Thyroidectomy case study help

[mgalloLPN]

I have a case study I am working on and the patient had a thyroidectomy due to multinodular goiter, left superior and right inferior parathyroidectomy due to adenoma.

She would continue to be on levothyroxine correct?

And here's my question that I am having trouble with:

What doctor's orders would you expect to be written for this patient?

[Fiona59]

Trach tray at bedside

[Daytonite, BSN, RN]

she would continue to be on levothyroxine correct?

yes. since she also had parathyroidectomies, she should also be started on calcium replacement as well.

what doctor's orders would you expect to be written for this patient?

general post-op patient:

• encourage deep breathing and coughing
  
  
• encourage turning
  
  
• progressive oral diet as tolerated (bowel sounds present and no nausea or vomiting)

thyroidectomy:

• pain medication prn
  
  
• vital signs q4h
  
  
• keep in high fowler's position
  
  
• report any difficulty speaking
  
  
• keep a tracheotomy tray at the bedside for the first 24 hours after surgery
  
  
• if drainage area enlarges reinforce the dressing until i come to do the first dressing change
  
  
• measure all drainage from drains
  
  
• report any excess bleeding
  
  
• assess for chvostek's and trousseau's signs q shift and report any positive findings
  
  
• report to me if any of the following signs and symptoms of thyroid storm occur suddenly: fever, sweating, tachycardia, tremors and restlessness

parathyroidectomy:

• pain medication prn
  
  
• vital signs q4h
  
  
• keep in high fowler's position
  
  
• keep a tracheotomy tray at the bedside for the first 24 hours after surgery
  
  
• if drainage area enlarges reinforce the dressing until i come to do the first dressing change
  
  
• measure all drainage from drains
  
  
• assess quality of voice and ability to speak
  
  
• daily serum calcium levels
  
  
• report abnormal serum calcium levels immediately
  
  
• begin oral calcium replacement when iv fluids are d/c'd with calcium gluconate
  
  
• monitor for and report any numbness and tingling of the fingers and toes or numbness around the mouth, muscle cramps and tetany
  
  
• assess for chvostek's and trousseau's signs q shift and report any positive findings
  
  
• high calcium, low phosphorus diet

[Daytonite, BSN, RN]

i want to also mention, having had 2 thyroidectomies, that the neck is very painful and difficult for the patient to move. it isn't supple enough to turn to make any kind of sudden left and right motions because it hurts! they need to be instructed to place both hands on the side of their head to support their head and neck when moving it. for this reason, as well, no driving or lifting for several weeks postoperatively where the muscles of the neck are put in strain.

[nlion87]

Monitor vitals, oxygen saturation, drain (if present), and dressings every 15 minutes initially, progressing to every 4hrs, as ordered. Decreased blood pressure with increased pulse should alert you to possibility of shock related to blood loss. Tachycardia and fever, along with mental status changes, may indicate thyrotoxic crisis. Check back of neck for pooling of blood. Because of the location of the surgery, observe for signs of respiratory distress, including increase in respiratory rate, dyspnea, or stridor. Ask pt to speak to detect hoorificeness of the voice, which may indicate trauma to the recurrent laryngeal nerve. Monitor pt's serum calcium levels and watch for evidence of tetany, such as numbness or tingling around the mouth or muscle spasms. Asseess pt's swallowing and gag reflexes prior to offering clear liquids to avoid aspiration. Have suction equipment availbale in case pt unable to cough up secretions effevtively. Use room humidifier or hunidified oxygen to keep airways and secretions moist

[mgalloLPN]

she would continue to be on levothyroxine correct?

yes. since she also had parathyroidectomies, she should also be started on calcium replacement as well.

what doctor's orders would you expect to be written for this patient?

general post-op patient:

• encourage deep breathing and coughing
  
  
• encourage turning
  
  
• progressive oral diet as tolerated (bowel sounds present and no nausea or vomiting)

thyroidectomy:

• pain medication prn
  
  
• vital signs q4h
  
  
• keep in high fowler's position
  
  
• report any difficulty speaking
  
  
• keep a tracheotomy tray at the bedside for the first 24 hours after surgery
  
  
• if drainage area enlarges reinforce the dressing until i come to do the first dressing change
  
  
• measure all drainage from drains
  
  
• report any excess bleeding
  
  
• assess for chvostek's and trousseau's signs q shift and report any positive findings
  
  
• report to me if any of the following signs and symptoms of thyroid storm occur suddenly: fever, sweating, tachycardia, tremors and restlessness

parathyroidectomy:

• pain medication prn
  
  
• vital signs q4h
  
  
• keep in high fowler's position
  
  
• keep a tracheotomy tray at the bedside for the first 24 hours after surgery
  
  
• if drainage area enlarges reinforce the dressing until i come to do the first dressing change
  
  
• measure all drainage from drains
  
  
• assess quality of voice and ability to speak
  
  
• daily serum calcium levels
  
  
• report abnormal serum calcium levels immediately
  
  
• begin oral calcium replacement when iv fluids are d/c'd with calcium gluconate
  
  
• monitor for and report any numbness and tingling of the fingers and toes or numbness around the mouth, muscle cramps and tetany
  
  
• assess for chvostek's and trousseau's signs q shift and report any positive findings
  
  
• high calcium, low phosphorus diet

thanks for your helper and for reading my rant the other day.