Post Total Thyroidectomy care. Was I right in doing this?

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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. :o

Also, when is it ok to remove the dressing to take a peek? We disagreed on that one, too.

No meeting afterall. I went in, ready for this meeting, ready for her to look like an AZZ, but it never happened. I'm speculating that she complained to someone, and that someone told her I was right.

For the record, no I was not being rough with the Pt, she was in no danger.

For those of you that are telling me that next time I should just use a glove or gauze to assess, I don't understand how that will tell me anything without looking for myself. It's my understanding that the whole point of "looking" is b/c the blood pools under the skin, but it doesn't seep out.

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Specializes in Utilization Management.
No meeting afterall. I went in, ready for this meeting, ready for her to look like an AZZ, but it never happened. I'm speculating that she complained to someone, and that someone told her I was right.

For the record, no I was not being rough with the Pt, she was in no danger.

For those of you that are telling me that next time I should just use a glove or gauze to assess, I don't understand how that will tell me anything without looking for myself. It's my understanding that the whole point of "looking" is b/c the blood pools under the skin, but it doesn't seep out.

I see. Under. Thanks for the clarification. I'll be checking for that next time, thanks!

I'm very glad all turned out well for you, Raindrop.

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I've never heard of blood poolong under the skin posteriorly, but I don't know it all.

I have however seen a co-workers patient develop a HUGE hematoma under the anterior neck(where the incision was). Apparently the doc had used a skin glue and no dressing. The patient was covered with a blanket up to the chin, and when the nurse checked she saw this huge bloody hematoma! This was in PACU but could happen anywhere. We always order and keep a Trach Tray at the bedside despite surgeons yelling that these are unecassary.

If the M.D writes an order "NO TRACH TRAY at bedside", then #1 they are stupid, and #2 they are stupid. An order is the only time we do not have one ordered.

I believe that progressive or new hoarsness(after wetting the throat) is generally apoor sign and needs immediate surgical consult(I would also send for that Trach Tray!) I believe it is a sign of vocal cord edema.

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Hi,

I appreciate most nurses and doctors, I have had great experiences with both. I had a total thyroidectomy in 2004 and woke up with a tube inserted into my chest that went under my skin and into my throat and in my hand was the drainage container. So I understand checking the back of the neck.

What SCARES me is the RN that didn't know that the blood would be on the inside and the other person that said to use the gloves. Pretty SCARY........

Hey, have any of you read any of the blogs from TT patients? A lot of us still having problems-The replacement hormone medication isn't all that great for some of us. Some of us didn't have very experienced surgeons and now are suffering from voice problems to parathyroid problems (sometimes the surgeon removes or damages the parathyroid glands during the procedure).

Don't RN's specialize also? Like post op or ICU...etc...?

Just a patient

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

i agree with daytonite .i had the same experience last year after my total thyroidectomy .could only move with my head and neck in neutral .large neck dressing that went around my neck.my surgeon came by next day took out small drain and changed dressing .i was up and about the next day.surgery wed home friday.

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Specializes in Acute Care Cardiac, Education, Prof Practice.

The only trouble I have ever had with a thyroidectomy was a bought of calcium induced tetany, which was pretty creepy.

My concern in your story is that another nurse felt it was necessary to interfere so dramatically into your patient care. That would have me in the manager office with her telling her to back the heck out of my space!!

I think a little extra check for blood is not a bad thing and I wouldn't let this other nurse sway you from careful, competent care.

Tait

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Specializes in med/surg, telemetry, IV therapy, mgmt.
hey, have any of you read any of the blogs from tt patients? a lot of us still having problems-the replacement hormone medication isn't all that great for some of us. some of us didn't have very experienced surgeons and now are suffering from voice problems to parathyroid problems (sometimes the surgeon removes or damages the parathyroid glands during the procedure).

i was originally on armour thyroid before synthyroid came onto the market. that stuff was scary because no matter how hard they tried it wasn't always perfectly manufactured and there were times when i got hyperthyroid from it. i have also, for some reason, gotten hyper- and hypothyroid on the synthyroid. it could just be me. i've had gastric bypass surgery and after i had lost 100 pounds i suddenly went hyperthyroid and had to have my daily dose adjusted down. i stayed that way for about a year. after i lost another 60 pounds i got severely hypothyroid and had to have my dose increased back to what it had been the year before. i had the same problem with hypertension medication. maybe my body is just weird.

voice problems. . .i had chemotherapy for colon cancer about 2 years ago and my voice went weird on me. i will have days when i can barely squeak it out. i talk as much as i write. when i am on a roll i can tell i am having a hard time physically getting the words out. the radiation therapy i had for a parotid tumor years ago left me with trismus, a side effect that only about 10% of people get. i worry that i may end up with a tracheostomy. the ent doc i see says it will never happen, but i still worry.

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Hi, I have had patients who has undergone TOTAL THYROIDECTOMY and I do remember that in College, we were told to check the the posterior side for bleeding.. What kind of dressing is the patient on?

All I can say is, its case to case basis. I'm working in the Surgical ward and the doctor in my hospital that do thyroidectomy is very particular in her dressing.

She does it really nice and cleaned and Postoperatively, we expect patient on STERISTRIP only and CURAPORE Transparent dressing with either 2 small Radivacs on the neck.

By this, you need not to check the posterior neck for any bleeding.It's gonna be evident on the dressing itself for any leaking.

In cases where Doctors used very thick dressing such as Plain Gauze and then Pen rose drains (which actually still been using in my Native country) then that's the case you need check

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