Our Lady of the Pillar College-

Cauayan
San Fermin, Cauayan City, Isabela
College of Nursing and Midwifery
CASE STUDY: TONSILLITIS

OVERVIEW:

Tonsillitis is an infection of the tonsils, which are two masses of tissue at the back of your throat.
Tonsils act as filters, trapping germs that could otherwise enter your airways and cause infection.
They also make antibodies to fight infection. But sometimes, they get overwhelmed by bacteria
or viruses. This can make them swollen and inflamed. Tonsillitis is common, especially in
children. It can happen once in a while or come back again and again in a short period.

DEFINITION:

Tonsillitis is the inflammation of the palatine tonsils, which are two oval-shaped masses of
lymphoid tissue located on either side at the back of the throat. It is commonly caused by viral
infections (such as those from adenovirus, rhinovirus, or Epstein-Barr virus) or bacterial
infections, most notably Streptococcus pyogenes (Group A Streptococcus), which causes
streptococcal pharyngitis (strep throat).

Tonsillitis is an inflammatory condition of the palatine tonsils, which are part of the body’s
lymphatic and immune system, located bilaterally in the oropharynx. It is primarily caused by
infectious agents, including viral and bacterial pathogens, and presents with symptoms of throat
pain, difficulty swallowing, fever, and swollen tonsils, sometimes with exudates. The condition
can be classified based on duration and recurrence into acute, recurrent, and chronic tonsillitis

Classification

Acute Tonsillitis

 Sudden onset of symptoms lasting ≤10 days

 Caused by viral or bacterial infections
 Common in children and young adults
Recurrent Tonsillitis

 ≥7 episodes per year, or ≥5 episodes per year for two consecutive years, or ≥3
episodes per year for three consecutive years
 Often requires long-term management and possible tonsillectomy
Chronic Tonsillitis

 Persistent inflammation lasting >3 months

 Our Lady of the Pillar College-
Cauayan
San Fermin, Cauayan City, Isabela
College of Nursing and Midwifery

 Characterized by recurrent sore throat, bad breath (halitosis), and tonsillar crypt
debris

CLINICAL MANIFESTATION

 Sore throat – Inflammation of the pharynx and tonsils due to infection leads to
pain and irritation, making the throat feel raw and scratchy.
 Difficulty or pain when swallowing (odynophagia) – Swelling of the tonsils and
throat tissues makes it painful to swallow food, liquids, or even saliva.
 Fever and chills – The body's immune response to infection results in an elevated
body temperature (fever) and shivering (chills) as it fights off the invading
pathogens.
 Swollen and red tonsils, sometimes with white or yellow patches – The tonsils
become inflamed and may develop pus-filled spots (exudates) due to bacterial or
viral infections. These patches indicate an immune response to infection.
 Bad breath (halitosis) – The accumulation of bacteria, pus, and debris in the
infected tonsils contributes to a foul odor in the mouth.
 Enlarged and tender cervical lymph nodes – Lymph nodes in the neck become
swollen and painful as they work to filter out pathogens and activate the immune
response.
 Hoarseness or muffled voice – Inflammation and swelling in the throat can
affect the vocal cords, leading to changes in voice quality.
 Ear pain due to referred pain from inflamed tonsils – The glossopharyngeal
nerve (cranial nerve IX) transmits pain signals from the throat to the ear, causing
discomfort even though the ear itself is not infected.

RISK FACTORS:

Modifiable Risk Factors

 Poor Hygiene: Tonsillitis is often caused by bacteria or viruses that spread

through direct contact. Poor handwashing or sharing food and utensils with an
infected person increases exposure to pathogens.
 Smoking and Exposure to Irritants: Cigarette smoke, air pollution, and
chemical fumes weaken the respiratory system and irritate the throat, making the
tonsils more vulnerable to infection and inflammation.
 Frequent Contact with Infected Individuals : Tonsillitis-causing pathogens,
such as Streptococcus pyogenes (strep throat), spread through droplets when an
infected person coughs or sneezes. Being in crowded places (schools, hospitals,
daycare centers) increases exposure.
 Poor Nutrition: A weak immune system due to nutrient deficiencies (e.g.,
vitamin C, zinc) reduces the body’s ability to fight infections, making a person
more prone to tonsillitis.
 Dehydration: A dry throat weakens its natural defenses, making it easier for
bacteria and viruses to attach to the tonsils and cause infection.

Non- Modifiable Risk Factors

 Age : Children and teenagers (especially those aged 5–15) have a developing
immune system and are more exposed to infections in school settings, making
them more susceptible to tonsillitis.
 Weakened Immune System: People with conditions like diabetes, HIV/AIDS, or
those undergoing chemotherapy have a lower ability to fight infections, increasing
their risk of recurrent tonsillitis.
 Our Lady of the Pillar College-
Cauayan
San Fermin, Cauayan City, Isabela
College of Nursing and Midwifery
 Seasonal Factors: Respiratory infections, which can lead to tonsillitis, are more
common during colder months due to dry indoor air and increased time spent
indoors, where germs spread more easily.
 Genetics: Some people may have a genetic predisposition to recurrent infections
due to differences in immune response or structural differences in the tonsils that
make them more susceptible to bacteria and viruses.

SURGICAL MANAGEMENT

TONSILLECTOMY- is the surgical removal of the tonsils,

indicated in cases of recurrent or chronic tonsillitis, obstructive
sleep apnea, or complications such peritonsillar abscess.

Procedure:

 General anesthesia is administered to ensure the patient is unconscious and does

not experience pain.
 The surgeon removes the tonsils using a scalpel, electrocautery (heat-based
removal), or laser.
 Bleeding is controlled using sutures, electrocautery, or topical hemostatic agents
to prevent excessive blood loss.
 The patient is monitored postoperatively for complications such as bleeding,
infection, or airway obstruction, which can occur due to swelling.
PHARMACOLOGICAL MANAGEMENT

 Antibiotic Therapy: rescribed for bacterial tonsillitis (e.g., Streptococcus

pyogenes) to eliminate infection and prevent complications such as rheumatic
fever and kidney disease. Ex. Penicillin or amoxicillin
 Analgesics & Antipyretics: helps control pain and fever, improving patient
comfort and reducing inflammation. Ex. Acetaminophen or ibuprofen

NON- PHARMACOLOGICAL MANAGEMENT

 Hydration: Encouraging fluid intake prevents dehydration, which is common in

patients who have difficulty swallowing due to a sore throat. Hydration also helps
maintain mucosal moisture, reducing throat irritation.
 Throat Lozenges & Gargles: Warm saline or antiseptic gargles help reduce
throat irritation, clear bacterial load, and provide symptomatic relief by soothing
the inflamed mucosa.
 Rest & Supportive Care: Adequate rest allows the body to recover faster, while
a soft diet minimizes further throat irritation and prevents discomfort during
swallowing.
 Humidified Air: Using a humidifier can help keep the throat moist, preventing
further irritation and discomfort.
 Avoiding Irritants: Patients should avoid smoking, strong-smelling chemicals,
and extreme temperature foods or beverages to prevent further throat irritation.

NURSING RESPONSIBILITY:

 Perform a thorough assessment of the patient’s symptoms, medical history, and

risk factors.
 Monitor for signs of complications such as peritonsillar abscess, difficulty
breathing, or worsening infection.
 Provide health education on proper hygiene practices to prevent infection and
reduce transmission.
 Our Lady of the Pillar College-
Cauayan
 Encourage compliance with prescribed
San Fermin, Cauayanmedications and follow-up appointments
City, Isabela
to ensure complete recovery.
College of Nursing and Midwifery
 Offer emotional support and reassurance to the patient and family to alleviate
anxiety about the condition and treatment.

Preoperative Care (if tonsillectomy is planned):

 Educate the patient and family about the procedure, expected recovery, and
potential risks to alleviate anxiety and ensure cooperation.
 Assess for bleeding tendencies (e.g., coagulation studies) to prevent excessive
bleeding during surgery, as tonsillectomy carries a risk of postoperative
hemorrhage.
 Obtain informed consent after explaining the benefits and risks of the surgery,
ensuring the patient or guardian fully understands the necessity of the procedure.
 Ensure NPO (nothing by mouth) status before surgery to reduce the risk of
aspiration during anesthesia, which could lead to respiratory complications.

Postoperative Care:
 Monitor for signs of bleeding (e.g., frequent swallowing, blood-tinged saliva), as
postoperative hemorrhage is a serious complication that requires immediate
medical attention.
 Assess vital signs and level of consciousness to ensure stable recovery from
anesthesia and detect any early signs of complications.
 Encourage a soft, cool diet (e.g., ice cream, gelatin, cold drinks) to minimize
throat irritation, promote healing, and provide comfort to the patient.
 Provide pain management with prescribed medications, ensuring timely
administration to keep the patient comfortable and prevent unnecessary distress.
 Educate the patient to avoid coughing, throat clearing, and using straws, as these
actions can dislodge clots and cause bleeding, leading to delayed healing or
further complications.
 Encourage adequate hydration and rest to promote healing, maintain mucosal
moisture, and prevent dehydration, which can worsen throat irritation.
Our Lady of the Pillar College-
Cauayan
San Fermin, Cauayan City, Isabela
College of Nursing and Midwifery