Tonsillectomy and Adenoidectomy Nursing Management

 Definition

The excision of the palantine tonsils, and if applicable, the removal of the nasopharyngeal tonsils (adenoids).

Description

• Chronic tonsillitis associated with otitis media and nasal obstruction due to enlarged adenoid glands are indications for a tonsillectomy and adenoidectomy procedure.
• The adenoids are usually absent in patients over 15 years of age.
• In children, the procedure is relatively simple. The older patient, the more fibrosis there is and the more difficult the procedure, with a greater incidence of postoperative complications.

Positioning

• Supine, arms may be extended on armboards or tucked at the patient’s side and restrained.
• The table is placed in slight Trendelenberg position. A rolled towel is placed under the shoulder to hyperextend the neck.

Packs/ Drapes

• Head or neck or basic pack with split sheet.

Instrumentation

• Tonsillectomy and adenoidectomy tray
• Suction/ cautery with cord
• Bayonet coagulating forceps with cord.

Supplies/ Equipment

• Basin set
• Suction
• Blade
• Tonsil sponges
• Medications
• Sutures
• Solutions

Procedure Overview

• 1. The surgeon will usually sit during the procedure.
  2. The mouth is retracted open with a self-retraining mouth gag, or a Davis model, which attaches to Mayo stand.
  3. The adenoids are removed first with an adenotome and/ or curette.
  4. A tonsil is grasped with a small tenaculum or tonsil-grasping forceps, and the mucosa is dissected free, preserving the posterior tonsil pillar.
  5. The capsule of the tonsil is separated from its bed.
  6. Suction should be immediately available.
  7. A tonsil snare is then looped over the tonsil and snapped over the pillar thus releasing the tonsil.
  8. The fossa may be packed with a tonsil sponge to aid in hemostasis.
  9. One or two plain catgut sutures may be placed over the tonsillar fossa.
  10. The procedure is repeated on the opposite side.
  11. An alternative method of hemostasis may be use of a combined suction-cautery unit.
  12. It is important to remember that the snare wire can only be used once, and is replaced for the removal of the other tonsil.
  13. The specimen should be separated, and one of the tonsils is tagged with a suture for identification.

Perioperative Nursing Considerations for Tonsillectomy and Adenoidectomy

1. The suction tip and tubing are never dismantled until the patient is completely out of the room.
2. The patient is placed on his or her side before being transported to the postanesthesia care unit.
3. Have ties mounted on a tonsil clamp ready in advance.
4. Sponges and needles are counted at routine intervals.