Adolescent Mental Health Disorders

South Louisiana Community College HNUR 2055 Section 2 Peds Review Guide 1. Adolescent mental health disorders A. Bipolar Disorder - Characterized by alternating mania and depression or rapid cycling of mood - May experience grandiose thought, pressured speech, extreme irritability, emotionally, distractibility, and high levels of activity, often at bedtime - Treatment: Lithium Carbonate - Therapeutic level of lithium: 1-1.2 for initial treatment; 0.5-0.8 for maintenance - Common side effects of lithium: fatigue, headache, impaired memory, ataxia, abdominal pain, dry mouth, and tremors - Takes 5-7 days for therapeutic effects to start B. Persistent Depressive Disorder - With periods of major depression and normal mood lasting several days or weeks - May be presented with pre-existing disorders such as somatization disorder, anxiety disorder or anorexia nervosa - May appear passive, dependent and lonely, or aggressive, angry and negative - Treatment: Antidepressants C. Depression - Not a state of sadness but a serious medical illness that affects young children and teens - Incidence in children is increasing - Imperative for the nurse to identify symptoms, assist with a fl formal assessment, and secure treatment - Unknown cause but associated with an imbalance in brain chemistry, another illness, substance use disorder, or environmental in uences; stressful events; hereditary link - Early treatment may help avoid depression from getting worse, extending for a long period of time, or becoming a lifetime challenge - Diagnosis: symptoms are present nearly every day for 2 weeks or longer - S/S * Hopeless, Sad, or Angry * Demonstrates a loss of interest in activities usually enjoyed * Physical symptoms ( fatigue, sleep disturbances, appetite disturbances, muscle aches, and headaches * Frequent crying spells - Evaluating depression *Poor Hygiene, stop communicating with friends and family, lose interest in teen life activities; suicidal thoughts - Intervention for Depression * Counseling * Antidepressants to help balance the natural chemicals in the brain * Psychotherapy * Serum levels of psychiatric drugs for select drugs * Herbal remedies ( St. John’s Wart - not recommend for Peds * Sunscreen while taking psychotherapeutic medications D. Suicide in childhood: * Suicide is death by taking one’s own life * Second leading cause of life for children, adolescents, and young adults ages 5 to 24 years * Three main causes of death by suicide: 1. Gunshot; Strangulation, Suffocation, or hanging; Poisoning * Any threats of suicide must be taken seriously!!! * Interventions 1. Transport the child to an in-patient hospital or psychiatric unit 2. Initial treatment will include medications * Nursing Considerations 1. Provide immediate stabilization and hospitalization with round the clock observation 2. Medications for depression 3. Contact both Child Protective Services and the law enforcement dept. 4. Search child’s home for weapons, drugs, and access to medications 5. Nursing care based on trauma, poison ingestion, and ensuring evaluation by a child mental heath specialist E. Non-suicide self injury ( NSSI) - Injuries that are not accompanied by suicidal ideation or intent, but to cope up with anxiety - NSSI Behaviors * Burning * Cutting * Excessive rubbing to the point of skin excoriation * Stabbing with various objects F. Schizophrenia - A chronic, severe, and disabling psychiatric disorder characterized by delusion, hallucination, and disrupted thought disorder - Characteristics fi * Chaotic state with paranoid delusions; Hebephrenia ( inappropriate silliness or behavior); Altering Moods; Aggressive behaviors; Social withdrawals - Interventions * Tx is lifelong; Neuroleptic medications to manage symptoms such as hallucinations and psychotic delusions * Neuroleptic medications have serious side effects the nurse monitor for like tar dive dyskinesia ( involuntary twisting of faces, limbs, and trunk) and neurleptic malignant syndrome G. Substance Abuse - Tobacco, Marijuana, Alcohol, Stimulants, Hallucinogens, Steroids, Inhalants, Prescription drugs, Opioids, Cocaine, “Club drugs” - Children at risk * Living in homes where substance use disorder occurs * Experiencing depression * Do not feel valued by their parents - Assess for signs of alcohol and substance use disorder in children and teens * Worsening academic performance * Problems with relationships at home * Social isolation * Presence of a family member who has or has had addiction problems ( the condition of compulsively seeking and using a substance despite harmful consequences ) - Parents need to rst acknowledge that the child has a substance use disorder and seek information, help, and treatment for their child - Interventions * Medications ( Naltrexone, Bupropion, Methadone) * Psychotherapy * Behavior modi cation * Cognitive behavioral therapy * 12-step program * Peer Group therapy - Nursing Considerations * Teach parents to keep narcotics and other medications away from children’s reach and sight * Inform parents on organizations that provide education and support for families who have a child with substance use disorder 2. Freud’s stages (know preschool, school age, and adolescent) A. Preschool: Phalliac phase - Finds sexual identity by exploring the genitalia and masturbating B. School Age: Sexual Latency - A time when sexual desires are lessened - Sexual drives are dormant or hidden (latent) white the school-aged child focuses attention on schoolwork, hobbies, friends and expanding socialization and independence C. Adolescent: Genital Stage - Engage in masturbation and sexual relations fi fl 3. Anticipatory guidance for adolescent - Prevent injuries, disease, and illness ( most causes of deaths are due to injuries, self harm, and high risk behaviors ) - Topics for anticipatory guidance: A. Dental Health: Brush their teeth at least twice a day and oss once a day. Dental visits should continue annually. B. Hearing: Teach families to be aware of the danger of developing cochlear damage from sustained loud music C. Posture: The inverse relationship between rapid skeletal growth and slower muscular growth, many adolescents demonstrate poor posture “slumping” while seated. Rule out scoliosis D. Preventing motor vehicle accidents: Wearing a seatbelt while driving or riding; Riding with underage drivers or allowing more riders in a car than there are seatbelts E. Tanning and sun exposure: Use sunscreen and glasses F. Social Isolation: Provide opportunities for teens to interact in group such as clubs, sports, and youth groups is imperative for healthy social and emotional development fi 4. Erikson’s developmental stages (know preschool, school age, and adolescent) A. Preschool: Initiative vs. Guilt - Child must master the process of initiating activities that are independent and self-directed; lack of opportunity may make the child reluctant to try new processes - Support the child in the attempts; frequent blame or negativity during skill exploration can cause feelings of guilt and decreased feelings of worth B. School Age: Industry vs Inferiority - Look for situations and opportunities that allow a school aged child to feel as though they have cooperated with contributed to and accomplished important responsibilities and task C. Adolescent: Identity vs Role Confusion - Form own self of identity - Develop con dence in their self identity and self esteem fi 6. Types of play (preschooler vs school age) A. Preschooler: Associative play - Interact and engage in a common activity with loose organization and rules - Are willing to exchange materials, although with hesitation, until each child is nished with the ones he or she is playing with - May attempt to control or limit participation - Encourage associative play and provide opportunity for quiet play that is creative, manipulative, constructive, and educational in nature - Ex: Play kitchens, Construction jobs, Automobile play kits, Tool chests, Medical and Nursing Kits - Offer no more than one repetition of a project per year of age ( Ex: Decorating 3 holiday cards or coloring three eggs) B. School Age: - Family games - Competitive team play (same-sex teams; soccer, basketball, swimming) - Helps develop sense of belonging, cooperation, and fi fl 5. Celiac disease - Gluten Intolerance is the inability to tolerate or fully digest foods that contain rye, wheat, oat, and barely glutens; causes atrophy of small intestine villi ( decrease intestinal absorption - S/S * Wt loss, foul smelling stools ( steatorrhea), and increased atulence - Treatment * Diet modi cations ( gluten - free diet ) 7. Neurovascular checks in r/t fractures- normal vs abnormal - Circulation: should be assess by pressing on the skin and observing for capillary re ll time. Should be brisk in a healthy child w/o preexisting cardiovascular disease - Color: Look for deviation such as pale or blue skin - Sensation: Assess by asking if child is experiencing any abnormal feelings of buzzing, burning, or tingling ( May indicate nerve regeneration or nerve damage) - Movement: Assess by asking the child to wiggle toes or ngers or move the extremity below the site of injury - Touch: Assess by asking the child if they can feel the presence of the caregiver’s ngers on the skin below the site of the injury - Use the 5 Ps to ensure that the injured site is receiving adequate perfusion and is not ischemic * Pain, Pallor, Pulselessness, Paresthesia, Paralysis fi 8. Health promotion for the preschooler - Assess the child’s growth and his or her mastery of developmental milestones with the HCP - Participate in recommended health screenings: * BP * Vision * Hearing * BMI * Hgb/Hct fi fi compromise - Develop “true” friendships ( Best friend; code words) - Enhances development of morality (Cheating may continue even when they learn the rule) * Lead * Tuberculosis, if at risk * Cholesterol, if at risk caused by obesity or other disease states - Administer scheduled immunizations 9. Conjunctivitis - In ammation of the conjunctive; “pink eye” - TX:- antibiotic eye drops if bacterial - Highly contagious - Nursing Considerations * Prevent the spread of bacterial infection * Teach how to cleanse the purulent drainage with warm moist cloth * Proper handwashing and a “no touch” rule * Proper eye drops instillation ( medicine bottle should never touch eye) Ointment - apply inner corner to outer lower eyelid 10.Box 20.1- review this box - There are Three components of pre conceptual thinking: * Arti cialism: The preschooler believes that everything is made by humans * Animism: The preschooler believes that inanimate objects are alive * Imminent justice: A belief that everything has a determined universal code of law and oder fi fl 11.Rheumatic fever - Systemic disease involving the joints, heart, CNS, skin, and subcutaneous tissues - Affects children ages 6-12 years most commonly - Autoimmune disease * Complication of untreated group A beta strep of throat * Destruction of connective tissue * Detrimental to the heart ( Scarring of mitral valve ) - Tx: Prevent heart damage, antibacterial treatment ( PCN or erythromycin), rest, pain/fever relief, management of heart failure 12.Immunizations for the preschool, school age, and adolescent- these are located in colored fl fl boxes in each chapter A. Preschool - DTAP ( Diphtheria, Tetanus, and Pertussis) - IPV ( Inactivated Polio vaccine) - MMR ( Measles, Mumps, and Rubella) - Varicella ( Chick Pox) B. School Age Boosters - TDAP - MMR - HPV - Meningococcal group B - Annual In uenza C. Adolescent - TDAP - MPSV4 - MMR ( if second dose wasn’t given earlier ) - HPV ( Initial dose will need to be followed with two or more doses at 2 months and 6 months) - Hep B - Hep A - Annual in uenza 13.Ringworm treatment and signs and symptoms - Characterized bt ring shaped, red, scaly patches with clear centers -Several types: - Tinea capitis: Scalp and hair ( patchy hair loss with an area of scalding on the scalp) - Tinea pedis: athletes foot ( Intense itching between the child’s toes with a characteristic erythematous rash that may include painful ssures that weep) - Tinea curries: jock itch (After sweating, itching in the child’s groin skin folds with a characteristic red rash) - Tinea corporis: Groin, extremities, and trunk ( Cutaneous lesions that are ring-shaped and can be found as one lesion or many; characteristics are annular, scaling, erythematous, sharply marginated, indurated lesions with hyperkeratotic borders. The center of the ring may be clear or pink, and the ring of the rash may consist of vesicles ) fi 14.Fractures - Any injury directly to bone material - Most common fractures in childhood include: * Clavicular ( collarbone) * Greenstick fracture ( Bone is bent) - Types of fractures * Transverse- Line crosses the shaft at a 90-degree angle * Spiral - A diagonal line coils around the bone; caused by a twisting force * Oblique- A diagonal line across the bone * Greenstick- Bone is bent but not broken; more common children * Comminuted- Three or more fracture fragments * Compression- Bone becomes wider and atter; usually seen in the spine 15.Normal growth and development for preschool, fi fl school age, and adolescent A. Preschooler ( 3-5 y.o) - Gains 5 pounds per year - Grows 2.5 to 3 inch per year in height - All primary teeth have erupted and begin to shed at the end of the preschooler period - Vital signs * HR: 65 to 110bpm * RR: 20 to 25 breaths/min * BP 95 to 110 over 60 to 75 Visual acuity matures * 20/40 by their 3rd birthday * 20/30 by their 4th birthday * Visual disturbances such as nearsightedness (myopia) and double vision ( amblyopia) present during the early preschool period - Hearing acuity is 100% intact with no expected de cits - The child will accomplish new, independent tasks and will want to showcase these accomplishments to parents, caregivers, and nurses - Provide praise when attempting a new accomplishment, whether or not the child masters it ( Ex: attempts to tie shoes) - Food consumption is about 1200 to 1600 cal/day - Need 12 hours of uninterrupted sleep B. School Age ( 6 to 12 y.o) - Weight gain: 4-6.6lbs per year fi - Average height increase is 2 in per year - More graceful movements and steadier on the feet - Physical activities more comfortable to perform - Becomes taller and thinner - Muscle tissue replaces fat - Decrease growth in head circumference - Increase in leg length growth - Body systems more mature and functional - Less snacking and less prompt feeding times - Total caloric requirements decreases - Bladder capacity variable - Immune system functions ef ciency - Bone and muscle tissue continue to mature - Need 10 - 12 hours of sleep C. Adolescence ( 13 -18 y.o) - Rapid physical growth and emotional maturity - Open communication is important, but teens do not “ Open up” - a bond needs to form - Increasingly diverse in culture, ethnicity, language, education level, spirituality, sexuality, and gender identity - Girls * weight gain: 15 to 55lbs * height increase: 1-3 inches per year * Growth spurt begins at 10 y.o and ends at 16 y.o. - Boys * weight gain: 15 to 65lbs * Height: 2-4 inches per year * Growth spurt begins at 13 y.o and ends at Late teens - V/S: By 18 years of age, VS are comparable to those adults 16.Egocentrism- de ne 17.Precocious puberty- define - Puberty that begins before age 8 for girls and age 9 for boys - Symptoms * Girls: Breast growth and rst period * Boys: Enlarged testicles and penis, facial hair, and voice deepening * Girls/ Boys: Pubic and underarm hair, early rapid growth, adult body odor, and acne TX: Puberty blockers fi fi fi fi 18.Nephrotic syndrome - Development of pores along nal ltration membrane of kidney and subsequent loss of serum proteins; cause unknown - Cardinal symptoms: * Severe proteinuria * Severe hypoproteinemia (aka hypalbuminemia) * Hyperlipidemia ( increased serum total cholesterol, triglycerides, and total lipids) * Edema - Diagnosing nephrotic syndrome/nephrosis * Nurse should report s/s to pediatrician - Interventions * Daily weights * Fluid restrictions and manage HTN * IV corticosteroids * Low salt, high protein - Nursing Considerations * Monitor v/s daily, daily was * Teach y to report s/s of relapse after d/c ( frothy, goldencolored urine) * Monitor for complications 19.School-age child preferred peer groups - Family, Friends, and school 20.Epilepsy - Disruption of the electrical communication - Epilepsy: Recurrent seizures - Loss of consciousness, abnormal motor movements, behavioral abnormalities, autonomic dysfunction, and sensory disturbances - Cause of seizure disorder is unknown - Interventions: * Secure safe environment; some children may need helments * Maintain seizure precautions in the hospital setting * Don’t stop or control movements or insert anything in mouth * Should wear a medical alert bracelet * Adherence to medications is important - Special considerations : * Record seizure activity * Ketogenic diet * Anticonvulsant therapy fl 21.Traumatic brain injury - Occurs across the lifespan - Those who participate in contact sports and unsafe physical activities are prone to head injuries - Types: * Concussion: Associated with transient loss of consciousness * Contusion: Localized bruising of the brain to one area - Tx: Depends on seriousness - Monitor for s/s of increased ICP 22.Adolescent sex education - Information to protect themselves from pregnancy and STIs - Nurses may nd teen is more comfortable speaking to them than a family member fi 23.Appendicitis complications and signs/symptoms - Infection of the small lymphoid tissue called the vermiform appendix * Can lead to rupture/perforation= risk for sepsis and peritonitis - Average onset= 10 years; most common cause of emergency abdominal sx - If suspected, no deep palpation should be done - S/S * Lower right - quad pain * N/V * Chills * Fever * Elevated WBC * Positive ultrasound - A sudden stop of persistent pain should be reported immediately = may mean perforation or rupture has occurred - Tx: Surgery for appendectomy - Keep child NPO and in semi-Fowler’s position for comfort - Nursing care for Postoperative child w/ rupture vs w/o rupture will be different * Without rupture, the child should follow an uncomplicated postoperative period with early ambulation and restoration of oral uids with a rapidly progressive diet * With rupture, Children may require days of antibiotics, experience much more pain, and resume ambulation later fl 24.ASD- autism spectrum disorder - A pervasive developmental disorder - Includes conditions such as: Rett’s syndrome, Asperger’s syndrome - No known cause - Exists from birth, with early symptoms noted in late infancy, and consistently develops before the child is 30 months of age - Contributing factors; genetics, irregular brain regions, environment - Characteristics * Pervasive and severe impairment in the child’s communication skills and social interactions * May be accompanied by repetitive and restrictive behaviors ( Echolalia) * The child will not relate comfortably with others - Evaluating autism * Minimal interaction with others; may not respond to own * A desire for very limited touching, cuddling, or molding * Minimal display of anticipatory behaviors * Lack of anxiety in a young child when separated from the parent * Uses peripheral vision and avoids direct eye contact * Minimal meaningful speech and echolalia * Pronoun reversal and nonsensical rhyming * Appearance of being deaf but without a hearing impairment * Abnormal responses to stimuli and lack of focus * Socially awkward or unacceptable behaviors and repetitive, rhythmic motions * Distress and resistance to changes in daily routines * Marked need for sameness and attachment to objects - Interventions for autism * No treatment cures * Combination of therapies ( speech) * Pharmacotherapy if anxiety, depression, or OCD symptoms are present - Nursing Considerations * One on one care with child * Give directions without rationales * Minimize touch * Provide calm and non stimulating environment * Be very supportive and empathetic to the parents 25.Impetigo - Infectious disease of skin cause by staph or group A strep - Gets into a “break” in skin - Reddened vesicles ooze a sticky, honey colored crust on face/hands - Highly contagious - Newborn susceptible because resistance to skin bacteria is low - Spreads from one area to another - TX * Antibiotics/Topical ointments like bactroban - Essential handwashing and washing of linens and bedding - Avoid scratching areas 26.Sickle cell anemia - Children have abnormal sickle -shaped hemoglobin S causing pain and fatigue - Crisis, or episodes, can be life threatening - Sickledex to screen for the presence of HbS - Tx: Pain control, hydration, oxygenation, rest, and antibodies if febrile or to prevent infection 27.Drownings/near drownings - Toddler period and during later adolescence - Drowning: when the chid dies within 24 hours after submersion - Near drowning: If the child lives beyond the 24 hours and recovers or dies - CPR should start at the scene, ventilation support, restoration of cardiac rhythm, correction of hypercapnia/ hypoxia, correction of shock, and IV uid administration - Nursing considerations: provide family support who will be in great distress and emotional shock; make referrals fl fi 28.ADHD - Neurobehavioral psychiatric disorder - Must exhibit 6 out of 9 signs and symptoms and symptoms mustbe present for at least 6 months or longer, occur in two settings, and be present before their 12th birthday: * Fidgets with ngers, hands, objects * Often leaves his or her seat in the classroom when expectations are to stay seated * Experiences forgetfulness at school with homework assignments, and at home with daily activities * Becomes easily distracted and excited when distracted * Seems not to listen and does not follow through with expectations * Talks excessively and blurts out answers * Interrupts, intrudes on others, and does not wait for a turn * Cannot pay attention to detail and makes frequent careless mistakes * Has dif culty playing quietly and has problems with focusing - Tx: Combination of therapies; medications ( amphetamine) Adderall, methylphenidate ( Ritalin ) - Nurses must assess for side effect of psychostimulant therapy fi 29.Anorexia vs bulimia A. Anorexia Nervosa - Unknown cause - Diagnostic criteria: * Voluntarily refuses to maintain a normal body weight * Has tremendous fear of gaining weight and views self as “fat” * Denies and does not recognize the seriousness of the condition * Females may experience amenorrhea B. Bulimia - Characterized by an excessive appetite and insatiable eating - Recurrent episodes of binge eating followed by guilt, humiliation, shame, and then self - induced vomiting, dieting, and exercise - The child will try to cover up or hide the behaviors - Often, the child or teen is of normal weight 30.SBE- subacute bacterial endocarditis - Infection in the lining of the heart - Risk factors * Congenital cyanotic heart disease * Presence of central lines * IV medication use * Rheumatic fever - Preventive antibiotic therapy for those susceptible before invasive or dental procedures - Tx: Antibiotics for 8 weeks fi fi 31.Type 1 DM vs Type 2 DM and signs & symptoms A. Type 1 DM - Chronic metabolic disorder marked by hyperglycemia - Body produces no insulin - Often rst presents with diabetic ketaoacidosis ( DKA) * Dangerous toxic state requiring intensive care * Kussmaul’s respirations- deeper, faster respirations - Diagnosing TID * Polyphagia ( excessive hunger), polydipsia ( excessive thirst), polyuria ( excessive urination ) - Interventions * those in DKA would receive care in the PICU * Insulin administration /pump * Teach family how to draw up insulin and check blood glucose * CHO counting * Should wear a medical alert bracelet - Patient teaching guidelines * Draw up clear insulin rst, do not shake vials * Rotate injection site to prevent lipodystrophy ( change in subcutaneous fat under the skin) * Knowing s/s of hypo vs. Hyperglycemia * When to call for help * Med information * Monitoring glucose - Labs and diagnostics * HbA1c B. Type 2 diabetes mellitus (T2D) - Caused by insulin resistance - Diagnosing T2D * Hyperglycemia, Acanthuses nigricans ( darkened, thickened skin pigmentation) - Interventions * Exercise and weight loss * Oral hypoglycemic * Insulin 32.Osteogenesis imperfecta - An autosomal dominant, heterogeneous disease where the child suffers from fractures and skeletal deformity or “brittle bone disease” - Defect in the genes that produce the precursor of collagen - Require special handling to prevent injuries 33.Legg-Calve-Perthes Disease - The blood supply to the epiphysis ( or end of the bone) is disrupted tissue death affects development of head of femur - Occurs in children 2-12 years - Onset of intermittent limp/hip pain - Can heal on own by keeping femoral head deep in hip socket while it heals and prevent weight bearing - Conservative tx: decreased activity, bed rest, NSAIDS 34.Ulcerative colitis vs Crohn’s A. Ulcerative Colitis - Disease of the large intestine with continuous lesions involving the super cial mucosa - Peak age 15 - 20 years old - Frequent blood stools; relief from abd pain after defecation; weight loss, anemia, extra intestinal symptoms - rash, arthritis, joint tenderness - Tx: Medications, diet modi cations, severe cases ( hyperal), IV steroids, and correction of acidosis/anemia; possible surgery for diseased bowel removal B. Crohn’s Disease - Ulcerations along the mucosal lining of the bowl but can affect any part of the alimentary tract, from the child’s mouth to the anus - Diarrhea w/ frank / occult blood; abd pain and cramping; weight loss; abscess formation; extra intestinal symptoms ( nger clubbing, arthritis, and amenorrhea) - Tx: Medications, correct nutritional de ciencies; surgery 35.UTI signs and symptoms - Assess for urinary frequency, urgency, pain - Odor of urine - Fever - Dehydration -Hematuria - Lethargy and poor feeding - History of previous UTI’s fi fi fi fi 36.Hemophilia - Lack of clotting factors which impairs clotting ability - Several types; Genetics - Medical Alert worn - No contact sports; Avoid rectal route, IM, SQ, Intradermal injection; monitor for any s/s bleeding ( tarry stools); teach family to administer factor replacement therapy for emergencies - Normal blood clots in 3-6 minutes — with this disease , > or = 1 hour - Tx: administration of clotting factor they are de cient in fi fi 37.Neutropenic precautions (see Leukemia) - Most common malignant cancer in children - An excessive amount of abnormal immature leukocytes are produced in the bone marrow and then invade the blood and various organs of the child’s body. Normal cells in the bone marrow are displaced by these abnormal cells, and therefore insuf cient numbers of RBCs, other WBC types, and platelets are formed - Multiple types - Dx: Bone marrow biopsies - Treatment: Chemo administering * Common side effects: Neutropenia, anemia, and thrombocytopenia - Symptoms * Fever, Fatigue, petechiae, bone pain, weight loss, anorexia - Nursing considerations * Monitor for signs and symptoms for infection * Any reaction to transfusions * Monitor IV / central line site, show family how to care for it * Offer food when tolerating, stomatitis is common * Address family concerns about emotions and physical changes * Wear appropriate PPE when caring for child receiving chemo drugs or if cleaning up drug spills fi fl fl 38.Tonsillitis and tonsillectomy - In ammation of tonsils caused by bacteria ( most commonly) or virus - S/S: sore, red throat , swelling, exudate on tonsils, dif cult swallowing making eating/drinking hard, Elevated WBC - Complications: Peritonsillar abscess - TX: Abe ( with strep = PCN X 10 days) salt H20 gargles, cool/liquid diet, tylenol, tonsillectomy surgery - Post op: Hemorrhage signs ( frequent swallowing or throat clearing ), Avoid red colored uids post op, Earache and low grade temp common 2-3 days days post op