I Swear to you I remember my nursing isnstructor stressing the importance of checking for blood pooling on the posterior side of the neck b/c sometimes that's how some of them bleed out. I can still hear her say, "don't just look at the front of the neck, look at the back!"
I was in the middle of doing this here at my agency job (1st day here at this facility), when one of the staff nurses walked and and screamed at me and told me that I'm being ridiculous, and how I am going to couse this Pt to go into edema b/c her neck wasn't in the "neutral" postion as I was assesssing her neck from the back.
I stood firm, and so did she. Now she wants to have a meeting with the manager tomorrow, with me. Please tell me I was right. Oh please let me be right.
Also, when is it ok to remove the dressing to take a peek? We disagreed on that one, too.
Dec 18, '05
As far as the "underside assessment"--how about tucking a couple of ab pads under the patient's neck and to "assess" you just change them or pull them out periodically to assess for drainage?
I've only had one thyroidectomy patient. Orders were to keep HOB up, so the drainage (if there was any) would've come down the sides of the neck.
We did not have a trach tray at the bedside, but I think to be safe, I will put one there the next time I have a patient with a thyroidectomy; it just makes sense.
Can someone please tell me more about why hoarseness can indicate a problem? Could that be an indication that the vocal cord was nicked? How about if they're actually cut, what do you do then, and how can you tell?
I thought most patients came out of surgery a little hoarse, but that's not the same as laryngeal stridor that indicates a closing airway, is it?
The patient I had was somewhat hoarse and had a huge dressing over her site that contained no visible drains. The surgeon removed the dressing the next day to reveal a very well-approximated incision, without drainage, but with generalized neck edema.
My patient was ambulatory also. I just "adjusted the pillow" for her a few times while she was sleeping to make sure there was nothing on it.
She went home the next day.
Last edit by UM Review RN on Dec 18, '05