Today, surgery is reserved for special circumstances - for example: ~ In pregnant women who are allergic to antithyroid medications ~ In patients with large goiters ~ In patients who are unable to take antithyroid agents Surgery for treatment of hyperthyroidism is performed soon after the thyroid function has returned to normal ~ 4 to 6 weeks The surgical removal of about five sixths of the thyroid tissue (subtotal thyroidectomy) reliably results in a prolonged remission in most patients with exophthalmic goiter Its use today is reserved for patients with obstructive symptoms, for pregnant women in the second trimester, and for patients with a need for rapid normalization of thyroid function Before surgery, an antithyroid medication is given until signs of hyperthyroidism have disappeared A beta-adrenergic blocking agent (e.g., propranolol) may be used to reduce the heart rate and other signs and symptoms of hyperthyroidism Medications that may prolong clotting (e.g., aspirin) are stopped several weeks before surgery to reduce the risk of postoperative bleeding Patients receiving iodine medication must be monitored for evidence of iodine toxicity (iodinism), which requires immediate withdrawal of the medication. Symptoms of iodinism include: ~ Swelling of the buccal mucosa ~ Excessive salivation ~ Cold symptoms ~ Skin eruptions The incidence of relapse with a total thyroidectomy is nearly 0%, whereas recurrence following a subtotal thyroidectomy is 8% at 5 years Thyroid Surgery - Management
PreOperative care ~ Alleviate signs/symptoms of thyrotoxicosis ~ Control cardiac problems ~ Assess for signs of iodine toxicity ~ Oxygen, suction equipment, and tracheostomy tray are available in room PreOperative teaching ~ Coughing, deep breathing, and leg exercises ~ Supporting head while turning in bed ~ Range-of-motion exercises of neck ~ Speaking difficulty for a short time after surgery ~ Routine postop care Check pulse and BP Observe dressing for bleeding Check incision for ___________________ PostOp Care ~ Monitor vitals. Think about when you want to call the doctor ~ Control pain. ~ Monitor for parathyroid removal (What do you assess?) Monitor for 72 hours. ~ Could lead to vocal cord paralysis and airway obstruction Document Y or N? ~ Every 2 hours for 24 hours Assess for signs of hemorrhage Assess for tracheal compression. Irregular breathing, neck swelling, frequent swallowing, choking ~ Semi-Fowler’s position No Tension on suture lines - Nursing Plan of care Planning and Goals
~ The goals for the patient may be improved nutritional status, improved coping ability, improved self- esteem, maintenance of normal body temperature, and absence of complications Nursing Diagnosis ~ Risk for injury ~ Imbalanced nutrition: Less than body requirements ~ Anxiety ~ Insomnia Nursing Management ~ Ambulatory and home care Discharge teaching: Monitor hormone balance periodically.
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- Summer '16