A child in postoperative ward under observation after tonsillectomy is suspected to have postoperative hemorrhage when the child?

1. A

   Snores noisily

2. B

   Pale skin

3. C

   Complains of thirst

4. D

   Swallows frequently

Appeared in: BHU NO - 2015

Explanation

• Frequent swallowing is a classic and early sign of bleeding after a tonsillectomy.
• This occurs because blood from the surgical site trickles down the back of the throat, stimulating the swallowing reflex as the child tries to clear it.
• Observing this sign allows for the earliest possible detection of hemorrhage, before more severe signs like tachycardia or pallor appear.
• Other associated signs may include restlessness, frequent throat-clearing, or vomiting of bright red or dark brown blood.

Why Other Options Were Wrong

• Option A: Snoring is a common finding after tonsillectomy due to inflammation and edema (swelling) of the airway tissues. It is not a specific sign of hemorrhage.
• Option B: Pale skin (pallor) is a sign of decreased tissue perfusion due to significant blood loss (hypovolemia). It is a systemic and late sign of hemorrhage, not an early one.
• Option C: Complaining of thirst is a non-specific symptom. It is common in postoperative patients due to pre-operative NPO (nothing by mouth) status, dehydration, or the drying effects of anesthetic agents.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of early signs of post-tonsillectomy hemorrhage in a pediatric patient as background academic context rather than a clinical decision trigger.
• Prompt recognition of frequent swallowing as a sign of hemorrhage is a critical nursing responsibility that allows for early intervention to prevent airway compromise and hypovolemic shock.
• Post-tonsillectomy hemorrhage is a medical emergency. The nurse's primary role is vigilant monitoring and immediate reporting of suspicious signs to the surgeon.
• Patient and family education is vital, as delayed hemorrhage can occur up to 10 days after surgery. Families must be taught to watch for frequent swallowing, spitting blood, or restlessness.

How to Approach the Question

• First, identify the core clinical scenario: a child in the postoperative period after a tonsillectomy.
• Next, focus on the specific complication mentioned: postoperative hemorrhage. The question is asking for an early sign.
• Consider the anatomy. The tonsils are in the oropharynx. If bleeding occurs here, the blood will trickle down the throat.
• Evaluate each option based on this pathophysiology. The body's natural reflex to clear fluid from the back of the throat is to swallow. Therefore, frequent swallowing is a direct consequence of bleeding.
• Differentiate between early and late signs. Pallor is a systemic sign of significant blood loss, which takes time to develop, making it a late sign.
• Eliminate non-specific options. Snoring (due to edema) and thirst (due to NPO status/anesthesia) are common postoperatively and not specific to bleeding. This leaves frequent swallowing as the most reliable and earliest indicator.

Concept Tested & Keywords

• Concept Tested: Recognition of early signs of post-tonsillectomy hemorrhage in a pediatric patient.
• Stem keywords: child, postoperative, tonsillectomy, postoperative hemorrhage
• Lead-in keywords: suspected to have
• Clinical cues: The patient is a child, which requires specific considerations for assessment and communication.
• Clinical cues: The setting is a postoperative ward, indicating a need for close monitoring for immediate complications.

Question ID

Qe_829E2UR-gLNFJTm_X7t

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 37-39

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 351-353