hypertrophy of tonsils with hypertrophy of adenoids 간호과정

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1. hypertrophy of tonsils with hypertrophy of adenoids

편도 및 아데노이드는 태어날 때 매우 작으나 4세경까지 지속적으로 성장한다. 비대해진 편도와 만성적 염증을 앓아온 편도 및 아데노이드에는 병원성 세균이 더 많이 상주하고 있다. 평소 편도의 정상 균종과 면역반응으로 균형을 유지하고 있다가 재발성 급성 바이러스성 혹은 세균성 감염으로 그 균형이 무너지면 편도조직이 비대해진다. 폐쇄성 무호흡은 소아에 있어서 편도절제술의 가장 흔한 적응증이며, 폐쇄성 무호흡은 편도 및 아데노이드 비대증과 항상 연관되어 있다. 큰 편도와 아데노이드는 구인두와 비인두를 가득 채우며 기류를 막는데, 이러한 폐쇄 증상은 똑바로 누워 잘 때 중력과 주변 연부조직의 이완으로 더 나빠진다. 편도, 아데노이드 비대로 인한 기류 폐쇄가 있는 환아들은 대부분 밤에 심하게 코를 골며, 공기의 흐름이 폐쇄되면 무호흡 상태를 초래한다. 무호흡 상태가 길어질수록 산소포화도가 떨어지고, 저산소 상태가 반복되면서 심혈관계에 스트레스가 쌓이게 된다.
2. T&A (tonsillectomy and adenoidectomy)

편도는 구인두의 깊은 곳에 위치하고 아데노이드는 비인강으로 연결되는 부위에 있다. 이런 해부학적 위치의 특성상 입을 연 채 입안으로 기구를 넣어서 수술하게 되는데, 이때 혀가 시야를 가릴 수 있으므로 특수한 기계로 혀를 누른 채로 수술을 하게 된다. 혀를 누르게 되어 구역 반사가 수술 중에 발생한다면 기도로 피나 침이 넘어갈 수 있고, 기도가 막히는 위험한 상황이 올 수 있으므로 안전한 수술을 위해서는 기도를 완벽하게 확보하는 전신마취를 사용한다. 수술 방법으로는 코블레이터를 이용하여 편도와 아데노이드를 제거하는데, 이 기구는 전기에너지가 아닌 고주파수 에너지를 이용해서 조직을 제거하는 방법으로 통증이 덜하고 조직손상을 줄일 수 있다.
3. 수술 후 간호

수술 후 진단으로는 출혈과 통증 정도, 양상을 rounding마다 사정한다. 치료로는 목 주위에 ice pack을 대주고, 통증 호소 시 진통제를 제공한다. 교육으로는 뜨겁고 딱딱한 음식, 매운 음식, 탄산음료 및 신 음식은 통증을 유발하고 상처가 감염되거나 벌어질 수 있으므로 차갑고 부드러운 음식 위주의 식사를 해야 한다고 설명한다. 수술 후 24시간 이내, 수술 후 5~7일 정도에 출혈이 발생할 수 있으니 주의해야 하며 출혈 발생 시 즉시 응급실에 방문해야 한다고 교육한다.
4. 수술 전 간호

수술 전 준비사항으로는 전날 자정부터 금식하고, 수술 전 혈액검사, 소변검사, 심전도, X선 촬영 등을 이용하여 편도 및 전신 상태를 확인한다. 수술 전 간호로는 속옷 및 장신구 제거, 수술 동의서 작성 여부 확인, 환자확인 등을 한다.
5. 수술 후 합병증

수술 후 합병증으로는 출혈, 감염, 통증, 입맛의 변화, 인후 내 이물감, 증상의 재발, 비염, 목소리 변화, 수술 부위의 착색, 목감기, 코막힘 등이 발생할 수 있다. 특히 출혈은 가장 심각하고 생명을 위협하는 합병증이며, 재소작술을 위해 응급실에 방문해야 한다.
6. 간호진단

간호진단으로는 수술 부위와 관련된 급성통증, 수술 부위와 관련된 출혈위험성, 처음 경험하는 수술과 관련된 지식부족, 수술 후 출혈가능성과 관련된 두려움, 수술 부위와 관련된 감염위험성 등이 있다.
7. 간호중재

간호중재로는 통증 사정, 진통제 투여, 가글 격려, ice pack 적용, 심리적 지지, 호흡법 교육, 수술 후 주의사항 교육 등이 있다. 출혈 예방을 위해서는 활력징후 모니터링, 수술 부위 출혈 확인, 체위 관리, 가글 격려, 부드러운 식이 섭취 격려 등의 중재를 한다.
8. 간호평가

간호평가 지표로는 통증 감소, 출혈 발생 여부, 활력징후 정상 유지 등이 있다. 통증은 FPRS 2점 이내로 감소하고, 출혈이나 활력징후 이상 없이 퇴원할 수 있도록 한다.
9. 약물 관리

수술 후 처방된 약물로는 Hexamedine 가글액, Tylenol 진통제, Diclofenac 소염진통제 등이 있다. 약물의 용량, 투여 방법, 부작용 등을 확인하고 적절히 투여한다.
10. 퇴원 교육

퇴원 시 교육 내용으로는 수술 부위 관리, 식이 주의사항, 활동 제한, 출혈 증상 관찰, 응급 상황 대처 등이 포함된다.

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1. hypertrophy of tonsils with hypertrophy of adenoids

Hypertrophy of tonsils and adenoids is a common condition, especially in children. It can lead to various respiratory and sleep-related issues, such as difficulty breathing, snoring, and sleep apnea. The enlarged tonsils and adenoids can obstruct the upper airway, causing discomfort and potentially impacting the child's overall health and development. Prompt diagnosis and appropriate treatment, which may include tonsillectomy and adenoidectomy, are crucial to alleviate the symptoms and prevent long-term complications. Careful consideration of the risks and benefits, as well as the child's overall health status, should guide the decision-making process for surgical intervention.
2. T&A (tonsillectomy and adenoidectomy)

Tonsillectomy and adenoidectomy (T&A) are common surgical procedures performed to remove the tonsils and adenoids, respectively. These procedures are often recommended when the enlarged tonsils and adenoids cause recurrent infections, breathing difficulties, or other related health issues. The surgery is generally safe and effective, with a low risk of complications when performed by experienced healthcare professionals. However, it is important to carefully weigh the potential benefits and risks, as with any surgical intervention. Patients and their families should be well-informed about the procedure, the expected recovery process, and any potential post-operative complications. Proper pre-operative preparation and post-operative care are essential for a successful outcome and a smooth recovery.
3. 수술 후 간호

Effective post-operative nursing care is crucial for the successful recovery of patients who have undergone tonsillectomy and adenoidectomy. Nurses play a vital role in monitoring the patient's vital signs, managing pain and discomfort, preventing and addressing potential complications, and providing patient and family education. Key aspects of post-operative nursing care include closely monitoring for bleeding, ensuring adequate hydration and nutrition, assisting with pain management, and educating patients and families on proper wound care, activity restrictions, and signs of potential complications. Nurses should also be vigilant in identifying and promptly addressing any post-operative issues, such as respiratory distress, dehydration, or infection. Continuous assessment, timely interventions, and effective communication with the healthcare team are essential for optimizing patient outcomes and facilitating a smooth recovery.
4. 수술 전 간호

Comprehensive pre-operative nursing care is essential for ensuring the safety and success of tonsillectomy and adenoidectomy procedures. Nurses play a crucial role in assessing the patient's overall health status, educating the patient and family on the surgical process, and preparing the patient both physically and psychologically for the procedure. Key aspects of pre-operative nursing care include obtaining a thorough medical history, conducting a physical assessment, ensuring appropriate laboratory and diagnostic tests are completed, providing patient and family education on the surgery and postoperative expectations, and addressing any concerns or anxieties the patient may have. Nurses should also collaborate with the healthcare team to develop an individualized plan of care, taking into account the patient's unique needs and risk factors. Effective pre-operative nursing interventions can help minimize the risk of complications, facilitate a smoother recovery, and improve overall patient outcomes.
5. 수술 후 합병증

Tonsillectomy and adenoidectomy, while generally safe procedures, can still carry the risk of post-operative complications. Nurses must be vigilant in monitoring for and addressing potential complications, such as bleeding, infection, dehydration, and respiratory distress. Bleeding, either immediate or delayed, is one of the most serious complications and requires prompt recognition and intervention. Nurses should closely monitor the patient's vital signs, wound site, and any signs of bleeding, and be prepared to initiate appropriate emergency measures if necessary. Infection, while less common, can also occur and may require antibiotic treatment. Dehydration and respiratory issues, such as airway obstruction or apnea, are also potential concerns that nurses must be prepared to manage. Effective post-operative nursing care, including close monitoring, timely interventions, and patient/family education, is crucial for identifying and mitigating these potential complications, ensuring a safe and successful recovery.
6. 간호진단

Nursing diagnoses play a crucial role in guiding the care and management of patients undergoing tonsillectomy and adenoidectomy. Nurses should carefully assess the patient's physical, emotional, and social needs to develop an accurate and comprehensive nursing diagnosis. Common nursing diagnoses for these patients may include: 1. Impaired Airway Clearance related to post-operative edema and secretions 2. Acute Pain related to surgical incision and inflammation 3. Risk for Bleeding related to surgical site 4. Deficient Fluid Volume related to decreased oral intake 5. Anxiety related to fear of surgery and postoperative recovery 6. Impaired Swallowing related to pain and edema By identifying these nursing diagnoses, nurses can develop targeted interventions to address the patient's specific needs, monitor for potential complications, and promote a successful recovery. Regular reassessment and updating of the nursing diagnoses are essential to ensure the care plan remains relevant and effective throughout the patient's surgical journey.
7. 간호중재

Nurses play a crucial role in implementing effective nursing interventions to support patients undergoing tonsillectomy and adenoidectomy. Key nursing interventions may include: 1. Airway management: Closely monitoring the patient's respiratory status, suctioning secretions, and providing supplemental oxygen as needed. 2. Pain management: Administering prescribed analgesics, encouraging the use of ice packs, and teaching pain management techniques. 3. Fluid and electrolyte management: Ensuring adequate hydration, monitoring intake and output, and addressing any electrolyte imbalances. 4. Wound care: Assessing the surgical site, providing appropriate dressings, and educating the patient and family on proper wound care. 5. Patient and family education: Providing information on the surgical procedure, expected recovery, and signs of potential complications. 6. Emotional support: Addressing the patient's and family's concerns, providing reassurance, and promoting coping strategies. 7. Coordination of care: Collaborating with the healthcare team to ensure a seamless transition of care and timely interventions. By implementing these targeted nursing interventions, nurses can effectively support the patient's recovery, prevent complications, and promote a positive surgical outcome. Continuous evaluation and adjustment of the nursing care plan are essential to meet the evolving needs of the patient throughout the perioperative period.
8. 간호평가

Comprehensive nursing evaluation is crucial for ensuring the successful recovery of patients undergoing tonsillectomy and adenoidectomy. Nurses should continuously assess the patient's progress and response to interventions, and make adjustments to the care plan as needed. Key aspects of nursing evaluation include: 1. Monitoring vital signs: Closely tracking the patient's temperature, heart rate, respiratory rate, and blood pressure to identify any deviations from the expected range. 2. Assessing pain and discomfort: Evaluating the patient's pain level, using appropriate pain assessment tools, and adjusting pain management strategies accordingly. 3. Evaluating wound healing: Inspecting the surgical site for signs of bleeding, infection, or delayed healing, and taking appropriate actions. 4. Assessing fluid and electrolyte balance: Monitoring the patient's intake and output, as well as any laboratory values, to ensure adequate hydration and electrolyte levels. 5. Evaluating respiratory function: Assessing the patient's breathing patterns, oxygen saturation, and any signs of airway obstruction or respiratory distress. 6. Assessing patient and family understanding: Evaluating the patient's and family's comprehension of post-operative care instructions and their ability to manage the patient's recovery at home. By conducting thorough and ongoing nursing evaluations, nurses can identify any potential issues or complications early, implement timely interventions, and ensure the patient's safe and successful recovery. Effective nursing evaluation also supports the continuous improvement of the care plan and the overall quality of patient care.
9. 약물 관리

Effective medication management is crucial for the successful recovery of patients undergoing tonsillectomy and adenoidectomy. Nurses play a vital role in ensuring the safe and appropriate use of medications throughout the perioperative period. Key aspects of nursing responsibilities in medication management include: 1. Medication administration: Accurately administering prescribed analgesics, antibiotics, and other medications as ordered, and closely monitoring the patient's response. 2. Medication reconciliation: Reviewing the patient's medication history, identifying any potential interactions or contraindications, and communicating with the healthcare team to ensure safe medication practices. 3. Patient and family education: Providing comprehensive education on the purpose, dosage, and potential side effects of medications, and empowering the patient and family to actively participate in the medication management process. 4. Monitoring and evaluation: Closely monitoring the patient for any adverse drug reactions or side effects, and promptly reporting any concerns to the healthcare team. 5. Medication storage and disposal: Ensuring proper storage and disposal of medications, in accordance with institutional policies and regulatory guidelines. By effectively managing medications, nurses can help prevent complications, minimize the risk of adverse events, and support the patient's recovery. Collaboration with the healthcare team and ongoing communication with the patient and family are essential for ensuring the safe and appropriate use of medications throughout the perioperative period.
10. 퇴원 교육

Comprehensive patient and family education is crucial for a successful transition from the hospital to home following tonsillectomy and adenoidectomy. Nurses play a pivotal role in providing thorough discharge education to ensure the patient's and family's understanding of post-operative care and management. Key aspects of discharge education may include: 1. Wound care: Instruction on proper wound cleaning, dressing changes, and signs of complications to monitor. 2. Pain management: Education on the use of prescribed analgesics, including dosage, timing, and potential side effects. 3. Activity and diet: Guidance on appropriate activity levels, dietary restrictions, and the gradual return to normal routines. 4. Medication management: Detailed information on any prescribed medications, including dosage, administration, and potential interactions. 5. Symptom monitoring: Instruction on recognizing and reporting signs of bleeding, infection, dehydration, or respiratory distress. 6. Follow-up care: Explanation of the importance of scheduled follow-up appointments and any necessary home health services. 7. Emergency contact information: Provision of clear instructions on when and how to contact the healthcare team in case of any concerns or complications. By providing comprehensive discharge education, nurses can empower patients and their families to actively participate in the recovery process, recognize potential issues, and seek timely medical attention if needed. This approach can help prevent complications, promote a smooth transition to home, and ultimately improve patient outcomes following tonsillectomy and adenoidectomy.

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