A Nurse is caring for a patient who has just been operated for Tonsillectomy surgery. Which of the following patient complaints indicates heavy bleeding?

Appeared in: PGIMER Chandigarh NO - 2015

Explanation

After a tonsillectomy, the surgical site is in the pharynx, and any bleeding can trickle down the throat.
The body's natural reflex to clear fluid from the throat is to swallow.
Therefore, frequent or continuous swallowing is a reliable and often the earliest sign of active bleeding from the tonsillar beds.
This sign may be present even before other signs of hemorrhage, like changes in vital signs, become apparent.

Option A: Increased blood pressure (hypertension) is not a typical sign of bleeding. While pain or anxiety can temporarily raise BP, significant blood loss (hemorrhage) leads to hypovolemia, which causes a decrease in blood pressure (hypotension), not an increase. Hypotension is a late sign of shock.
Option C: A decreased pulse rate (bradycardia) is the opposite of the body's expected response to bleeding. To compensate for the loss of blood volume, the heart beats faster (tachycardia) to maintain cardiac output and circulate the remaining blood.
Option D: A decreased respiratory rate is not a direct indicator of hemorrhage. In fact, as shock progresses from blood loss, the respiratory rate often increases (tachypnea) as the body tries to compensate for the resulting metabolic acidosis and decreased oxygen delivery.

Clinical Relevance

Nursing practice connection: Use the key finding related to Postoperative Complications to guide bedside assessment, documentation, and the next nursing action.
Recognizing frequent swallowing as a sign of bleeding is critical for patient safety. Post-tonsillectomy hemorrhage can be life-threatening if not identified and managed promptly.
Nurses must educate the patient and family to report frequent swallowing, throat clearing, or the sensation of something trickling down the throat.
A primary nursing responsibility is to maintain airway patency. If bleeding is active, positioning the patient on their side is crucial to prevent aspiration of blood.

How to Approach the Question

First, identify the core of the question: What is an early and specific sign of bleeding after a tonsillectomy?
Consider the location of the surgery: the throat. Think about where blood would go if bleeding occurred. It would go down the pharynx.
Evaluate the body's natural response to fluid in the back of the throat, which is to swallow.
Analyze the options in the context of hemorrhage. Bleeding causes volume loss.
Recall the classic vital sign changes in hypovolemic shock: heart rate increases (tachycardia), and blood pressure eventually decreases (hypotension). This eliminates the options suggesting a decreased pulse or increased BP.
Conclude that frequent swallowing is the most logical and specific early sign among the choices provided.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 113-115

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 51-53

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