Following a tonsillectomy, the nurse needs to suspect haemorrhage if:

AIIMS Delhi NO-2016

Medical Surgical Nursing

Easy

Appeared in: AIIMS Delhi NO-2016

Explanation

Frequent swallowing is the earliest and most reliable sign of bleeding after a tonsillectomy.
The mechanism involves blood from the surgical site trickling down the posterior pharynx, which irritates the throat and triggers a constant swallowing reflex.
This subtle sign appears before more obvious and later signs of hemorrhage, such as vomiting blood (hematemesis) or signs of shock.
Early detection of frequent swallowing is critical for prompt intervention to prevent significant blood loss.

Option B: Haemoptysis (coughing up blood) is not the typical presentation. Due to the location of the surgical site, blood is more likely to be swallowed than coughed up. Furthermore, patients are discouraged from coughing as it can dislodge the clot and worsen bleeding.
Option C: Hematemesis (vomiting blood) is a later sign of hemorrhage. It indicates that a significant amount of blood has already been swallowed and has accumulated in the stomach before being vomited.
Option D: Cool and clammy skin is a sign of hypovolemic shock, which is a very late and life-threatening complication of hemorrhage. It signifies that the body has lost a large volume of blood and is failing to compensate.

Clinical Relevance

Nursing practice connection: Knowing Early signs of post-tonsillectomy hemorrhage helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Vigilant monitoring for frequent swallowing is a key nursing responsibility in post-tonsillectomy care, especially in children who may not be able to articulate their symptoms.
Promptly reporting this sign to the surgeon can prevent the progression to severe hemorrhage, airway compromise, and shock.
What if? If the patient with frequent swallowing also becomes restless and has an increased heart rate (tachycardia), the nurse should suspect that bleeding is becoming more significant. The immediate action would be to place the patient on their side, notify the surgeon immediately, and prepare for potential emergency intervention.

How to Approach the Question

Identify the core of the question: It asks for the earliest sign to suspect hemorrhage after a tonsillectomy.
Consider the pathophysiology: After a tonsillectomy, the surgical site is in the oropharynx. Any bleeding will naturally trickle down the back of the throat.
Evaluate each option based on this pathophysiology:
Swallowing: Trickling blood will trigger the swallowing reflex. This is a direct and immediate response.
Coughing (Haemoptysis): Less likely, as the blood is posterior and more likely to be swallowed.
Vomiting (Hematemesis): This requires blood to first be swallowed and accumulate in the stomach, making it a later event.

Concept Tested & Keywords

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