Tonsillitis: Nursing process (ADPIE)

Mason Taylor is a 22-year-old male college student who presents to the college health clinic  with a two-week history of a sore throat and a   subsequent decrease in oral intake due to pain with swallowing. He reports a very painful sore throat, fatigue and feeling feverish. 

Tonsillitis is an inflammation of the palatine tonsils, which are two lymphoid organs located in the oropharynx. Tonsillitis is sometimes accompanied by adenoiditis, which refers to inflammation of adenoid tonsils in the nasopharynx, as well as pharyngitis, which is an inflammation of the throat or pharynx.

Tonsillitis is most often caused by a viral infection. Common viruses that cause tonsillitis include rhinovirus, adenovirus, and respiratory syncytial virus, or RSV. Other important viral causes of tonsillitis include coronaviruses, human immunodeficiency virus or HIV, and Epstein-Barr virus or EBV, which causes infectious mononucleosis. 

On the flip side, one of the most common causes of tonsillitis is bacterial infection from group A streptococcus. This is why bacterial tonsillitis is commonly referred to as strep throat.

Now, the main risk factor for tonsillitis is being between the age of 5 and 15 years of age. Other risk factors include being in crowded environments where pathogens can be transmitted from person to person, and not practicing good hand hygiene. In addition, tonsillitis occurs more commonly during winter and early spring. Finally, clients who don’t get properly treated for bacterial tonsillitis, like those who don’t complete an antibiotic course, are more likely to develop it again later.

Now, symptoms of tonsillitis depend on the underlying cause. Symptoms of viral tonsillitis include a low grade fever, cough, rhinorrhea or runny nose, and sneezing. On the other hand, bacterial tonsillitis tends to present with more severe symptoms, such as a high grade fever, sore throat, as well as dysphagia or difficulty swallowing, and odynophagia or painful swallowing. Some clients may also experience headache, nausea, and vomiting.

Now, if not treated, clients with groups A streptococcus tonsillitis are at risk of complications.  If the infection spreads to nearby tissues, it can result in suppurative complications, in which there’s a buildup of pus in a localized area. 

Suppurative complications include peritonsillar abscess, where tonsillar infection turns into a pocket of pus around the tonsils, and parapharyngeal abscess, where the infection spreads to the space around the pharynx. 

What’s worse, peritonsillar and parapharyngeal abscess may put the client at risk of upper airway obstruction, which can be life-threatening!

On the flip side, nonsuppurative complications include rheumatic fever, which occurs due to antibodies that are made against streptococcal proteins; so once the infection is resolved, these antibodies can mistakenly attack the heart valves, joints, skin, and brain. 

Recurrent episodes of rheumatic fever may eventually lead to rheumatic heart disease, in which the heart valves are permanently damaged. 

Another nonsuppurative complication is post-streptococcal glomerulonephritis, where the immune system attacks the glomeruli in the kidneys, leading to hematuria or blood in the urine, as well as a decline in kidney function, resulting in decreased urine output, hypertension, and edema.

Diagnosis of tonsillitis starts with examining the throat, which typically shows enlarged and erythematous tonsils. In some cases, the tonsils may be covered with a whitish exudate. 

Clients may also have cervical lymphadenopathy, which is when lymph nodes in the neck area are enlarged. 

Next, a rapid strep antigen test, or RST for short, can be performed to look for bacterial antigens in a throat swab. However, RST can give false positive results, since these bacteria can normally live in a person’s throat without causing infection or disease. So, a definitive diagnosis requires a culture from the throat swab. 
Now, treatment of tonsillitis depends on the underlying cause. 

For viral tonsillitis, the treatment is typically supportive, which involves adequate hydration and pain medications like acetaminophen. 

For bacterial tonsillitis, the standard therapy includes the antibiotic penicillin. Clients who are allergic to penicillin may take cephalosporins such as ceftriaxone, or macrolides such as azithromycin. Finally, for clients who experience recurrent tonsillitis, generally defined as 7 or more episodes in a year, or if the enlarged tonsils cause difficulty breathing, the tonsils can be surgically removed via tonsillectomy.