A child who underwent a tonsillectomy and adenoidectomy is being prepared for discharge. What is the most critical sign of a potential complication that the nurse must instruct the parents to watch for and report immediately?

1. A

   Low-grade fever of 99.5°F (37.5°C)

2. B

   Complaints of a sore throat

3. C

   Presence of white patches in the throat

4. D

   Frequent or continuous swallowing

Appeared in: NORCET -9 Prelims

Explanation

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• Frequent or continuous swallowing is a primary and often subtle sign of bleeding from the surgical site.
• The child is attempting to clear blood that is trickling down the back of the throat, which can mask the severity of the hemorrhage.
• Post-tonsillectomy hemorrhage is a medical emergency that can lead to airway compromise and hypovolemic shock if not treated immediately.
• Other signs of bleeding include restlessness, increased heart rate, pallor, or vomiting of bright red or 'coffee-ground' emesis.

Why Other Options Were Wrong

• Option A: A low-grade fever is a common and expected finding after surgery due to the body's inflammatory response. It is not considered a critical or life-threatening sign.
• Option B: A sore throat is an expected and unavoidable consequence of having the tonsils surgically removed. While it causes discomfort, it is a normal symptom, not a sign of a critical complication.
• Option C: The presence of white or yellowish patches in the throat is a normal part of the healing process. These are scabs (composed of fibrin) that form over the surgical sites and typically fall off within 5 to 10 days.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Post-operative complications of tonsillectomy and adenoidectomy in acute care settings.
• The nurse's primary role in discharge teaching is to empower parents to recognize subtle but life-threatening signs of hemorrhage, as this is the most critical post-operative risk.
• Parents should be instructed to immediately report any signs of bleeding, including frequent swallowing, throat clearing, or vomiting blood, to their healthcare provider or go to the nearest emergency department.
• It is vital to educate that bleeding can be delayed, often occurring 5-10 days post-operatively when the scabs dislodge. This is not a 'safe' period.

How to Approach the Question

• First, identify the keywords in the question: "child," "tonsillectomy," "discharge," and especially "most critical sign."
• The phrase "most critical" directs you to prioritize the options based on life-threat. You are looking for the sign that indicates the most dangerous potential outcome.
• Evaluate each option's severity. Is it a normal/expected finding, a minor issue, or a sign of a medical emergency?
• Recall or deduce the most severe complication after a tonsillectomy, which is hemorrhage (bleeding).
• Analyze how each option relates to hemorrhage. A low-grade fever, sore throat, and white patches are expected parts of recovery.
• Recognize that frequent swallowing is a classic, textbook sign of concealed bleeding in the throat, making it the most critical sign to report.

Concept Tested & Keywords

• Concept Tested: Post-operative complications of tonsillectomy and adenoidectomy
• Stem keywords: tonsillectomy, adenoidectomy, discharge, complication, critical sign
• Lead-in keywords: most critical
• Clinical cues: Child post-tonsillectomy
• Clinical cues: Discharge instructions

Question ID

Q4p3x0qIFKmSarYNpd9zTk

Copy ID

Reference Book

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