Assignment - Medical Study

[JHCmed]

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

[Here.I.Stand, BSN, RN]

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.

[BuckyBadgerRN, ASN, RN]

I had a TT for Graves Disease. I was effing SICK from the anesthetia. SICK SICK SICK. Honestly, I didn't care about my pain, I was terrified of vomiting everywhere and messing up the surgical site and sutures. THAT was my priority as a patient, LOL!!

Also, yes, hypocalcemia can set in very quickly---my very next draw hours later confirmed that, but I had classic Sx---tingling lips and fingers, big time