Nursing Care Process:

TONSILLITIS

I. INTRODUCTION

It is presented in this comprehensive nursing process the case of Ms.

K.A.T, a 2-year old female, who has had high fever because of her tonsillitis. She
is under the care of nurses at Antipolo Medical Hospital since July 4, 2009. She
was admitted and has been under the care of her attending physician Dra.
Ferrer.
Tonsillitis is an inflammation of the tonsils, the fleshy clusters of tissue on
both sides of the back of the throat that fight off germs that enter the body
through the mouth. The tonsils become enlarged and red, and can be coated
with a yellow, gray, or white substance.
Most types of tonsillitis are contagious. It usually spreads from person to
person by contact with the throat or nasal fluids of someone who is infected. A
person with tonsillitis may have a sore throat, fever, swollen glands in the neck,
and trouble swallowing.
Many cases of tonsillitis never reach the doctor's office, so there are no
national figures on the prevalence of these infections. However, if the results of a
recent study from Manitoba of tonsillectomy rates hold across the country, it
appears that 50,000 people have their tonsils removed each year. Tonsillectomy
(tonsil removal) has always been the most common childhood operation, though
it represents a tiny and shrinking fraction of the total number of cases of
tonsillitis, and is considered a last resort these days.
This case was chosen because of the prevalent cases of Tonsillitis most
especially amongst children aged three to seven, who have larger tonsils than
adults and older children. The students believe in attending to such cases and
address the needs of the client for experience and improvement of skills as they
go on with other exposures.

II. OBJECTIVES
After implementation this case study the student nurse should be able to:
1. Recognize and be appropriate the mainly suitable Nursing Theory to patient, in
assortment to provide relevance for the patient health status.
2. Elucidate and build up the most appropriate nursing management for the
expansion of nursing care plan or NCP.
3. Intricate and develop assessment skills and identification of predictable
conclusion.
4. Discuss the Anatomy and Physiology of Human Respiratory Systems Tonsils.
5. Establish different health teachings that would be advantageous for the
patients recent health provision.

III. THEORETICAL FRAMEWORK

The Core, Care, Cure Theory was developed in the late 1960s. She
postulated that individuals could be conceptualized in three separate domains:
the body care, the illness, cure, and the person core.
Hall thought patients should receive care merely from professional nurses.
Nursing involves interacting with a patient in a complex process of teaching and
learning. Hall was not pleased with the concept of team nursing she said that
"any career that is
defined around the work that has to be done, and how it is divided to get it done,
is a "trade" rather than a profession.
Nursing functions in all three of the boxes (core, care, and cure) but
shares them to different degrees with other disciplines. For example, the nurse's
function in the cure boxes is limited to helping patients/families deal with the
measures instituted by the physician. She felt that the care box was exclusive to
nursing. The core box was shared with social workers, psychologists, clergy, etc.
The Patient

The Body

The Disease

Social sciences

Natural and Biological

Pathological and

Therapeutic use of self

Sciences

therapeutic sciences

Intimate bodily care

Seeing the patient and

aspect of nursing.
The Core

the family
Aspects of nursing
Through the medical care
The Care

By the Physician and

Nurses
The Cure

The theorist, Lydia E. Hall with her theory which is Core, Care, and Cure was
preferred for this particular case because the student nurses patient who is
suffering hypertension was a could do with a great assessment and the theory of
Lydia E. Hall was needed to expand the patients skill in providing a care for her.
As a student nurse, should first recognized a connection, a relationship with
patient so as to assess the patient for the present problems or disease that the
patient has also this possible disease or risk that the patient might encounter and
plan the suitable things to be done to the patient. This is the enlightenment for
the core of he student nurses patient.
The relevance of the nursing intervention or NANDA will have a massive role
and give support to provide a proper Care to the patient to help the patients
development from a complaint.
Cure is provided when the student nurse apply the knowledge for the
treatment of the patient. As it should be provided administering medication as
prescribed by the doctor or physician, which is also a part of the recovery of the
patient.

Nursing Care Process

I. BIOGRAPHIC DATA

Name:

Ms. K.A.T.

Address:

Antipolo City

Date of Birth:

November 23, 2006

Age:

2 years and 8 months old

Sex:

Female

Civil Status:

Single

Place of Birth:

Baguio City

Educational Attainment: N/A

Occupation:

N/A

Religion:

Roman Catholic

Ethnic Group : None

Parents:
Mother: M.T
Age: 22 y.o
Occupation: housewife
Father: M.T.
Age: 24 y.o
Occupation: Seaman
Health Care Financing:

Medical Insurance at USA

Annual Income:

P500, 000-P700, 000

Room and Bed Number: Room 409B

Chief Complaint:

Fever and Tonsillitis for 3 days

Provisional Diagnosis:

Acute Pain r/t Tonsillitis

Attending Physician:

Dra. Ferrer

Admitting Date:

July 4, 2009 (4:45 A.M)

Admitting Doctor:

Dra. Ferrer

II. NURSING HISTORY

A. Past Health History
The mother of Ms. K.A.T. stated that she has been fully immunized since
then. Heres the table of her immunizations including the dosage and age she got
it.
Immunization
TICE BCG
Cholera Vaccine
(Generic)
ActHIB, Comvax, hibTITER, liquid
PedvaxHIV
(Haemophilus B conjugated vaccine
and hepatitis B surface antigen)
Meningococcal Polysaccharide Vaccine
Prevnar

DTaP
(diphtheria and tetanus and acellular
pertussis vaccine)
Twinrix
(hepatitis A vaccine with hepatitis B
recombinant vaccine)
Biavax II
(rubella and mumps vaccine)
M-R-Vax II
(measles and rubella virus vaccine)
Orimune
(pollovirus vaccine; trivalent)

Varivax
(against chickenpox)

Dosage
0.2 mL. percutaneously
0.2 mL IM
Three 0.5 mL. IM injections at 2 years
old with 0.5 mL booster at 1 year and 3
months old
0.5 mL SC
Three 0. mL. IM doses; 7-11 months
old
Two 0.5 mg. IM doses; 1 year old 1
year and 11 months old
0.5 mL IM; 1 year and 6 months old
1 mL IM; 1 year old
Followed by booster doses at 2 years
and 6 months old
0.5 mL0 SC
0.5 mL SC
1st dose: 0.5 mL PO at 2 months old, 4
months old and 1 year and 6 months
old
2nd dose: two doses; 2 years old and 2
years and 2 months old
0.5 mL SC; 1 year old
0.5 mL SC; 1 year and 2 months old

Her mother claims that she has experienced a childhood illness which is
Urinary Tract Infection. She had no major operations to date nor serious injuries
or accidents. She has been hospitalized for four times, including present

confinement, for some different reasons. She has been confined due to fever
related to her Tonsillitis.
She was diagnosed of having Urinary Tract Infection and she has it
for 2 years. She has no maintaining medication prescribed by her physician but
she takes up medicine whenever she is confined in the hospital.
She doesnt experience yet any foreign travel, only out-of-town
activities.
Date
26 March,
2007-2nd April,
2007
22nd
December,
2007-12th
January, 2008
24th May, 200825th of June,
2008
th
20 March,
2008 26st
March, 2008
th

Place
Baguio

With whom
With family

Duration
One week

Purpose
Vacation

Bicol

With family

Three weeks

Visited
grandmother

Ilocos Norte

With family

One month

Visited
grandfather

Baguio

With family

6 days

Vacation

B. History of Present Illness

The said client has a chief complaint of intermittent high-grade

fever around 38.5C and it is predominant prior to her admission. Her fever was
accompanied with temporal headache, which resulted to her decreased appetite
with which he reported to have not eating anything. She did not have any other
pain or related symptoms like coughs and colds with her fever. She was not selfmedicated by her mom.
With his condition and the signs and symptoms she is manifesting,
her mother brought her to the hospital to consult a doctor and also to confine her
for several days.
C. Family History
The client is K.A.T who is currently 2 years and 8 months old. Her
parents are M.T and M.T, aged 22 and 24 years old, respectively. She doesnt
have any siblings. Her family doesnt have a family history of any diseases on
both matriarchal and patriarchal side.

DRUG STUDY

Generic
Name
Ampicillin

Specific
Name
Ampicin

Dosage
IV 500 mg - q8h

Albuterol

Ventolin

PO 5ml - q6h

Uses

Actions

Infections of GU,
A broadrespiratory, and
spectrum semiGI tracts and skin
synthetic
and soft tissues;
aminopenicillin,
also gonococcal
is highly
infections,
bactericidal even
bacterial
at low
meningitis, otitis
concentrations,
media, sinusitis,
but is inactivated
and septicemia
by penicillinase
and for
prophylaxis of
bacterial
endocarditis.
Used parenterally
only for
moderately
severe to severe
infections.
To relieve
Synthetic
bronchospasm
sympathomimetic
associated with
amine and
acute or chronic
moderately
asthma,
selective beta2bronchitis, or
adrenergic
other reversible
agonist with
obstructive airway
comparatively
diseases. Also
long action. Acts
used to prevent
more prominently
exercise- induced
on beta2
bronchospasm.
receptors
(particularly
smooth muscles
of bronchi,
uterus, and
vascular supply
to skeletal
muscles ) than
on beta1 (heart)
receptors.
Minimal or no
effect on alphaadrenergic

Paraceta
mol

Tempra

PO 160 mg q4h RTC

Fever reduction.
Temporary relief
of mild to
moderate pain.
Generally as
substitute for
aspirin when the
latter is not
tolerated or is
contraindicated.

Health Perception and Health Management Pattern

receptors.
Inhibits histamine
release by mast
cells.
Produces
analgesia by
unknown
mechanism,
perhaps by
action on
peripheral
nervous system.
Reduces fever by
direct action on
hypothalamus
heat-regulating
center with
consequent
peripheral
vasodilatation,
sweating, and
dissipation of
heat. Unlike
aspirin,
acetaminophen
has little effect on
platelet
aggregation,
does not affect
bleeding time,
and generally
produces no
gastric bleeding.

During the interview, the client already is in her fourth day of confinement at
Antipolo Medical Center for having a provisional diagnosis of intermittent high-fever
related to her Tonsillitis. The client admitted that for the present year, this already was his
second time to be brought to a hospital for the same diagnosis. For the past history of
the client, she received all the childhood vaccines. She still presently has Urinary Tract
Infection. Now, she is not taking any medications but during her stay in the hospital she
took up Ampicin(Ampicillin), Paracetamol(Tempra) and Albuterol(Ventolin). Health
according to her mom, para sa akin, para maconsider na healthy ang isang tao,

siya dapat ay walang sakit at physically healthy para walang problema.

Also, her mom rates her overall health as 8 out of 10 with 10 being the highest.
With his traditional concepts regarding health, the client does not believe that herbal
medicines might be good to improve or promote wellness. Other than this, the client has
no other particular beliefs and practices as her mom verbalized.
As an average person, the clients mom regularly practices personal hygienic
measures to maintain her clean, presentable and germ-free. And for her mom, the most
important thing to maintain health was thru providing a good lifestyle and good
perception regarding their health for today and for the coming years of their life. Lastly,
the clients mom describes their home environment by saying Malinis sa loob at labas,
accessible naman ang health facilities and adequate ang space para sa kanyang
pagtakbo at paglalaro. The clients mom also stated that they have adequate supply of
mineral purified drinking water and they have a hazard and vector free community
because of proper waster management collection of about twice a week. She also stated
that as much as possible, they maintain their home environment clean and sanitize
because this is as well for their own good.
Interpretation: The clients mom exhibits a normal pattern with regards to maintaining
their health.
Analysis:

Each person defines health in terms of his or her own values and beliefs. The
family, community, and society in which one lives also influence ones personal
perception of health. Health, as defined by each person, integrates all the human
dimensions-the physical, emotional, socio-cultural, spiritual, and environmental aspects
as a whole person. (Fundamentals of Nursing: Concepts, Process, and Practice, 7 th
Edition by Kozier, p.60)
Behavior-specific knowledge, beiefs, and relationships are considered to be
major motivators for engaging in health-promoting behaviors. (Fundamentals of Nursing:
Concepts, Process, and Practice, 7th Edition by Kozier, p.65)

Nutritional-Metabolic Pattern
The clients usual meal consists of 1 cup of rice and any viand which is prepared
by her mom. She 3 to 5 glasses of water a day and sometimes drinks C2 in the morning.
She doesnt have any food preferences. She eats whatever she likes. Her mom also
claimed she had a huge appetite until he experienced signs and symptoms of headache
and fever because of her tonsillitis, since then, her appetite decreased and hasnt eaten
normally as before. She then cannot consume rice for the mean time. The client also has
no diet restrictions. She also takes Poten-Cee for her vitamins. The client has no
difficulty regarding swallowing or chewing of food. Her mom is the one who prepare
meals for them. The client has no spiritual or cultural belief regarding food. Her mom is
the one who manages the buying and preparing of food.

Time of the Day

Monday
( July 6, 2009)

Time of
Eating
Break fast
8:15 A.M8:30 A.M
Lunch
12:0012:30 pm

Snack
4:30 pm
Dinner
( 9:309:45 pm)

Type of food
-Bread
-milk

Quantity
-3 pcs. Regular
size
-1 glass-250 ml
-2 pcs of bread
1 slice of tomato
2 teaspoon of
mayo with
shredded meat
and onion.
-1 bottle-250 ml

-Baked
-Cold milk

water

1 glass-250 ml

Cold drinks

-Chopsuey
-Rice
-Water
-banana

-1 small saucer as
big as a cup
- 1 glass-250 ml
-1 banana

-Stir fry
-steame rice
-cold drinks
-ripe banana

-Jollibee
burger
-C2

FNRI Food Pyramid for the Filipinos

Method of Cooking

First level water and other beverages

Second level Carbohydrate-rich foods (root crops, rice)

-burger patty is fried

-Other ingredients were
not cooked
-Cold drinks

Third level - combination of vegetables and fruits

Fourth level -Protein rich foods, animal meat like poultry, pork, fish,
seafood, dairy products and as well as dried beans
Fifth level - Fats and oils

The daily needed servings for every food in the Food Pyramid

Beverages - 6-8 glasses

Carbohydrate-rich food- 6-8 servings
Vegetables- 3 servings
Fruits - 3 servings
Milk - 1 glass
Egg -1 pc.
Fish, meat, poultry -2 servings
Sugars and sweets 5-6 tsps.
Fats and oils- 6-8 tsps.

She eats more protein rich foods (eggs).

Her fluid intake is 3-5 glasses of water a day but most of the time she
drinks C2 as for her refreshment beverage.

She always eats a lot anytime of the day.

Interpretation:
The alteration in nutrient requirements that results from illness and trauma varies
with the intensity and duration of the stress. For instance, fever increases the need for
calories and water. Unlike fevers related to septicemia, however, fever caused by a mild
case of flu requires few dietary adjustments.
(Source: Fundamental of Nursing, Taylor, page 1251)
Analysis:
Pain, illness, anxiety and medications can contribute to anorexia and poor intake
when in healthcare facility or home. To the hospitalized patient, food and eating may
take on much greater meaning. Loss of control over food choice, the way food is
prepared, when and how food is served and eating alone may do little to encourage
normal eating.
(Source: Fundamentals of Nursing, Taylor, page 1260)

Elimination Pattern

The client urinates 6 times a day or whenever needed. It is amber in

yellow in color, aromatic in odor. She doesnt feel any discomfort, burning

sensation or anything while urinating. She can control her urine. He eliminates 12 times a day. Normally his excreta are brown in color. He doesnt feel any
discomfort while eliminating. The clients usual bowel pattern is every other day,
or sometimes when she just feels the urge to eliminate her bowel. It is brown in
color, soft formed, semi-solid, cylindrical and moist. She doesnt experience yet
to have diarrhea or history of bleeding.
She doesnt have excessive perspiration. It was also mentioned that her
practice to achieve normal elimination is to drink a lot of water.
Interpretation:
The client seems no difficulty in urinating, and urinates in normal amount. She
also defecates normal amount per day.
Analysis:
The frequency of micturation depends on the amount of urine being produced.
The more urine produced, the more often voiding is necessary, except when fluid intake
is very large. Most people have individual patterns of bowel elimination involving
frequency, timing considerations, position and place. For example many people defecate
after breakfast, when the gastrocolic and duoodenocolic reflexes cause mass propulsive
movements in the large intestine. (Reference: Fundamentals of Nursing 5th edition by
Taylor pg. 1292 and 1341)

Activity-Exercise Pattern
The patient prior to hospitalization spends pretty much of his time at home
playing and watching television all the time. She seldom walks and usually found at her

room. Also as part of his activity and exercise, her mom and the client is strolling to
some places whenever there is free time. She lives with her mom and uncle; she doesnt
help in household chores since shes too young to do so. Aside from the mentioned
routine of activity and exercise, her mom did not mention any other form of exercising.
From the time that he was confined to the hospital because of having fever for 3 days,
she was kept lying in bed.
ACTIVITIES OF DAILY LIVING
Activities of Daily
Living

Before
Hospitalization

During
Hospitalization

Interpretation and
Analysis

1. Nutrition

She usually has a

big appetite. She
eats rice and viand
for breakfast, with a
cup of milk. She
eats heavy lunch
and heavy supper.
He usually drinks 35 glasses of water a
day.

As she got sick, the

clients mom
reported a decrease
in appetite. she also
went for 1day
without eating due
to this appetite
decrease. she
drinks about 3-5
glasses of water a
day and 5 bottles of
Gatorade.

2. Elimination

She urinates about

4 times a day
without any pain,
difficulty, or
discomfort. Her
mother stated that it
could vary
depending on how
much her daughter
has eaten or drank
or with the
temperature of her
environment.
She eliminates

she urinates about

10 times a day
without pain,
difficulty, or
discomfort. Her
bowel movement
has decreased to
once every two or
three days. Though
this is the case, she
does not feel that
she is under
constipation.

People of her age

usually tend to eat a
healthy diet,
following the
recommended
portions of intake of
food groups. 2-3L of
liquid is usually
included in the diet.
Nutritional intake,
however, can be
greatly affected by a
feeling of illness or
disease.
(Fundamentals of
Nursing by Kozier,
p.1180)
The increase in the
frequency of voiding
is related to the
increase in fluid
intake. The
decrease in bowel
movement is related
to the decrease in
appetite which
decreased her
nutritional intake.
When it comes to
bowel movement,
there is no normal

stool every other

day, also without
any pain, difficulty,
or discomfort.

3. Exercise

She doesnt have

any regular exrcise
activity

The client has not

had any chance to
do any other forms
of exercise except
for walking.

4. Hygiene

He likes to keep
himself clean. He
bathes for 2-3 times
a day and brushes
his teeth for 2-3
times a day. He
trims his nails and
wears clean clothing

He can only bathe

for once a day, but
still is able to brush
his teeth for 2-3
times a day. He is
still able to attend to
his hygienic needs.

frequency, and if the

act of defecation is
painless coupled
with regular
intervals and soft,
formed stool, then
functional problems
regarding
elimination will
seldom, if not,
occur. (p.1340,
Taylor, 5th ed.) The
frequency of
urination depends
on the amount of
urine being
produces, which
depends on the food
and fluid intake. As
the intake of food
and fluids decrease,
the frequency of
urination will also
decrease. (p. 1292,
Taylor, 5th ed.)
The clients activity
pattern has changed
from active and
regular exercise to
short walks. This is
hindered by his
nutritional dilemmas
and IV therapy.
(p.1175, Taylor, 5th
ed)
The client is
hygienic. He still
wants to keep his
hygiene even if he
has been
hospitalized. A
disease or injury
may reduce a

and footwear.

5. Substance Use

He is an active
smoker for already
10 years and
consumes about a
pack of cigarettes in
a day. He drinks 3-4
bottles of beer 1-2
times a week.

He has not engaged

in any cigarette
smoking or alcohol
drinking.

6. Sleep and Rest

He usually sleeps
for 7-8 hours a day.
He describes the
sleep as continuous
and satisfying
enough to promote
relaxation.

He only sleeps for 34 hours in the

nighttime and
another 3-4 hours in
the daytime. He
reports his sleep to
be paputol-putol,
and somehow he is
satisfies although
there are times he
does not feel too
relaxed.

7. Sexual Activity

He usually engages
in sexual intercourse
for about once or
twice a week. He
reports not using

He has no sexual
activity or
intercourse.

persons ability to
perform hygienic
measures. In the
clients case, the
intravenous fusion
reduces the ability
to perform usual
hygiene practices.
(p.1009, Taylor, 5th
ed)
Substance abuse is
significantly related
to risk-taking
behavior. The
absence of such
behavior may
indicate that there is
no abuse of
alcoholic beverages.
(p.410-411, Taylor,
5th ed).
Middle-aged adults
generally maintain
the sleeping pattern
they have
established at a
younger age. They
usually sleep 6-8
hours per night, with
the number of
arousals per sleep
increasing. Any
disease or
discomfort can
affect the quantity
and quality of sleep.
(Fundamentals of
Kozier, p.1116)
Sexual activity is
common as one
establishes lifestyle
and values.
Although they often

any contraceptive
devices.

require information
about measures to
prevent pregnancy
(i.e., abstinence,
contraceptive
devices). Regular
communication is
required to
understand
partners sexual
needs and to work
through problems
and stresses.
(Fundamentals of
Nursing by Kozier)

Interpretation:
The patient does not exhibit a healthy form of activity and exercise since she
doesnt exert any effort to do so. She just plays around and watches television all the
time.
Analysis:
A number of changes take place during the middle ages. At 40, most adults can
function as effectively as they did in their 20s. Many middle- aged adults remain healthy
however; the risk of developing health problems is greater than that of the young adult.
Exercise involves the active contraction and relaxation of muscles. Exercises can be
classified according to the type of muscle contraction whether isotonic, isometric or
isokinetic and according to the source of energy such as aerobic or anaerobic. Walking
and playing golf is included in the isotonic exercises in which the muscle shortens to
produce muscle contraction and active movement. Isotonic exercises increase muscle
tone, mass and strength and maintain joint flexibility and circulation. During isotonic
exercises, both heart rate and cardiac output quicken to increase blood flow to all parts
of the body. Little or no change in blood pressure occurs. Aerobic exercise is the activity
during which the amount of oxygen taken in the body is greater than that used to
perform the activity. This uses large muscle groups, is performed continuously and is
rhythmic in nature and an example of this is walking. (Reference: Fundamentals of
Nursing by Kozier pg.1065)

The Timbreza-Tubadeza Family

J.T.
48 y/o
A and W

J.T.
20 y/o
A and W

M.T.
44 y/o
A and W

J.T.
24 y/o
A and W

J.T.
17 y/o
A and W

F.T.
51 y/o
A and W

M.T
22 y/o
A and W

M.T.
24 y/o
A and W

K.A.T
3 y.o
A and W
Legend:
- Female
-Client
A and
W- alive and well

-male

M.T
30 y/o
A and W

E.T.
50 y/o
A and W

M.T.
20 y/o
A and W

M.T
19 y/o
A and W

M.T
16 y/o
A and W