Altered metabolic state d/t potential injury to the parathyroid glands o What can happen is they get hypocalcemic (low calcium levels) If you work in the PACU or surgical unit & you see that the pt has had a thyroidectomy à your brain should think low calcium levels, calcium levels, calcium levels!! (1 st thing you’ve gotta think about other than ineffective breathing pattern/obstructed airway (the airway issue of course))! Will be monitoring the pts Ca 2+ levels, may be drawing them q12h or qd Check Trousseau’s & Chvostek's sign Ask pt are you having an tingling or numbness in your lips or hands? Keep calcium gluconate 10% IVP (IV push) at the bedside & if they start having the tetany (muscle spasms) then you’ll have to give this. There will be orders set about how to deliver it. It has to be readily available. o Trachea kit & calcium gluconate have to be kept at the pts bedside!! So you don’t have to go digging around in the code cart to find the calcium gluconate. o Bc when they go into spasms like that, part of breathing is ventilation & that’s neuromuscular, so if their having spasms of their muscles they could start having problems w/ their breathing as well, & so it becomes a medical emergency!! Thyroidectomy = think Ca 2+ levels o Hypocalcemia Calcium gluconate: IV push need it available, trachea kit is kept at bedside w/ this as well o Bc if they go into spasms like this bc part of breathing is ventilation = becomes a medical emergency Nursing Diagnosis Nursing Intervention Patient Outcome Impaired communication RT Preoperative Assess voice quality Note/Report voice changes immediately Patient’s voice maintained 24
Nerve Injury Postoperative Assess respiratory status Monitor voice quality and changes Assess cough, swallowing, and aspiration Before pt goes for sx you want to note what their voice quality is like & doc that! o Reason: there’s a recurrent laryngeal nerve that comes through this area & if there’s any damage to it it could change their voice quality & so you would want to document that o & again you should keep assessing their resp status & such Parathyroidectomy Very similar to thyroidectomy, post-op care is really the same Types : o Subtotal Parathyroidectomy Partial removal of parathyroid gland Parathyroid function usually returns to normal by 5 to 7 days o Total Parathyroidectomy Total removal of parathyroid gland Life-long calcium replacement necessary Monitor for: going to monitor for the same things essentially o Hemorrhage (bleeding) o Airway obstruction – d/t potential hematoma or swelling in their throat o Hypocalcemia (low Ca 2+ levels) Nursing Interventions o Tracheostomy set should be available for immediate emergency use – Must be kept at bedside for emergent tracheostomy if the pt can’t breathe allowing them to breathe o Monitor serum calcium levels Assess for tetany (muscle spasms) o Depends on how much of the gland is removed on what the calcium levels do!
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- Summer '19