A nurse is caring for a child who is postoperative following a tonsillectomy. which of the following

A tonsillectomy is the surgical removal of the tonsils, which are two pads of glandular (lymphatic) tissue on each side of the back of the throat. Tonsils help defend the body against infection which may enter through the nose or mouth. They are prone to inflammation and enlargement, which can lead to a condition called tonsillitis. A doctor usually suggests a tonsillectomy when tonsillitis is frequent and severe, or causes complications.

Índice Show

The operation
Preparation for surgery
After the operation
Pain relief
When to seek urgent medical attention
Food and drink
Post-operative review
Physical Activities

The operation

A tonsillectomy is performed under general anaesthesia. The surgeon will use a special device to keep the mouth open so that they can see the tonsils during the surgery. The procedure takes approximately 45 to 60 minutes. This includes the anaesthetic, the operation and time spent in the recovery room.

Your child will stay in hospital overnight for observations but should be able to go home the next morning if he/ she can eat and drink, swallow medicine, does not have any severe pain and is not bleeding from the nose or mouth.

Note: There is a slight risk of bleeding within 14 days after discharge, so it is important to stay within 45 minutes of the Queensland Children’s Hospital during this time. Families from regional or remote areas should make suitable accommodation arrangements.

Preparation for surgery

Do not give your child Aspirin for one week before the operation or two weeks after. Do not give ibuprofen (Nurofen®) for 72 hours before the operation.

After the operation

All children react differently to surgery. They may cry, be distressed, be awake and alert, or very sleepy. Do not be alarmed as your child will settle after a short time.

Your child will have either Intravenous Therapy (IV drip) or an IV cannula overnight. This will be removed the following morning once your child is tolerating foods and fluid.

Pain relief

Pain relief will be prescribed by the doctor after your child’s operation. Paracetamol and Oxycodone (a stronger prescription-only medicine) are commonly used for pain relief after tonsillectomy.

Throat pain builds up for the first few days and is usually at its the worst around the fifth day after surgery. Pain and discomfort will usually then ease until the seventh or ninth day after surgery when some of the scab covering the tonsillectomy site falls off. After this there is a steady reduction in pain.

Some children will experience a mild earache after a tonsillectomy. This is because the ears and the tonsils share the same nerve.

It is important to provide your child with regular pain relief during their recovery. This includes waking them at night for one or two days after the surgery.

Do not wait for your child to say they have pain or they may not take their medication and may not eat or drink, putting them at risk of bleeding and dehydration.

Paracetamol can be given every four to six hours with a maximum of four doses per 24 hours or as directed. Paracetamol should be given regularly for the first 48 hours and then as required.

If pain is not relieved by Paracetamol alone, Oxycodone can also be used. Oxycodone can be given every four to six hours, with a maximum of four doses per 24 hours.

It is important for you and other carers to record the name of the medication, and the date and time you have given it to keep track of medication usage.

Do NOT give your child Aspirin for two weeks after the operation. Ibuprofen may be given after the operation if advised by your child’s doctor.

Do not give any other pain relief medicines without checking with your child’s doctor because some products may double-up with prescribed medication.

Local anaesthetic lozenges can also be used by older children to supplement pain relief.

When to seek urgent medical attention

Contact your doctor or the hospital immediately if your child:

has bright red blood in their nose or mouth
has persistently high temperatures above 38°C
has increased throat or ear pain not relieved by medication
is not eating or drinking
is nauseous or vomiting with no sign of relief
is dehydrated. Look for signs such as dry mouth, dark or lack of urine, sunken eyes and looking increasingly unwell

Food and drink

For the first two hours after the operation, your child can have clear fluids (water, cordial, iceblock). When he/she is tolerating clear fluids your child may then have non- carbonated fluids (milk, ice-cream, custard).

Children may refuse to drink fluids after the surgery because of throat pain but they must be encouraged to drink regularly (half a cup every hour) to avoid dehydration. Dehydration can lead to increased pain and also increase the chance of bleeding.

Two hours after returning to the ward your child can eat regular meals. During the first eight hours after surgery your child may eat without too much discomfort due to the local anaesthetic used in the surgery.

It is important to maintain your child’s fluid intake at home to prevent dehydration. Your child should also resume their normal diet as soon possible, although he/ she will probably be fussy about food at first. Any food is better than none in the first few days. Some foods (hot and/or spicy, acidic) may cause discomfort when eating so should be avoided for a few weeks.

Chewing gum or chewy lollies will increase saliva production and help to reduce jaw stiffness.

Mouth care

Bad breath is a normal part of the healing process. Drinking plenty of water will help reduce the odour and teeth should be brushed as normal. The site where the tonsils have been removed will turn yellow/white – this is also normal.

Activity

Your child will need to stay home from school or childcare for two weeks and should avoid all sports and rough play. Encourage plenty of rest and quiet play or entertainment such as puzzles, reading and watching DVDs.

Post-operative review

A review of your child will be scheduled after the operation. This will be performed at an outpatient appointment or over the phone. If you have any concerns prior to the review, contact the hospital.

Contact us

Ear, Nose and Throat Outpatients Department
Level 3a, Queensland Children’s Hospital
501 Stanley Street, South Brisbane

Clinical nurse
t: 07 3068 2563 (8am – 5pm, M-F)

Clinical nurse consultant
t: 07 3068 1889 (7am – 3.30pm, M-F)

Day surgery (4c)
t: 07 3068 3430 (24 hours, M-Sat)

Hospital switchboard
t: 07 3068 1111 (24 hours, 7 days)

In an emergency, always call 000.

If it’s not an emergency but you have any concerns, contact 13 Health (13 43 2584). Qualified staff will give you advice on who to talk to and how quickly you should do it. You can phone 24 hours a day, seven days a week.

The following instructions will help you know what to expect in the days following surgery. Do not, however, hesitate to call if you have any questions or concerns.

Physical Activities

After this surgery, children should rest but may play inside after one or two days and may be outside after three or four days, if they feel up to it. Strenuous physical activity following surgery is discouraged. Children may return to school whenever comfortable; a week is average, but 10 days is not unusual.

Diet

The more your child drinks, the sooner the pain will subside. Water, apple juice, grape juice, and Gatorade are excellent sources of liquid. Soft foods such as ice cream, sherbet, yogurt, pudding, apple sauce and jello, should also be encouraged. Other soft, easily chewed foods are also excellent. Avoid hot or spicy foods, or foods that are hard and crunchy. Often, chewing gum speeds comfortable eating by reducing the spasm after surgery and can be started anytime after surgery.

Pain

For the first several days (occasionally up to 10 days) following surgery, pain in the throat is to be expected. This can usually be controlled with Liquid Tylenol (acetaminophen) or Tylenol with Codeine (prescription will be given at time of surgery). Avoid medication containing aspirin, ibuprofen, or other anti-inflammatory medication, for two weeks. Pain is often worse at night and may prompt the need for additional pain medication. Ear pain, especially with swallowing is also a common occurrence; it is not an ear infection but due to referred pain from the surgery. Treat it with Tylenol or Tylenol with Codeine. Occasionally a stiff neck may occur. Please call if it becomes excessively painful.

Ice Collar

An ice collar can also be helpful for post operative sore throat. Make this by placing ice cubes and water in a large Zip-Loc bag and wrapping it in a towel. Gently lay the ice pack on the front of the neck.

Fever

A low-grade fever (less than 101 degrees) following surgery may occur and should be treated with Tylenol (acetaminophen). Follow the directions on the bottle. While children have a fever, they should play quietly or remain in bed. If the fever persists (more than two days) or if a higher fever develops, call. Fever may indicate that you have not taken in sufficient fluids or may have an infection.

Bleeding

Post-operative bleeding is unusual, but it can occur up to two weeks after surgery. Most bleeding is minor and you may only see a little coating of blood on the tongue. Put your child into bed, sitting upright, and place an ice collar on their neck. Watch for spitting, coughing, or vomiting of blood. If you suspect bleeding following surgery, call immediately.