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Please help, Case study on Parathyroidectomy

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I am completley stuck on the last two quesiton on my case study. :confused::uhoh3:

Please help if possible:

7. After surgery, C.P.'s thyroid hormone levels were elevated and the physician ordered propranolol 80 mg ER (extended-release) tabs for "surgically induced thyrotoxicosis." Is this reaction expected following parathyroid surgery or did something go wrong during surgery? Explain.

8. Eighteen hours after surgery, C.P. calls you into her room complaining of (C/O) numbness around her mouth and tingling at the tips of her fingers. She appears restless but is aware alert & oriented. Realizing that C.P. may be experiencing hypocalcemia, you notify the physician. What should you do in the interim before the physician returns your call?

Sugarcoma, RN

Specializes in Trauma/Tele/Surgery/SICU. Has 2 years experience.

Think back to A&P. Where are the parathyroids located? If someone goes digging around in area of small space what may happen to the surrounding tissue? Irritation and inflammation yes? How would you expect an irritated thyroid to behave? Is it expected? No but can it happen yes. Doesn't mean anything went wrong with the procedure. Google thyrotoxicosis after parathroidectomy.

Hypocalcemia- why is it bad? what can it do the pt.? Of those potential things which is the worst? You already know your pt. is Alert and orientated but restless. What are the first symptoms of respiratory distress? How do you find out if your patient has that or is just anxious due to thyrotoxicosis? Check a pulse ox, listen to her breathing, how does it sound? Listen to her upper airways do you hear air moving around in there? Stridor? Listen to the sound of her voice does it sound hoarse? This pt. may need an emergency trach (one should ALWAYS be at the bedside of a thyroid or parathyroidectomy pt.). So working in order of ABC's I would send a tech for the intubation box while I took pulse ox, listened to the quality of her voice and auscultated lung sounds. If I hear stridor or hoarseness or sats were dropping, I would call a rapid response. I would place the pt. on telemetry, take vitals and then pad her siderails in case of seizures.

Thank you for the help

Much appreciated

XB9S, BSN, MSN, EdD, RN, APN

Specializes in Advanced Practice, surgery. Has 33 years experience.

I am completley stuck on the last two quesiton on my case study. :confused::uhoh3:

8. Eighteen hours after surgery, C.P. calls you into her room complaining of (C/O) numbness around her mouth and tingling at the tips of her fingers. She appears restless but is aware alert & oriented. Realizing that C.P. may be experiencing hypocalcemia, you notify the physician. What should you do in the interim before the physician returns your call?

Part of our protocol for parathyroids is in the event of tingling, give the patient a glass of milk

Works wonders as well.

We don't keep emergency trach's at our bedside, if the patient shows signs of resp distress usually opening the neck wound alone will be sufficient to relieve the pressure, we keep clip removers for the surgeon who still uses clips and a scalpel for the one who glues

Remember your ABC's as the previous poster has mentioned but tingling post parathyroid is not unexpected, the mouth and tips of fingers are usually the first to go. They can get complete tetnai type symptoms with claw hands.

Ways to check if it's hypocalcaemia Trousseau sign of latent tetany, Trousseau's sign occurs in patients with hypocalcaemia and results from enhanced neuromuscular excitability.

Google Trousseau and you'll find it

There is also Chvostek's sign (tapping of the facial nerve, which results in facial nerve spasm)