists and otolaryngologists. Finally, a sound knowledge of this topic enables graduate nursing students to develop appropriate primary care nursing goals for these patients.
Tonsillitis is usually an outpatient condition that is common in school-going children in winter and spring. It is usually a clinical diagnosis with a self-limited course. The treatment is largely supportive with analgesics, hydration, and antibiotics tailored to throat culture results. Knowledge about this condition is of tremendous significance to graduate nursing students.
Anderson, J., & Paterek, E. (2022). Tonsillitis. https://pubmed.ncbi.nlm.nih.gov/31335062/
Haidara, A. W., Sidibé, Y., Samaké, D., Coulibaly, A., Touré, M. K., Coulibaly, B. B., Soumaoro, S., Guindo, B., Diarra, K., Coulibaly, K., Sanogo, B., Kéïta, M., & Mohamed, A. A. (2019). Tonsillitis and their complications: Epidemiological, clinical and therapeutic profiles. International Journal of Otolaryngology and Head & Neck Surgery, 08(03), 98–105. https://doi.org/10.4236/ijohns.2019.83011
Zaman, N., Khan, K., Zaman, F., & Zaman, B. (2021). Prescribing frequency, trends and patterns of Antimicrobial therapy in patients with acute tonsillitis: A review. Bulletin of Pharmaceutical Sciences, 0(0), 0–0. https://doi.org/10.21608/bfsa.2021.105675.1240
Discuss a HEENT case on a topic of interest and post for class discussion.
The case may be a real patient you have actually cared for or one that you heard about, read about, or made up. My suggested topics is:
Include a rationale as to why you think this is a good topic for graduate nursing students to learn.
Indicate if the case represents something you would expect to see in an outpatient or inpatient setting.
Which guidelines would you use to develop a treatment plan?