THYROIDECTOMY - THYROIDECTOMY Thyroidectomy, although rare,...

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THYROIDECTOMY Thyroidectomy, although rare, may be performed for patients with thyroid cancer, hyperthyroidism, and drug reactions to antithyroid agents; pregnant women who cannot be managed with drugs; patients who do not want radiation therapy; and patients with large goiters who do not respond to antithyroid drugs. The two types of thyroidectomy include: Total thyroidectomy: The gland is removed completely. Usually done in the case of malignancy. Thyroid replacement therapy is necessary for life. Subtotal thyroidectomy: Up to five-sixths of the gland is removed when antithyroid drugs do not correct hyperthyroidism or RAI therapy is contraindicated. CARE SETTING Inpatient acute surgical unit RELATED CONCERNS Cancer Hyperthyroidism (thyrotoxicosis, Graves’ disease) Psychosocial aspects of care Surgical intervention Patient Assessment Database Refer to CP: Hyperthyroidisim (Thyrotoxicosis, Graves’ Disease), for assessment information. Discharge plan DRG projected mean length of inpatient stay: 2.4 days considerations: Refer to section at end of plan for postdischarge considerations. NURSING PRIORITIES 1. Reverse/manage hyperthyroid state preoperatively. 2. Prevent complications. 3. Relieve pain. 4. Provide information about surgical procedure, prognosis, and treatment needs. DISCHARGE GOALS 1. Complications prevented/minimized. 2. Pain alleviated. 3. Surgical procedure/prognosis and therapeutic regimen understood. 4. Plan in place to meet needs after discharge. NURSING DIAGNOSIS: Airway Clearance, risk for ineffective Risk factors may include Tracheal obstruction; swelling, bleeding, laryngeal spasms Possibly evidenced by [Not applicable; presence of signs and symptoms establishes an actual diagnosis.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Respiratory Status: Airway Patency (NOC) Maintain patent airway, with aspiration prevented. ACTIONS/INTERVENTIONS RATIONALE
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Airway Management (NIC) Independent Monitor respiratory rate, depth, and work of breathing. Auscultate breath sounds, noting presence of rhonchi. Assess for dyspnea, stridor, “crowing,” and cyanosis. Note quality of voice. Caution patient to avoid bending neck; support head with pillows. Assist with repositioning, deep breathing exercises, and/or coughing as indicated. Suction mouth and trachea as indicated, noting color and characteristics of sputum. Check dressing frequently, especially posterior portion. Investigate reports of difficulty swallowing, drooling of oral secretions. Keep tracheostomy tray at bedside. Collaborative Provide steam inhalation; humidify room air. Assist with/prepare for procedures, e.g.: Tracheostomy; Return to surgery. Respirations may remain somewhat rapid, but development of respiratory distress is indicative of tracheal compression from edema or hemorrhage.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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THYROIDECTOMY - THYROIDECTOMY Thyroidectomy, although rare,...

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