While monitoring a child after tonsillectomy, the nurse observes him swallowing frequently. This indicates th… - SCTIMST Staff Nurse - 2015 (Set-A)

SCTIMST Staff Nurse - 2015 (Set-A)

Child Health Nursing (Pediatrics)

Easy

Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)

Explanation

Frequent swallowing is the most common and often the earliest sign of bleeding after a tonsillectomy.
The child is reflexively swallowing blood that is trickling down the back of the throat from the surgical site.
This sign is considered a clinical emergency because hemorrhage can lead to airway obstruction and significant blood loss (hypovolemia).
Other signs of bleeding include restlessness, increased pulse rate (tachycardia), pallor, and vomiting of bright red or coffee-ground colored blood.

Option A: A child who is simply thirsty would likely ask for a drink or show other signs of thirst, rather than the specific, repetitive action of swallowing to clear the throat.
Option B: Recovery from anesthesia typically involves increasing alertness, drowsiness, or sometimes nausea. It does not characteristically cause frequent, repetitive swallowing.
Option D: Pain after a tonsillectomy (odynophagia) makes swallowing very painful. A child in pain is more likely to avoid swallowing, refuse fluids, and may be observed drooling to avoid the painful act of swallowing.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Recognition of post-operative complications, specifically post-tonsillectomy hemorrhage in a pediatric patient in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Recognizing frequent swallowing as a sign of hemorrhage is a critical nursing responsibility. Failure to act can lead to airway compromise, aspiration of blood, and hypovolemic shock.
Post-tonsillectomy hemorrhage is a surgical emergency. The nurse's primary role is immediate assessment, notification of the surgical team, and ensuring patient safety by positioning to prevent aspiration.
What if? If the child with frequent swallowing also becomes restless and their heart rate increases from 100 to 130 bpm, it indicates more significant blood loss and progression towards shock, requiring even more urgent intervention.

How to Approach the Question

First, identify the core elements of the clinical scenario: a pediatric patient, a recent tonsillectomy, and a specific assessment finding (frequent swallowing).
Next, consider the most common and life-threatening complications associated with a tonsillectomy. Hemorrhage is the primary concern.
Analyze the specific sign: 'swallowing frequently'. Ask yourself what would cause a child to do this. It implies something is accumulating in the back of the throat that needs to be cleared.
Evaluate each option against this analysis. Does thirst, anesthesia recovery, or pain cause frequent swallowing? Or does bleeding?
Rule out the distractors. Pain would cause the opposite (avoiding swallowing). Thirst and anesthesia recovery don't fit the specific sign.
Conclude that frequent swallowing is the body's attempt to manage accumulating blood, making 'Bleeding' the most logical and critical answer.

Concept Tested & Keywords

Concept Tested: Recognition of post-operative complications, specifically post-tonsillectomy hemorrhage in a pediatric patient.
Stem keywords: child, tonsillectomy, monitoring, swallowing frequently
Lead-in keywords: indicates
Clinical cues: The key clinical cue is 'swallowing frequently' in the context of a recent 'tonsillectomy', which points towards a specific, life-threatening complication.

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