Question

You are working on the postoperative unit and will be receiving a patient from the recovery room. The post-anesthesia care unit nurse calls and gives the following report: C.P. is a 50-year-old woman with a subtotal thyroidectomy for papillary carcinoma. The estimated blood loss was 25 mL. Vital signs (VS) are 130/82, 80 to 90, 20, and Sa O 2 94% on room air. She has a peripheral IV of D5.45NS with 20 mEq KCl infusing at 100 mL/hr. She has received a total of 3 mg morphine sulfate IV push, and she remains awake, but drowsy, and fully oriented. C.P.'s past medical history includes a total abdominal hysterectomy for fibroids and low-level radiation treatments to the neck 30 years ago for eczema. Her medications include lovastatin (Mevacor) and levothyroxine (Synthroid). Both parents are living; her father had a myocardial infarction at 70 years of age; her mother has hypothyroidism but never had thyroid tumors.

1. You receive C.P. from the recovery room. Discuss priorities for your initial assessment, what complications will you monitor for post-op specific to the surgical procedure performed? Include actions and rationales.

2. During your initial assessment, you document negative Chvostek's and Trousseau's signs. Describe data that would support this conclusion.

3. Identify the major risk factor that might have contributed to the development of thyroid adenoma in C.P.

4. After surgery, C.P.'s thyroid hormone levels are elevated, and the physician orders propranolol (Inderal) 80 mg ER orally twice daily for “surgically induced thyrotoxicosis.” Is this reaction expected following thyroid surgery, or did something go wrong during surgery? Explain.

5. As part of your discharge instructions to C.P. note five key teaching points with rationale.

Answer 1

Monitoring of patient vitals after surgery , see any sign of bleeding or hemorrhage

Monitoring of calcium level in blood, beacuse in total thyroidectomy chances of Remove parathyroid gland , so decrease parathyroid hormones and decrease calcium level - tetany and respiratory paralysis

2 - negative both represent Normal calcium level in blood , beacuse due to remove by mistake parathyroid with thyroid reduce calcium level in blood

3 - perior exposure to radiation to neck

4- during surgery - thyroid tissue cursing and release of thyroid hormones in blood