Clinical meaning
Tonsillectomy is the surgical removal of the palatine tonsils, performed most commonly for recurrent tonsillitis or obstructive sleep apnea in children. The tonsillar fossa is a highly vascular area supplied by branches of the external carotid artery. After surgical excision, a fibrin clot (white eschar) forms over the wound bed and sloughs off naturally over 7-10 days. The greatest risk is post-operative hemorrhage, which can occur within the first 24 hours (primary) or 5-10 days post-operatively (secondary) when the eschar separates. The nurse monitors for bleeding, pain, hydration status, and dietary progression, reporting concerns immediately.
Exam relevance
Risk factors: - Recurrent tonsillitis (≥7 episodes in 1 year, ≥5/year for 2 years, or ≥3/year for 3 years) - Peritonsillar abscess - Obstructive sleep apnea from tonsillar hypertrophy - Young age (most common in pediatric patients) - Bleeding disorders - History of post-operative bleeding
Diagnostics: - Monitor vital signs and report tachycardia or hypotension (signs of hemorrhage) - Inspect throat for excessive bleeding or fresh blood - Monitor oral intake and report inability to swallow or excessive drooling - Report frequent swallowing (may indicate posterior bleeding) - Monitor for signs of dehydration: decreased urine output, dry mucous membranes