Tonsillectomy is one of the most common surgical procedures done in Otorhinolaryngologic department. Tonsillectomy is a surgical procedure that is often performed to remove the tonsils from either side of the throat. According to Eisele & Smith (2009), roughly about 500000 cases of tonsillectomy are done annually nonetheless, tonsillectomy have seen a tremendous evolution during the last two decades where patient selection and pre-operative evaluation have improved, various new techniques have been developed and the procedure has become largely ambulatory. Hence, it is essential for all perioperative nurses to be familiar with the procedure instruments and management of a tonsillectomy patient. There are many surgical methods for tonsillectomy. The methods can be the cold steel dissection where the tonsils are removed as a whole using sharp metal instruments and the bleeding is controlled with ties or sutures (Hazarika & Nayak, 2005). Methods by using monopolar or bipolar diathermy where the tonsils are dissected using the diathermy. Tonsillectomy can also be done by using the laser and finally the most commonly used now in most hospital is the coblation method. Coblation is a radio-frequency dissection method that cuts the tissue by breaking down the inter-cellular bonds and seals the wound at the same time. It is a bipolar system working through a medium of normal saline that is incorporated in a disposable wand and also consist of a built-in suction (De Souza, 2010). The following is a case study of a patient undergoing tonsillectomy surgery using the Coblation method. Miss D is a 19 year old female that was previously seen in the emergency department on the 3rd of October for cough. She returned to the emergency department on the 11th of October for the same problem and claimed to have odynophagia. Aside from this, Miss D has a painful lump on the left posterior neck. This is her third episode this year. Miss D is treated with antibiotics augmentin, corticosteroid prednisolone and difflam. Miss D is given an appointment to see an Otorhinolaryngologic specialist on the 22nd October 2010 and was scheduled for surgery on the 3rd of November for Tonsillectomy.
Anatomy and Physiology of the Tonsils
There are three different structures referred to as tonsils. The tonsils also known as palatine tonsils are a pair of soft tissue masses located at the rear of the throat where each tonsil is composed of tissue similar to lymph nodes that is covered by pink mucosa. Another set of tonsils called the lingual tonsils are located under the tongue and lastly are the adenoids that are embedded in the upper rear wall of the oral cavity. The adenoids also known as pharyngeal tonsils are often prominent in childhood but usually diminish in size during adulthood. All of the tonsillar structures are part of the lymphatic system and contain lymphoid tissue. The physiological function of the tonsils is to process lymphatic fluid and it serves to fend off infections. The tonsils grow in size whenever the body is fighting an infection (Sigler & Schuring, 1993).
Indications and Sign & Symptoms of Tonsillectomy.
Some of the indications for tonsillectomy are recurrent episodes of acute tonsillitis where the patient suffers more than six episodes per year or more than three attacks per year for more than two years. Chronic tonsillitis where there are signs of chronic disease such as enlarged cervical nodes or anterior pillar congestions. Other indications for tonsillectomy are peritonsillar abscess and obstructive tonsillar hyperplasia where the patient presents with varying degrees of Obstructive Sleep Apnoea (Hazarika & Nayak, 2005). The signs and symptoms are red, swollen tonsils, white or yellow coating or patches on the tonsils, sore throat, difficult or painful swallowing and fever (De Souza, 2010). Pre-operative Phase
One day before surgery, pre-operative instructions such as no eating and...