REFERENCE CARE PLAN: Tonsillectomy/Adenoidectomy Post-op PATIENT POPULATION This care plan is for patients who have undergone Tonsillectomy and/or Adenoidectomy surgery. DEFINITIONS The tonsils are two pads of tissue located on either side of the back of the throat. Tonsils can become enlarged in response to recurrent tonsil infections or strep throat. They can also become a reservoir for bacteria. Tonsillectomy is performed under general anesthesia either as an outpatient or with overnight observation (spending the night in the hospital). Tonsillectomy is often performed with an adenoidectomy. The surgery takes 30 – 45 minutes and children remain at the hospital 2 – 4 hours afterwards or overnight for observation. The adenoids are pads of tissue found behind the nose in the throat. They cannot be seen by looking into the mouth. Adenoids can get big and block the eustachian tube (leading to the ears) or the nasal airway (in the nose). Adenoids can also become a storage place for bacteria. Nasal (Nose) Obstruction -Enlarged adenoids can block the nasal airway and lead to mouth breathing and snoring. Removing the adenoids, called an adenoidectomy, allows the child to breathe normally through the nose again. Chronic Ear Infections - Enlarged adenoids can block and allow bacteria to enter the eustachian tubes in the ear. This can lead to ear infections. Removing the adenoids along with inserting ear tubes may help treat chronic ear infections. An adenoidectomy is usually done as an out-patient. Your child will get medicine to make them sleep before surgery begins. The surgery takes 20-30 minutes and the child usually stays at the hospital one to two hours afterwards. Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use - 1 -
REFERENCE CARE PLAN: Tonsillectomy/Adenoidectomy Post-op
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PATIENT POPULATIONREFERENCE CARE PLAN: Tonsillectomy/Adenoidectomy Post-op
PATIENT POPULATION This care plan is for patients who have undergone Tonsillectomy and/or Adenoidectomy surgery.
DEFINITIONS The tonsils are two pads of tissue located on either side of the back of the throat. Tonsils can become enlarged in response to recurrent tonsil infections or strep throat. They can also become a reservoir for bacteria.
Tonsillectomy is performed under general anesthesia either as an outpatient or with overnight observation (spending the night in the hospital). Tonsillectomy is often performed with an adenoidectomy. The surgery takes 30 – 45 minutes and children remain at the hospital 2 – 4 hours afterwards or overnight for observation.
The adenoids are pads of tissue found behind the nose in the throat. They cannot be seen by looking into the mouth. Adenoids can get big and block the eustachian tube (leading to the ears) or the nasal airway (in the nose). Adenoids can also become a storage place for bacteria.
Nasal (Nose) Obstruction -Enlarged adenoids can block the nasal airway and lead to mouth breathing and snoring. Removing the adenoids, called an adenoidectomy, allows the child to breathe normally through the nose again.
Chronic Ear Infections - Enlarged adenoids can block and allow bacteria to enter the eustachian tubes in the ear. This can lead to ear infections. Removing the adenoids along with inserting ear tubes may help treat chronic ear infections.
An adenoidectomy is usually done as an out-patient. Your child will get medicine to make them sleep before surgery begins. The surgery takes 20-30 minutes and the child usually stays at the hospital one to two hours afterwards.
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 1 -
Problem/Potential Problem Objectives Anticipatory/Therapeutic Nursing Interventions Evidence-base/Rationale
Potential for airway obstruction due to edema related to surgical procedure.
Respiration will remain easy, regular, quiet, and oxygen saturation will remain within normal range.
• Keep HOB elevated at least 30 degrees • Offer only cool liquids and food for tonsillectomy
patients. • Monitor O2 saturation as ordered • Position sleeping patient to maximize open airway
(e.g. avoid neck flexion and sleeping flat on back). • Administer oxygen prn as per physician’s orders. • Notify physician immediately if increasingly noisy
breathing, respiratory distress, or if amount of oxygen required to maintain oxygen saturation is increasing.
To ensure patient is assessed and ensure complications can be detected early and interventions can be initiated. Snoring and mouth breathing are normal after surgery because of swelling. Normal breathing should resume 10 – 14 days after surgery.
Potential for bleeding related to surgical procedure
Surgical site will remain free from bleeding
• Assess skin colour, level of consciousness and vital signs (Temperature, Heart Rate, Respiratory Rate and Blood Pressure –TPR and BP) with transferring RN. Confirm patient status is unchanged or improved from PACU.
• If patient is stable, then MONITOR vital signs: hourly x 4, then every 2 hours x 2, then as per physicians order thereafter or as per unit routine
• Discourage crying, coughing, frequent clearing of throat
• Avoid hard objects in mouth • Avoid sucking (ie.straws, soother) • No red liquids , popsicles, jello, or foods with red
sauce ie.spaghetti sauce. • Treat post-operative vomiting promptly • No aspirin • For adenoidectomy patients they can eat whatever
they want once they have progressed from clear fluids to full fluids then diet as tolerated. The food can be any temperature.
• Notify Physician immediately if any bleeding is noted.
Bleeding usually means the scabs have fallen off too early and this needs immediate attention. Every reasonable attempt will be made to control the bleeding in the Emergency Department. Some children may need to be taken to the Operating Room to control the bleeding.
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 2 -
Problem/Potential Problem Objectives Anticipatory/Therapeutic Nursing Interventions Evidence-base/Rationale
Pain related to surgical procedure
Patient will remain comfortable enough to be able to maintain adequate fluid intake and sleep
• Assess for pain using appropriate pain scale q1- 4h, post analgesic administration and prn. • Administer ordered analgesics regularly, NOT prn. • Ensure ordered analgesic dosage is appropriate for patient’s weight • If analgesia ineffective, notify ENT Physician • Offer small amounts of cool fluids, popsicles, ice chips frequently • If a child is reluctant to drink, offer a favourite drink about one hour after analgesic is administered. • Encourage child to talk at regular intervals and chew gum, if age appropriate, and if there is parental approval.
Establishing a pain- management plan based on the findings from the assessment and incorporating the person’s beliefs and goals is important for minimizing pain and distress. Unrelieved acute pain can cause long-term pain problems that affect body functioning The chewing motion is beneficial to relieve referred pain.
Potential for dehydration due to inadequate fluid intake related to pain.
Patient will drink at regular intervals during hospitalization
• Measure intake and output. Note colour of urine indicating concentration/dilution.
• Offer preferred fluids and soft/frozen foods at regular interval
• Maintain IV access and rate as per physician’s orders
• Monitor IV site q1h and PRN • Assess IV site using TLC • Teach and support families to assess IV site. • Reinforce importance and benefits of maintaining
adequate fluid intake to patient and family
Provides thorough assessment of infusion system so complications can be detected early and immediate interventions can be provided in a timely manner. Educates family on importance of performing the hourly site assessments and engages them in the process
Potential for infection at surgical site.
Surgical site will remain free of infection
• Administer antibiotics if prescribed • Assist child in maintaining good oral hygiene
(brush teeth but no gargling). • Report signs of infection (ie. Increased pain,
lethargy, general deterioration of condition) to Physician. The patient may have a smell to their breath post-op. If the breath smell gets stronger after they are discharged then they should notify the physician.
Provides thorough assessment of patients clinical status including vitals, surgical wound, and comfort to ensure complications can be detected early and immediate interventions can be initiated
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 3 -
Anxiety related to surgery and hospitalization
Patient and family will display positive coping skills during hospitalization.
• Orient patient/family to unit layout and routines • Encourage parental/caregiver presence and
involvement as desired • Encourage use of personal comfort measures i.e.
blanket, stuffy, etc. • Prepare patient/family before any tasks or
procedures that need to be done. • Encourage questions and discussion of
concerns. .
Having open, reliable and timely information available regarding the plan of care for family members and caregivers increases families’ satisfaction with the hospital experience.
Discharge teaching Patient and family will state an understanding of information relevant to post-op recovery and will express realistic plans for home care by discharge
• Review and ensure that the patient/family have a copy of appropriate discharge pamphlet ‘Your child has had a Tonsillectomy’ or ‘Adenoids and Adenoidectomy’
• Ensure patient/family has the contact information for ENT Clinic RN 604-875-2345 local 7053 or toll free 1-888-300-3088 local 7053. Voicemail also includes how to contact the ENT Resident on Call
To ensure the family understands and is prepared to care for the child at home with the necessary equipment and prescriptions as required
CROSS-REFERENCES Any related policies/procedures, other care plans, teaching flow sheets, patient/family teaching resources, etc.
Nursing Assessment and Documentation
Pamphlet ‘Your child has had a Tonsillectomy’
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 4 -
REFERENCES Lewis, S.M., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (9th ed.). St. Louis: Mosby Registered Nurses’ Association of Ontario. (2007) Assessment and management of pain. Best Practice Guidelines. Retrieved March 8th, 2016 from: http://rnao.ca/bpg/guidelines/assessment-and-management-pain https://www.cincinnatichildrens.org/health/t/tonsillectomy Comp, D. (2011). Improving parent satisfaction by sharing the inpatient daily plan of care: An evidence review with implications for practice and
research. Pediatric Nursing, 37(5), 237-242 6p.
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
PATIENT POPULATION This care plan is for patients who have undergone Tonsillectomy and/or Adenoidectomy surgery.
DEFINITIONS The tonsils are two pads of tissue located on either side of the back of the throat. Tonsils can become enlarged in response to recurrent tonsil infections or strep throat. They can also become a reservoir for bacteria.
Tonsillectomy is performed under general anesthesia either as an outpatient or with overnight observation (spending the night in the hospital). Tonsillectomy is often performed with an adenoidectomy. The surgery takes 30 – 45 minutes and children remain at the hospital 2 – 4 hours afterwards or overnight for observation.
The adenoids are pads of tissue found behind the nose in the throat. They cannot be seen by looking into the mouth. Adenoids can get big and block the eustachian tube (leading to the ears) or the nasal airway (in the nose). Adenoids can also become a storage place for bacteria.
Nasal (Nose) Obstruction -Enlarged adenoids can block the nasal airway and lead to mouth breathing and snoring. Removing the adenoids, called an adenoidectomy, allows the child to breathe normally through the nose again.
Chronic Ear Infections - Enlarged adenoids can block and allow bacteria to enter the eustachian tubes in the ear. This can lead to ear infections. Removing the adenoids along with inserting ear tubes may help treat chronic ear infections.
An adenoidectomy is usually done as an out-patient. Your child will get medicine to make them sleep before surgery begins. The surgery takes 20-30 minutes and the child usually stays at the hospital one to two hours afterwards.
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 1 -
Problem/Potential Problem Objectives Anticipatory/Therapeutic Nursing Interventions Evidence-base/Rationale
Potential for airway obstruction due to edema related to surgical procedure.
Respiration will remain easy, regular, quiet, and oxygen saturation will remain within normal range.
• Keep HOB elevated at least 30 degrees • Offer only cool liquids and food for tonsillectomy
patients. • Monitor O2 saturation as ordered • Position sleeping patient to maximize open airway
(e.g. avoid neck flexion and sleeping flat on back). • Administer oxygen prn as per physician’s orders. • Notify physician immediately if increasingly noisy
breathing, respiratory distress, or if amount of oxygen required to maintain oxygen saturation is increasing.
To ensure patient is assessed and ensure complications can be detected early and interventions can be initiated. Snoring and mouth breathing are normal after surgery because of swelling. Normal breathing should resume 10 – 14 days after surgery.
Potential for bleeding related to surgical procedure
Surgical site will remain free from bleeding
• Assess skin colour, level of consciousness and vital signs (Temperature, Heart Rate, Respiratory Rate and Blood Pressure –TPR and BP) with transferring RN. Confirm patient status is unchanged or improved from PACU.
• If patient is stable, then MONITOR vital signs: hourly x 4, then every 2 hours x 2, then as per physicians order thereafter or as per unit routine
• Discourage crying, coughing, frequent clearing of throat
• Avoid hard objects in mouth • Avoid sucking (ie.straws, soother) • No red liquids , popsicles, jello, or foods with red
sauce ie.spaghetti sauce. • Treat post-operative vomiting promptly • No aspirin • For adenoidectomy patients they can eat whatever
they want once they have progressed from clear fluids to full fluids then diet as tolerated. The food can be any temperature.
• Notify Physician immediately if any bleeding is noted.
Bleeding usually means the scabs have fallen off too early and this needs immediate attention. Every reasonable attempt will be made to control the bleeding in the Emergency Department. Some children may need to be taken to the Operating Room to control the bleeding.
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 2 -
Problem/Potential Problem Objectives Anticipatory/Therapeutic Nursing Interventions Evidence-base/Rationale
Pain related to surgical procedure
Patient will remain comfortable enough to be able to maintain adequate fluid intake and sleep
• Assess for pain using appropriate pain scale q1- 4h, post analgesic administration and prn. • Administer ordered analgesics regularly, NOT prn. • Ensure ordered analgesic dosage is appropriate for patient’s weight • If analgesia ineffective, notify ENT Physician • Offer small amounts of cool fluids, popsicles, ice chips frequently • If a child is reluctant to drink, offer a favourite drink about one hour after analgesic is administered. • Encourage child to talk at regular intervals and chew gum, if age appropriate, and if there is parental approval.
Establishing a pain- management plan based on the findings from the assessment and incorporating the person’s beliefs and goals is important for minimizing pain and distress. Unrelieved acute pain can cause long-term pain problems that affect body functioning The chewing motion is beneficial to relieve referred pain.
Potential for dehydration due to inadequate fluid intake related to pain.
Patient will drink at regular intervals during hospitalization
• Measure intake and output. Note colour of urine indicating concentration/dilution.
• Offer preferred fluids and soft/frozen foods at regular interval
• Maintain IV access and rate as per physician’s orders
• Monitor IV site q1h and PRN • Assess IV site using TLC • Teach and support families to assess IV site. • Reinforce importance and benefits of maintaining
adequate fluid intake to patient and family
Provides thorough assessment of infusion system so complications can be detected early and immediate interventions can be provided in a timely manner. Educates family on importance of performing the hourly site assessments and engages them in the process
Potential for infection at surgical site.
Surgical site will remain free of infection
• Administer antibiotics if prescribed • Assist child in maintaining good oral hygiene
(brush teeth but no gargling). • Report signs of infection (ie. Increased pain,
lethargy, general deterioration of condition) to Physician. The patient may have a smell to their breath post-op. If the breath smell gets stronger after they are discharged then they should notify the physician.
Provides thorough assessment of patients clinical status including vitals, surgical wound, and comfort to ensure complications can be detected early and immediate interventions can be initiated
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 3 -
Anxiety related to surgery and hospitalization
Patient and family will display positive coping skills during hospitalization.
• Orient patient/family to unit layout and routines • Encourage parental/caregiver presence and
involvement as desired • Encourage use of personal comfort measures i.e.
blanket, stuffy, etc. • Prepare patient/family before any tasks or
procedures that need to be done. • Encourage questions and discussion of
concerns. .
Having open, reliable and timely information available regarding the plan of care for family members and caregivers increases families’ satisfaction with the hospital experience.
Discharge teaching Patient and family will state an understanding of information relevant to post-op recovery and will express realistic plans for home care by discharge
• Review and ensure that the patient/family have a copy of appropriate discharge pamphlet ‘Your child has had a Tonsillectomy’ or ‘Adenoids and Adenoidectomy’
• Ensure patient/family has the contact information for ENT Clinic RN 604-875-2345 local 7053 or toll free 1-888-300-3088 local 7053. Voicemail also includes how to contact the ENT Resident on Call
To ensure the family understands and is prepared to care for the child at home with the necessary equipment and prescriptions as required
CROSS-REFERENCES Any related policies/procedures, other care plans, teaching flow sheets, patient/family teaching resources, etc.
Nursing Assessment and Documentation
Pamphlet ‘Your child has had a Tonsillectomy’
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
- 4 -
REFERENCES Lewis, S.M., Dirksen, S.R., Heitkemper, M.M., & Bucher, L. (2014). Medical-Surgical Nursing: Assessment and Management of Clinical Problems (9th ed.). St. Louis: Mosby Registered Nurses’ Association of Ontario. (2007) Assessment and management of pain. Best Practice Guidelines. Retrieved March 8th, 2016 from: http://rnao.ca/bpg/guidelines/assessment-and-management-pain https://www.cincinnatichildrens.org/health/t/tonsillectomy Comp, D. (2011). Improving parent satisfaction by sharing the inpatient daily plan of care: An evidence review with implications for practice and
research. Pediatric Nursing, 37(5), 237-242 6p.
Reviewed/Revised: December 2016 Refer to online version – Print copy may not be current – Discard after use
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