Question

Surgery Assignment

25-year-old female client is being admitted to the postanesthesia care unit (PACU)
following a thyroidectomy for hyperthyroidism. The client had undergone three
months of preoperative treatment with antithyroid medications and iodine
preparations to establish euthyroid status prior to her surgery. At the client's bedside
the nurse has set up a tracheostomy set, endotracheal tube, laryngoscope, and suction
equipment. There are ampules of calcium gluconate on hand. The nurse places the
client in a semi-Fowler's position, and is supporting her head and neck with pillows
and sandbags. The nurse frequently checks the client's vital signs, and assesses her
suture line for strain or bleeding. Once the immediate postoperative period has passed,
the client will be transferred to the surgical ward where she will recuperate and learn
about lifelong thyroid replacement therapy

.
a. Develop a plan of care for this patient including 2 actual and 2 potential nursing diagnosis

Answer 1

Answer: A Thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland,when a patient has thyroid cancer or some other condition of the thyroid gland such as hyperthyroidism or patients with large goiters who do not respond to anti thyroid drugs, pregnant women who cannot be managed with drugs,patient who do not want radiation therapy .The two types of thyroidectomy include: Total and Subtotal thyroidectomy

Total thyroidectomy: The gland is removed completely,usually done in case of malignancy.Thyroid replacement therapy is necessary for life.

Subtotal thyroidectomy: Up to five- sixths of the gland is removed when anti thyroid drugs do not correct hyperthyroidism or RAI therapy is contraindicated.

Nursing Care plan for 2 actual and 2 potential nursing diagnosis.

1. Acute Pain
2. Risk for Impaired Airway clearance
3. Impaired verbal communication
4. Deficient Knowledge

1) Acute Pain,May be related to surgical interruption/ manipulation of tissue/ muscles,post operative edema.

Nursing interventions:

• Assess verbal and non verbal reports of pain,location,intensity (0-10 scale) and duration and Administer analgesics and / or analgesic throat spray and lozenges as necessary
• Rationale: to evaluate the choice of interventions and effectiveness of therapy,reduces pain and discomfort,enhances rest.
• Keep the patient in semi- Fowler’s position and support head and neck with sand bags or small pillows .Instruct the patient to use hands to support the neck during movements
• Rationale: Protect the integrity of suture line by preventing hyperextenion of the neck
• Give cool liquids or soft foods such as ice cream or popsicles.
• Rationale: Soft foods may be tolerated better than liquids if patient experiences difficulty swallowing
• Provide ice collar if indicated to reduce tissue edema and decrease the perception of pain

2) Risk of ineffective airway clearance include tracheal obstruction,swelling,bleeding,laryngeal spasms

Nursing Interventions:

• Monitor Respiratory rate,depth and work of breathing.Ascultate breath sounds,noting the presence of rhonchi,dyspnea,strider,crowing and cyanosis.Keep tracheostomy tray at bed side
• Rationale: To Assess the development of respiratory distress is indication of tracheal compression due to edema or bleeding,laryngeal spasms,requires prompt evaluation and interventions in life threatening situation requiring an emergency procedure
• Suction mouth and trachea as indicated,noting color and characteristics of sputum.
• Rationale: Edema and pain may impair patients ability to clear own airway
• Check dressing frequently,especially the posterior portion
• Rationale: Anterior dressing may appear dry because blood pools dependently,if bleeding occurs
• Assist with repositioning,deep breathing exercise,and coughing,steam inhalation,humidify roomair
• Rationale:Maintains clear airway and ventilation,reduces the discomfort of sore throat and tissue edema and promotes expectoration of secretions

3) Impaired verbal communication related to vocal cord injury/ laryngeal nerve damage,tissue edema,pain/ discomfort

• Assess speech periodically,encourage voice rest,keep communication simple,ask yes or no questions,provide alternative methods of communication as appropriate
• Rationale: Hoarseness and sore throat may occur secondary to tissue edema or surgical damage to the laryngeal nerve,permanent nerve damage may cause paralysis of the vocal cords or compression of the trachea
• Post notice of the patients voice limitations at central station and answer call bell promptly to prevent patient from straining voice to make needs known or summon assistance

4) Deficient Knowledge:

• Discuss the need an well balanced nutritious diet and appropriate inclusion of iodized salt
• Rationale: Promote healing and helps the patient regain or maintain an appropriate weight and use of iodized salt is often sufficient to meet iodine needs
• Recommend avoidance of goitrogenic foods like excessive ingestion of sea food soya beans,turnips which contraindicated after partial thyroidectomy because these foods inhibit thyroid activity
• Identify foods high in calcium and vitamin D,maximizes supply and absorption of calcium if the parathyroid function is impaired
• Review importance of rest and relaxation,avoid stressful situations and emotional outbursts.Instruct incisional care,post operative exercise,use of loose fitting scarves to cover the scar,avoid the use of jewelry.
• Review drug therapy and the necessity of continuing even when feeding well to understand the rationale for replacement therapy and the consequences of failure to routinely take medication and continued medical follow up.