Medical Surgical Tonsillitis #2

Question

The nurse is precepting a nurse graduate on the med-surg floor. The nurse graduate begins to suction a post-tonsillectomy client due to excess saliva and mucus in the mouth. Which action by the preceptor is most appropriate?

Answers

  1. Instruct the nurse graduate on the appropriate way to suction.
    • Rationale:

      This answer is not correct because a client who has undergone a tonsillectomy is at risk for hemorrhage. The client should only be suction if there is an airway obstruction.

  2. Allow the nurse graduate to suction the client without assistance.
    • Rationale:

      This answer is not correct because the client should only be suctioned if there is an obstruction in the airway. Post-tonsillectomy clients are at risk of hemorrhage and suctioning can cause this.

  3. The preceptor nurse will suction the client first.
    • Rationale:

      This answer is not correct because of the risk of a postoperative hemorrhage. The client who has undergone a tonsillectomy should only be suctioned if there is an obstruction.

  4. The preceptor nurse will stop the action by the nurse graduate.
    • Rationale:

      This answer is correct because the post-tonsillectomy client should not be suctioned unless there is an airway obstruction. Suctioning can cause a hemorrhage due to the throat’s vascularity or aggravate the operative site. Excess saliva and mucus is normal after throat surgery. Encourage the client to swallow the excess or sip cool, clear liquids to help swallow.

Overview

Suction equipment should be at the bedside of a post-tonsillectomy client. The client who is post-tonsillectomy should only be suctioned, however, if there is an airway obstruction.

Explanation

Learning Outcomes

Suction equipment should be at the bedside of a post-tonsillectomy client. The client who is post-tonsillectomy should only be suctioned if there is an airway obstruction. Suctioning can cause a hemorrhage due to the throat’s vascularity. Suctioning can also loosen the sutures or aggravate the operative site. Excess saliva and mucus is normal after throat surgery. Encourage the client to swallow the excess or sip cool, clear liquids to help swallow. Also placing the client in the prone or side-lying position will facilitate drainage.

Test Taking Tip

Have knowledge of when to and when not to utilize suction equipment on a client.

Video Rationale