Question

The patient is a 42-year-old female, Tracy Williams, who had a Thyroidectomy a week ago. The patient is complaining of twitching and numbness and tingling feelings of the hands, fingers and around the mouth. She states that her breathing is difficult. 1. Based on the patient’s recent surgery what electrolyte imbalance are you concerned about? What is the normal range for this electrolyte? Hypocalcemia means low calcium. The normal range is 8.6-10.2 2. What are the objective and subjective signs and symptoms of this electrolyte imbalance? 3. Describe how you would assess for hypocalcemia? (The lab values return, and the calcium level is 6.9 mg/dL). There are 2 key assessment findings. Also don’t forget to assess DTR’s. What are your findings? 4. Your preceptor tells you, “Keep an eye on her breathing, okay?” What is the significance of this? 5. What 3 factors control calcium levels and how? 6. Hospitalization is required for this patient for stabilization and treatment of the hypocalcemia. What orders do you as the nurse anticipate? 7. As you develop your plan of care for the patient you include Risk for impaired gas exchange and Risk for injury related to tetany and neuromuscular impairment. What interventions are you including? 8. The patient is discharged 48 hours later. What should be included in this patient’s teaching related to the best dietary sources of calcium? What additional supplements should the patient be taking for adequate calcium absorption?

Answer 1

The patient had thyroidectomy and has complaints of twitching, numbness, and tinkling feeling of hands with difficulty in breathing. These signs indicate parathyroid gland damage and decreased serum calcium level due to hypoparathyroidism.

1 . Calcium. Decreased serum calcium or hypocalcemia. Normal value is 8.6 to 10.2 mg /dl.

2. objective and subjective signs and symptoms of hypocalcemia.

Symptoms include

i) Tingling and numbness in finger, hand and feet, and around mouth.

ii) Difficulty in breathing

Iii) Muscle spasm and cramps

Iv) memory lose and confusion.

v) hallucinations

Signs include

i) Tetany or sustained muscle contractions.

ii) Positive Chovstek's sign which means tapping on the facial nerve in front of the ear leadsvto contraction of facial muscles.

iii) Positive Trousseas sign which means

iv) ECG changes.

v) Hyper reflexia

vi) seizure

3 Assessment of hypocalcemia

i) Chovstek's sign; Tapping the facial nerve leads to contraction of facial muscles in hypocalcemia.

ii) Trousseau sign; the blod pressure cuff is fasten to patients arm by inflating to 20 mmHg and wait for 3 minutes causes spasm of Muscles of hand and forearm.

iii) Deep tendon reflex is assessed by tapping on muscle tendon which causes contraction of the muscles. Hyperreflexia is seen in hypocalcemia.

4. Patient complaints of breathing difficulty. This may be due to the abnormal muscle spasm of the muscles in the larynx or bronchospasm. So the breathing should be assessed to find signs of respiratory failure due to tetany.