Altered metabolic state dt potential injury to the

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!