Question

JT is a 28 year old patient who is visiting her nurse practitioner for her yearly physical examination. During the assessment the practitioner notices significant swelling in the front of the patient’s neck. The nurse practitioner orders labs, ultrasound, and a CT scan of the thyroid. The patient is diagnosed with thyroid cancer, and a total thyroidectomy is performed. On the first post-operative day JT says she feeling tingling around her mouth and in her fingers. She feels like her heart is “skipping beats”.

What would the nurse recognize the problem JT is having and would be the nursing considerations?

Answer 1

Answer.

Patient already underwent total thyroidectomy.

One of the most common complication followed by thyroid surgery is low calcium level. The patient with low calcium level will experience numbness or tingling in their fingers and around their lips. So the nurse can identify the problem of JT is due to low calcium level followed by total thyroidectomy.

So the nursing considerations include;

1. Following surgery patient should be monitored for calcium level to check for iatrogenic hypoparathyroidism

2. Monitoring serial lab values and cardiac monitoring are important.

3. ECG evaluation for prolonged QT and ST interval due to hypocalcemia

4. Patient safety is important: Take fall precaution as patient is at risk for fracture, seizure precaution and watch for laryngeal spasms.

3. Patient will be initially asymptomatic for hypocalcemia, classic symptoms like numbness or tingling of fingers and perioral area, presence of chvostek sign and trousseau sign should be assessed periodically.

4. Administer IV calcium(10% calcium gluconate) as ordered as slow as possible due to risk of arrhythmia.

5. Administer oral calcium with vitamin D suppliment if ordered.

6. Check for high phosphorus level and notify the doctor to start medicine to reduce phosphorus level. because high phosphorus level will decrease calcium level.

7. Encourage the patient to take food rich in calcium like milk, spinach, cheese,yogurt etc.

8 Before discharge, the nurse should instruct the patient regarding the signs of hypocalcemia like numbness or tingling of fingers and perioral area and also proper follow up of lab investigations.