Tonsillectomy: surgical procedure and clinical considerations

Tonsil Problems

Surgery is a traumatic and often dangerous event. While tonsillectomies are somewhat common in the history of surgical procedures, it is necessary to investigate the problems of Amy as listed in the case study following a post operative procedure in which her tonsils were removed. In order to determine the patient's pathophysiology it is necessary to identify the problematic or typical physiological processes that are occurring with the patient.

The first step in discussing this problem should identify any problems or situations that are out of the normal set of circumstances for a tonsillectomy. Most of these types of surgeries are simple and require little to no healing time and prescriptions to finish the process. Here in Amy's case however, there seems to be a definite problem. The main problems deals with the patient's mental state and her fear of not healing. This fear has no doubt complicated her body's ability to recoup from such trauma and is leading here immune system down the wrong path. No matter what efforts are provided for by allopathic means, the mental approach by the patient remains the most important physiological indicator of her condition.

Hemorrhaging is common after such procedures and should not be cause for alarm but poses unique circumstances. Mosges et al. (2011) argued that "According to recent statistics presented by German university hospitals, approximately every 25th patient undergoing a tonsillectomy in these hospitals providing maximal medical care must reckon with postoperative hemorrhage (requiring reoperation) (from 1.0 to 9.7%, median 3.8%). There is still no generally accepted definition of the term hemorrhage with regard to post-tonsillectomy hemorrhage available. Different authors may use varying definitions of hemorrhage depending on their technique used for assessing hemorrhage, e.g. macroscopic evaluation or by microscope. Some publications focused solely on the need to return to theater, meaning hemorrhage requiring reoperation, whereas other studies recorded all postoperative hemorrhages. The discrepancies in definitions of secondary bleeding led to a big variation in figures stated in various publications. Thus, bleeding rate percentages have to be interpreted carefully."

The post-operative state that Amy has found herself in has demonstrated her loss of cognitive capabilities. Amy is in much pain and is most likely very thirsty as her throat is inflamed with injury. The main consideration is that empirical evidence can give no clear cut clues on her exact condition due to the multitude of events that serve to confuse both the mind and body after such a surgery.

Question 2

The Postanaesthesia Care Unit (PACU) discharge criteria is useful in many ways and provides some important means to identify and eventually treat any problems that may be experienced after such events where anesthesia has been administered. A modified Aldrete Score can help model the patient's condition and in order to effectively judge the potency and healing capabilities of the treatment and allow the patient to recover in a state of ideal health where the repercussions of the medicine do not linger and cause confusion leading to other health problems that can worsen over time.

The "Activity" component of the PACU focuses on the ability for the patient to move spontaneously or on command. It is very simple and lacks specific detail. The criteria only seeks to judge the movement of extremities and not other parts of the body which may provide telling information that can lead to the healing of the patient. This criteria seems somewhat vague and not enough detail is included to provide a useful criteria in judgment. It is important to remember that the trauma inflicted during the surgery may have serious aftereffects intensifying the reactions to the anesthesia. Aukburg et al. (1989) agreed when they wrote " The duration and severity of post anesthetic risk are dependent on the patient's original condition, nature of the surgical procedure, length of the procedure, drugs used, blood and other vital fluid loss and individual patient responses. During the immediate postoperative period, patients are particularly at risk for adverse circulatory and respiratory events."

Overall the form is well laid out and represents a useful and practical manner in judging the effects of the treatment given before, during and after surgery. The most important aspect towards this form is that the evaluator, who is usually the nurse, can decide the appropriate actions to take when determining the effects of how anesthesia impacted the patient. During this time the patient is at their most vulnerable state and their lives are in the hands of the nursing professionals.

It is important to understand that in surgeries as simple as a tonsillectomy many things can go wrong. Hospitals are very dangerous environments, where success is not achieved as often as people would like to believe. Many times patients become sicker when entering hospitals. "Nearly 1 in every 10 patients admitted to a hospital will undergo an adverse event.[1] The consequences of these events range from temporary disability to death. Ever since this fact has been recognized, many studies have attempted to shed light on the incidence, nature, causes and consequences of adverse event and medical errors. Recently, the use of a checklist in the operating room was shown to be associated with a significant decrease in postoperative complication and mortality rates. However, several studies have shown that the majority of surgical errors occur outside of the operating room," (DeVries, et al. 2011).

The form provides the nurse an ability to rate specific areas of interest that would indicate a problem has occurred from the application of the anesthesia. The form is simple and allows for the easy transmission of information due to the clear and concise nature of the form. The form is divided into four areas of assessment the measure important elements of the healing processes that occur within the human body after such trauma has been inflicted on the patient.

The "Respiration" area of assessment has the necessary components to properly evaluate the patient in a satisfactory way. Measuring breathing is not as complicated as other monitoring efforts and the criteria in listed in this scorecard is sufficient. The "Circulation" area of assessment is also very practical and provides a useful and standardized means of determining the cardiopulmonary strength of the patient in a post operative environment. Using a blood pressure diagnostic to determine the value of this assessment is used and is satisfactory in its attempt. This fundamental tests allows to evaluator to measure the internal aspects of the patient as they recover from the surgery. The scales of acceptability are perhaps a little vague and can be improved upon by providing more detailed information regarding the BP readings and how they can be incorporated into a more complete summation of the patient's problems. The "Consciousness" area of scoring is quite ambiguous in many ways, but does provide the minimum information for nurses to complete their assessment on the patient. Measuring this aspect of health is often tricky and places much of the judgment in the view of the evaluator. There becomes not substitute for experiences and the more practice nurses have in this clinical skill the better professionals they will most likely become. This area could be improved by placing more detail in this scorecard to provide with a better summation of the events.