Assignment - Medical Study

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Hello, I was currently assigned a case study with various questions. The case is related to a 50-year-old coming out of the PACU after she had a total thyroidectomy (multinodular goiter), left superior and right inferior paratyroidectomy due to adenoma.

The recovery room nurse provides the EBL, vitals and meds info. Additional data that I should obtain from her is the type of anesthesia used, whether the patient is still intubated and if any surgical or anesthetic complications occurred. I shoulkd prepare before the patient arrives by speaking with the Doctor and obtaining any prescription for the patient, have her bed ready in an appropriate angle to prevent post-op swealling and have a Tracheostomy kit ready.

What can I be missing in the additional data needed and preparations before the patient arrives from PACU? Am I on the right direction with what I've proposed up till now?

I understand that my initial assessment should be focused on the patients level of pain and how to manage it, according to the Doctor's orders. I believe I should also focus on any present or possible breathing problem and changes in her vital signs.

Another thing that I'm having some trouble is in the case that the patient may experience hypocalcemia and I decide to notify the Doc, what should I do in the time it takes for him to return the call? I believe I should check for Chvostek's and Trousseau's sings since the patient could present them, but what else could I do?

I'm mostly looking for opinions on how I'm focusing my care in this assignement, since I haven't experienced this situation with a patient, and I'd like to know if I'm on the right path in the way I take care of said patient. I'm very open to opinions on this and any help, and will greatly appreciate it. -JHCmed

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Specializes in NICU, ICU, PICU, Academia.

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.

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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.

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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?

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

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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!

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Specializes in Complex pedi to LTC/SA & now a manager.

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

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

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Specializes in Emergency, Telemetry, Transplant.
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.

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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?

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Specializes in Emergency Room.

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

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Specializes in Emergency Room.
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.

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