Pathophysiology Of Peritonsillar Abscess

Joe, a 6-year-old kid, was taken to the emergency room after a 3-day of fever, ear pain, vomiting, including swallowing difficulty. He has developed serious tonsillitis. Also, according to the recent analysis, he has developed a peritonsillar abscess, which requires urgent quinsy tonsillectomy. A peritonsillar abscess seems to be a pus-filled lesion near the tonsils in the rear of a mouth. The abscess could be very uncomfortable, making it challenging to open the mouth. It could also lead to swelling, causing a tonsil to press against the uvula (Klug et al. 2020).

Therefore, this paper is going to discuss the pathophysiology of the condition, nursing assessment and management, using the appropriate paediatric tool, and appropriate health promotion plan for Joe.

The main reason for Joe’s admission is serious tonsillitis. Anderson & Parterek (2021) mention tonsillitis, as well as tonsil irritation, is a frequent ailment that accounts for around 1.3 per cent of outpatient services. Tonsillitis occurs whenever a microorganism, whether virus or bacteria, attacks the tonsils as well as causes inflammation. Whenever viruses invade tonsils, they trigger the inflammatory reaction including up-regulated cytokines. Group A-hemolytic streptococcus (GABHS) streptococcus pyogenes invasion causes acute bacterial tonsillitis. Also, S. pyogenes as well as taxonomically-similar germs penetrate the barrier, tonsillar epithelium, effectively breaching the defensive mucosal layers inside the nasal and oral canal (Abu Bakar et al. 2018).  Moreover, Staphylococcus aureus is the most common source of typical bacterial tonsillitis. S. aureus is swallowed via non-phagocytic cells via fibronectin-binding protein as well as beta-integrins after penetration. Tonsillitis has been caused by the infiltration of the non-eukaryotic cells, which causes the up-regulation of various cytokines (Dan et al. 2019). Tonsillitis is linked to a variety of illnesses and diseases caused by microbial agents. Tonsillitis is usually caused by a viral or bacterial infection. The most prevalent causes are viral infections. The most prevalent viral culprits are rhinovirus, respiratory syncytial virus, adenovirus, as well as coronavirus, all of which cause the common cold. All of those are usually low-virulent and cause little problems. Tonsilitis can also be caused by viruses including Epstein-Barr virus (which induces mononucleosis), CMV, hepatitis A, rubella, as well as HIV.  Management Of Peritonsillar Abscess In A 6-Year-Old Child Essay Paper Both anaerobic and aerobic microorganisms can cause bacterial tonsillitis (Yeoh et al. 2019). Corynebacterium diphtheriae, which causes diphtheria, must be considered as a cause in unvaccinated individuals.

To focus on and oversee Joe’s treatment, the nursing team must first evaluate him using a range of tools as well as evaluations in order to create a nursing strategy. The Children’s Early Warning Tool (CEWT), a tool, which screens for medical deterioration among children, would be one of those evaluations (Cassidy et al., 2019). According to the nursing assessment, Joe has a temperature of 39.3 °C, heart rate (HR) of 139 beats per minute (BPM), oxygen saturation (SpO2) of 91% on room air, respiratory rate (RR) of 34 breaths per minute (BPM) with moderate respiratory distress, blood pressure 95/72mmhg, and capillary refill time (CRT) < 2 seconds. Also, Joe is oriented to the voice. According to the CEWT, for temperature he scores 2, RR score 1, HR score 1, respiratory distress score 2, SpO2 score 1, and consciousness score 1; totalling 8. As a result, he needs to be in an urgent emergency (Slater et al. 2021). Also, it is important to contact the doctors.

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Nursing Assessment And Management Using The CEWT

Joe’s elevated HR, as well as RR, suggests inefficient airway clearance, as well as a respiratory examination, must be performed to rule out any unexpected or diminished respirations. To improve his conditions bronchodilators can be used. However, the main cause of his poor respiration is the infection. Therefore, the nurse needs to administer the proper level of antibiotics to manage his condition. According to these values, it is indicated that he is starting to develop tachypnea (Hinkle & Cheever 2018). The nurse also needs to encourage Joe to take deep breaths to improve his respiration. Moreover, if his condition starts to decline more, it is important to start the Continuous positive airway pressure (CPAP). An artificial breathing device is used in this therapy (Alviset et al. 2020). The device delivers a steady stream of air to the patient’s airways, helping to maintain the lungs’ small air passageways open. This intervention will also help to improve his respiratory distress.

Furthermore, Joe also has a poor blood oxygen level, indicating that his body does not have a sufficient level of oxygen. This condition can lead to hypoxia, which can be a very serious issue. As a result, of poor oxygen levels, many organs would not receive a sufficient amount of oxygen and will fail to maintain cellular function. For example, to function properly brain needs an adequate amount of oxygen. However, in this case, due to a lack of oxygen, Joe’s brain fails to function properly (Memar et al. 2019). As a result, he is not fully alert. This may lead to permanent brain damage. Hence, to improve his condition, the nurse needs to administer additional oxygen. Oxygen therapy, or oxygen, which is more than the quantity present within the atmosphere without being altered, is most typically administered to the patient through a nasal cannula, or an O2 mask, or by incorporating it into the CPAP machine. This intervention will help to improve the level of oxygen in his body retaining proper brain function.

Additionally, proper administration of medication is another important criterion that a nurse needs to follow. The nurse must adhere to the NSQHS standard 4, medication safety process (Jensen 2020). According to this, the nurse must administer the right amount of medication at right time. This will help to reduce the chance of negative outcomes. However, in case of clinical deterioration, the nurse needs to act quickly and needs to report to the doctor.

Furthermore, Joe has developed a peritonsillar abscess. As a result, Joe is scheduled for a quinsy tonsillectomy, within 4 hours. This can be considered minor surgery. Incision, suction, as well as antimicrobial therapy, are the most common treatments for peritonsillar abscess, followed by tonsillectomy. Therefore, the nurse needs to properly educate Joe’s mother about the procedure and must take informed consent. However, in this case, the issue will be establishing proper communication. It was mentioned that they have migrated from Vietnam and have some difficulty communicating in English. Therefore, it might create a barrier. According to the NMBA (Ossenderg et al. 2020) registered nurse standard 2, an RN is responsible for engaging in a therapeutic rapport with the patient family. Also, the nurse needs to respect the culture and beliefs of the patient. Hence, here the nurse needs to use proper verbal and non-verbal communication skills to educate Joe’s family regarding the procedure. Also, the nurse needs to tell them the importance of the procedure and the risk and benefits associated with it. This will help to improve the understanding of the patient’s family. Also, in any paediatric care, the involvement of the parents is important in a decision making procedure (Hinkle & Cheever 2018). Therefore, the nurse must take informed consent from Joe’s parents for the surgery.

Respiratory Examination And Oxygen Therapy

For the health promotion before the surgical procedure, the nurse needs to offer necessary patient education to Joe’s family. This will help them to develop a better understanding of how to prevent the occurrence of tonsillitis. To promote Joe’s health reducing the chance of clinical deterioration, the nurse needs to thoroughly check all of his vital signs (Hinkle & Cheever 2018). This will help to detect any early indication of health decline, thus providing enough time to take the necessary step to managing it. Therefore, this will help to prevent the occurrence of clinical complications during the surgical procedure.

Conclusion

According to the CEWT tool, Joe has developed several complications and needs urgent intervention to manage his situation. The nurse needs to check his respiratory system to prevent airway blockage. Also, the nurse needs to administer oxygen to improve his blood oxygen level. The nurse needs to properly educate Joe’s family regarding the importance of the procedure.

References

Abu Bakar, M., McKimm, J., Haque, S. Z., Majumder, M., & Haque, M. (2018). Chronic tonsillitis and biofilms: a brief overview of treatment modalities. Journal of inflammation research, 11, 329–337. https://doi.org/10.2147/JIR.S162486

Alviset, S., Riller, Q., Aboab, J., Dilworth, K., Billy, P. A., Lombardi, Y., … & Ioos, V. (2020). Continuous positive airway pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: a retrospective cohort study. PloS one, 15(10), e0240645. https://doi.org/10.1371/journal.pone.0240645

Anderson, J., & Paterek, E. (2021). Tonsillitis. In StatPearls [Internet]. StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK544342/

Cassidy, C. E., MacEachern, L., Best, S., Foley, L., Rowe, E., Dugas, K., & Mills, J. L.A. (2019). Barriers and enablers to implementing the children’s hospital early warning score: A pre-and post-implementation qualitative descriptive study. Journal of pediatric nursing, 46, 39-47. https://doi.org/10.1016/j.pedn.2019.02.008

Dan, J. M., Havenar-Daughton, C., Kendric, K., Al-Kolla, R., Kaushik, K., Rosales, S. L., Anderson, E. L., LaRock, C. N., Vijayanand, P., Seumois, G., Layfield, D., Cutress, R. I., Ottensmeier, C. H., Lindestam Arlehamn, C. S., Sette, A., Nizet, V., Bothwell, M., Brigger, M., & Crotty, S. (2019). Recurrent group A Streptococcus tonsillitis is an immune susceptibility disease involving antibody deficiency and aberrant T_FH cells. Science translational medicine, 11(478), eaau3776. Management Of Peritonsillar Abscess In A 6-Year-Old Child Essay Paper