Question

Patient Profile: You have just finished discharging two patients to home when the charge nurse informs you that you will be receiving a patient from surgery following a partial thyroidectomy. You will admit the patient from the post-anesthesia care unit and will be assigned as the primary nurse. Since you have two more workdays scheduled, you will be assigned to this patient for a total of three days.

Critical Thinking Questions: Answer each question completely and thoroughly.

1. What supplies should you ask the nurse assistant to place in the room?

2. Why should vital signs be assessed every 15 minutes for 2 hours, then hourly for 4 hours then every 2 to 4 hours for 24 hours?

3. What instructions about positioning and transferring the patient to the bedside chair should you give to the nurse assistant?

4. What symptoms and signs should you assess?

5. What should the patient understand about daily thyroid medication?

Answer 1

Answers are as follows:

1. Post-op Partial thyroidectomy, the nurse should arrange items to check Vital signs ,Keep Tracheostomy tray ready as there could be a risk for damaging the laryngeal nerve during surgery

-Also keep ready a measuring tape to check for neck circumference, giving an idea if hematoma develops

- Keep Inj. Calcium Carbonate ready at bedside as there could be a chance for parathyroid glands to get affected or cut leading to hypocalcemia

2. Check vitals signs at different intervals is very important. Initial vital signs checking is mainly to assess hemorrahge and later is to assess for wound infection

3. Post-op position should be 25-30 degrees head elevation to promote proper breathing. Instruct the nurse assistant to always support neck while transfering the patient

4. - Assess for signs of hemorrage such as check dressing on the front and especially on the back of neck for bleeding, Also Assess if the patient is frequently swallowing indicating bleeding

-Assess for hematoma by checking circumference of neck frequently

-Assess for breathing difficulty, watch SpO2 and keep Tracheostomy Tray ready

- Assess for signs of hypocalcemia, for chvostek's sign (twitching of facial muscle in response to tapping on the area where facial nerve is located) and Trosseau's sign ( Apply blood pressure cuff on the hand, inflate it above systolic pressure, keep it for 2-3mins, exhibits spasm of wrist and hand