Hypocalcemia and tetany can occur if parathyroid

■ > Hypocalcemia and tetany can occur if parathyroid glands are damaged or removed.
Indications are tingling of toes or around mouth, and muscle twitching. Check for positive
Chvostek's and Trousseau's signs. Ensure that IV calcium gluconate or calcium chloride
are immediately available.
■ > If no drain is in place, prepare the client for discharge the day following surgery as
indicated. However, if a drain is in place, the surgeon will usually remove it, along with half
of the surgical clips, on the second day after surgery. The remaining clips are removed the
following day before discharge
System Specific Assessments - (1)
● Polycystic Kidney Disease, Acute Kidney Injury and Chronic Kidney Disease: Expected Findings (Chp 59)
○ Expected findings are nausea, fatigue, lethargy, involuntary movement of legs, depression,
intractable hiccups
○ In most cases, findings are related to fluid volume overload
○ Serum creatinine gradually increases 1 to 2 mg/dL every 24 to 48 hours or 1 to 6 mg/dL in 1 week
6

○ BUN can increase to 80 to 100 mg/dL within 1 week
○ Urine specific gravity greater than 1.000 to 1.010 in postrenal type (1.030 in prerenal)
○ Decreased Hgb & Hct
○ Decreased sodium and calcium and increase in potassium, phosphorus, and magnesium
● Renal Calculi: Assessing Client Pain (RM AMS RN 10.0 Chp 61, Active Learning Template - System Disorder)
■ Flank pain suggests calculi is in ureters or kidney
■ Flank pain that radiates to the abdomen, scrotum, testes, vulva suggest calculi in ureter or
bladder
Physiological Adaptation
Alterations in Body Systems - (4)
● Acid-Base Imbalances: Identifying Client at Risk for Metabolic Alkalosis (Chp 45)
○ Continuous suctioning
○ Oral ingestion of excess amount of bases (antacids)
○ Venous administration of bases (blood transfusions, total parenteral nutrition, or sodium bicarbonate)
○ Acid deficit>> loss of gastric secretions (prolonged vomiting, suctioning), potassium depletion
(thiazide diuretics, laxative overuse, cushing’s syndrome, hyperaldosteronism), increased digitalis
toxicity
● Asthma: Using a Peak Flow Meter (Chp 18)
○ Stand up, inhale, put to mouth, exhale, record
● Postoperative Nursing Care: Monitoring for Wound Complications (Chp 96)
○ Observe drainage tubes for patency and proper functioning
○ Check dressings for excessive drainage and reinforce as needed. Report excess drainage to the
surgeon.
○ Outline drainage spots with a pen, noting date and time. Report increasing drainage to the surgeon.
○ Encourage the client to consume a diet high in vitamin C, protein, and calories.
○ If wound dehiscence or evisceration occurs, call for help, stay with the client, cover the wound with a
sterile towel or dressing that is moistened with sterile saline, do not attempt to reinsert organs, place
in a low-fowler’s position with hips and knees bent, monitor for shock, and notify provider immediately.