Assignment - Medical Study

I cannot help with this as it is in a completely different zipcode from my experience.

BUT I want to commend you on not just posting the assignment and expecting the assembled masses to do it FOR you. You have provided ample evidence of substantial work BEFORE posting and for that- I commend you.

Many, many other posters would do well to follow this example.

Yeah I'm not exactly looking for anyone to do it for me, it's preparation that I need! I really just want opinions and and guidance if I'm not exactly on the right track with this.

I am just a student as well, so I really don't know anything. But, the question I have regarding this scenario, would hypocalcemia show up that quickly in the PACU? Or would it take some time post surgery?

I'm not really sure how quick it would manifest, but in my clinical case it took 24 hours.

BIG update on my assignment. Would REALLY love some feedback

So to continue from where I left off:

In the preparations before the patient arrives from the PACU I've also noted the importance of getting a prescription for analgesics, for the obvious pain management post-op. I should have Calcium gluconate available in case of a calcium deficiency (which she later has).

I focused my initial assessment on monitoring for complications. I noted Hemorrhage, Respiratory Distress, Laryngeal Damage and Tetany, and how/why it should be assessed.

It is noted that I should explain why Synthroid is used pre-op in my patient. I did some reaserch and most pointed to the use of Synthroid AFTER operation. Is it correct to state that Synthroid is used pre-op since she is having a total thyroidectomy and this synthetic thyroid hormone is needed to prevent hypothyroidism?

In the identification of the major risk factor for the development of parathyroid adenoma: I pointed to two things:

Her age. She's 50, and this affliction does have a higher risk of appearing in women who are 60 years or older but the possibility of happening during adulthood is not discarded.

Radiation treatment in the area of her neck. What worries me in adding this as a major risk to her parathyroid adenoma is that her radiation treatment was 38 years ago. I am not entirely sure if there is a relation ship between the two with such a large time gap.

In the reduction of risk for post-op swelling, I identified The use of two or three pillows to allow elevation of her head. And also the educating the patient on why she should avoid smoking and alcohol until a full recovery, since this also promotes swelling and makes a slower healing process.

Since she goes through hypocalcemia 24 hours after her surgery, is it correct to administrate Calcium gluconate while I get an answer from the Doctor? I also noted that a defibrillator should be at hand, since one of the possible complications of hypoglycemia is congestive heart failure.

Any feedback on this will be greatly appreciated!

Why would you need a defibrillator for congestive heart failure? Check the pathophysiogy of CHF, s/sx and standard treatment.

Thanks, I actually confused CHF with the possibility of MI for some reason.

Since she goes through hypocalcemia 24 hours after her surgery, is it correct to administrate Calcium gluconate while I get an answer from the Doctor? I also noted that a defibrillator should be at hand, since one of the possible complications of hypoglycemia is congestive heart failure.

Do you mean just give calcium gluconate "just in case?" What should you have (from the doctor) before you administer a medication?

Also, when someone comes from the PACU to you unit what is always the first assessment you should make (I took several NCLEX practice questions that addressed this)? Why is this especially important given the type of surgery this pt. had? Hint: when you mentioned in your OP what you should have at the bedside it indicates you are on the right track.

Do you mean just give calcium gluconate "just in case?" What should you have (from the doctor) before you administer a medication?

Also, when someone comes from the PACU to you unit what is always the first assessment you should make (I took several NCLEX practice questions that addressed this)? Why is this especially important given the type of surgery this pt. had? Hint: when you mentioned in your OP what you should have at the bedside it indicates you are on the right track.

So I need the medical order before proceeding with this, but then what can I do for this patient before I can get in touch with the doctor?

Observe for signs of hypocalcemia ...numbness and tingling, tetany, seizures, and QT prolongation.

So I need the medical order before proceeding with this, but then what can I do for this patient before I can get in touch with the doctor?

When I worked SDS - we always had our Drs write some basic PRN meds before they left the unit. That would include antiemetic, opiates, and normally some type of benzo PRN seizures.

IME, coming out of anesthesia - patients seizure threshold is usually lower. That's not even taking to patients calcium level into matter.

This is a potentially difficult airway, so I do agree with keeping a trach kit at the beside. You'll also need suction.

You can't just give calcium gluconate while waiting for the MD to call back; RNs can't prescribe or dispense. You could suggest/ask MD immediately post-op about ordering a PRN dose for a Ca++

The cardiac complications of hypocalcemia are CHF and angina. The indications for defibrillation are V fib and pulseless V tach, so I wouldn't worry about having the crash cart in the room.

When taking report from the PACU, I also would ask about any intra-op antibiotics so you can time the next dose correctly. Where I work, if an MD orders a new antibiotic, the pharmacy automatically times it for when the med was verfied. I've seen new orders for Vanco and Zosyn both timed to be given at 1555. So since Zosyn is given q 6 hrs--more frequently than Vanco--I'll give the Zosyn first and re-time the Vanco for, say, 1700.

I work in an ICU, so sometimes our pts bypass the PACU; so I'll ask the CRNA (who calls report if coming straight to the ICU from the OR) what time they last had a paralyzing agent.

And then you'll monitor the same things as with every post-op pt--integrity of the incision, signs of local and systemic infection, pain, nausea, lung and bowel sounds. Teach and encourage pulmonary hygiene; this can require strong encouraging if the pt is having a lot of pain. Make sure you have an Rx for prn antiemetics; this is true for every post-op pt, but with an incision in the neck you want to protect that incision. You don't want the pt's body to put extra pressure on that incision, and of course you want to avoid getting emesis on the incision (even if she'd been NPO, people can still throw up gastric secretions.

The comment from meanmaryjean about not asking us to do your homework for you is a reference to maaaaaaany a nursing student who come on here with questions like "What ethical challenges do nurses face?" or "What do you teach a pt about his nitro?" with NO explanation of what they've researched, no indication of their thought process.