C.'s mother takes C.e. to an eNT specialist. It is determined that her enlarged tonsils might be contributing
to the frequent throat and ear infections, and a tonsillectomy and adenoidectomy (T&A) is scheduled.
she
is admitted postoperatively for 24-hour observation. After the surgery, the postoperative nurse receives
C.e. in the short-stay unit from the postanesthesia care unit (PACu). C.e. is awake and alert, bilateral breath
sounds are clear, and her oxygen saturation is 98% on room air. she has tolerated sips of clear fluids, and
her parents are with her.
Which of these orders would you expect to see in her postoperative orders? Select all that
apply, and discuss the rationales for each of your choices.
a. Vital signs q4h
b. Clear liquids; advance to regular toddler diet
c. Methylprednisolone (Solu-Medrol) 2.3 mg IV q8h × 3 doses
d. Acetaminophen (Tylenol) 210 mg (15 mg/kg) PO q4h prn for pain
e. Home prescription for amoxicillin (Amoxil) 120 mg PO q8h
f. Maintain peripheral IV with D5½NS at 50 mL/hr; saline lock when taking PO well
g. Aggressively gargle and swish with water after eating or drinking
a, c, d, f
a: You should carefully monitor VS, looking for any changes from baseline.
b: Order is incorrect because once the patient is taking clear liquids, she should be advanced to
a tonsillectomy diet. During the immediate postoperative period, cool, soft foods should be
offered. Avoid milk products because they may cause the patient to clear the throat. Foods such
as Jell-O, warm broth, applesauce, and popsicles are encouraged. The patient can then advance
to an increased variety of soft foods for the next 2 weeks, avoiding foods with sharp edges (e.g.,
chips, crackers).
c, d: On admission to the unit from the PACU, you would expect a corticosteroid to be ordered to
address inflammation and swelling. Pain control is important and should be advanced to PO as
soon as the patient is fully awake and able to tolerate fluids. Use of acetaminophen or ibuprofen
has been shown to give adequate pain control after tonsillectomies.
e: Order should be questioned because the patient has a penicillin allergy. An alternative PO
antibiotic order should be obtained.
f: IV fluids are generally continued at maintenance levels until the patient is taking PO fluids well and
then can be decreased to a maintenance rate or saline lock.
g: Order is incorrect because patients should be protective of the operative site and avoid aggressive
gargling.
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