Tonsilectomy test question....

[smstar1996]

Hello, i'm an LPN in school for my RN, this test question is driving me crazy......what would you answer. Your caring for a child who just had a tonsilectomy, what would be the first thing the nurse would address?

A. PT c/o pain in hes throat when he swallows.

B. Bright red blood noted in emesis.

C. Child falls asleep during your assesment.

I choose C. b/c even though child may be tired after surgery, I think it would be unusual for PT to fall asleep DURING assesment. also, how do you know they fell asleep??? ABC's of nursing right? Many other students chose B. d/t s/s of hemorage.

OK then I must be wrong. The question staes what is the FIRST thing to address. Now clearly you would address all three issues. But I thaught one can't asume one is sleeping, couldn't this be a possible Airway issue? So if PT falls asleep during your assesment, wouldn't you check to make sure it's nothing more serious and that PT actualy did fall asleep. So confused b/c I know bleeding is important to.

[ChristineN, BSN, RN]

I think I would go with B, the fact that it specifies "bright red bleeding" makes me want to investigate further. Although, A tempts me, since with Tonsilectomies frequent swallowing can be a sign of hemmorhage.

[Crux1024]

B. All the way..

Bright red blood would make you want to call the surgeon..The other two, not soo much. There will be pain when he swallows for a little while that is normal and kids can sleep/fall asleep through anything, so that wouldnt be a huge warning sign either.

[leslie :-D]

i'm going with b, although i'd be very concerned with excess bleeding.

the question doesn't say how much blood.

spotting is ok but needs monitoring.

leslie

[Crocuta, RN]

B, most certainly. Pain while swallowing is a normal finding following this surgery, and it's really not that unusual for post surgical patients to fall asleep while you're talking to them.

Bleeding is a possible Airway issue, and needs to be addressed.

[Ivanna_Nurse, BSN, RN]

I say B also. Pain and drowsiness are normal occurrences with this type of surgery. ~Ivanna

[CRNA2007]

You are reading way too much into the answers the child is sleeping thats all. Not apneic and is sleeping, just sleeping (good pain control). B is your obvious choice as this is an arterial bleed and the patient might need immediate surgical intervention to cauterize the bleeding.

[chenoaspirit, ASN, RN]

Yep...B

Drowsiness is common immediately after surgery.

Pain is normal finding s/p tonsillectomy due to nature of the surgery.

Bright red blood in emesis means bleeding is occuring and warrants further investigation. That can compromise airway and decrease in H&H.

[Lorie P.]

answer would be b- bright red blood indicates active bleeding and airway complications so there are the abc's we are taught to use !

a- naturally sore after surgery

c- falling alseep is noraml after being sedated from surgery, plus the pain meds could cause drowzynes.

at least these are my thouoghts on how to answer.

but now that i have researched my suanders rn review and the section on tonsillectomy, the following is listed

interventions postoperatively'

1. postion prone or side-lying to facilitate drainage.

2. have suction equipment available, but do not suction unless airway is obstructed.

3. monitor for signs of hemorrhage ( frequent swallowing may indicate hemorrhaging)

10 . instruct parents to notify physician if bleeding, persistent earache, or fever occurs.

list 11 interventions to do.

so now i would have to say a, don't you just love nursing exams?!!:banghead:

goes all the way to 11 interventions.

[Lorie P.]

answer b!

after i posted my previous reply and re-read the whole question and answers again.

got carried away with my research and forgot what the a answer was.

i'm tired, time for bed, nope more all nurse's cause i am addicted!

[chenoaspirit, ASN, RN]

Well, it doesnt say "frequent swallowing". It says PAIN when swallowing...big difference. You have to read EVERY word. I soooooo dont miss nursing exams!

[romantic, BSN, RN]

"PT c/o pain in hes throat when he swallows."

The question doesn't state that the child swallows constantly, but says that there is a pain when child swallows--it's about having a pain, not about how often the pt swallows.And pain is an expected symptom after tonsillectomy.