Question

Surgery Assignment

A 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. Why is it so important for the client to be euthyroid prior to thyroidectomy
b. Why is it mandatory to have emergency equipment and ampoules of calcium
gluconate on hand following thyroidectomy?
c. Why is it important to support the client's head and neck with sandbags and
pillows?
d. Develop a plan of care for this patient two (2) actual and two (2) potential

Answer 1

a.Why is it so important for the client to be euthyroid prior to thyroidectomy

- it is to avoid complication of thyroid storm

-hyperthyrodism the TSH level is very low , so during thyroidectomy with untreated hyperthyrodism can lead to abnormal rise in BP, heart rate at the immediate post op
b. Why is it mandatory to have emergency equipment and ampoules of calcium
gluconate on hand following thyroidectomy?

- as there is a chance for haemorrhage from the blood vessel ligated (Superior thyroid artery or inferior thyroid artery), if any haematoma formed it can lead to comprimise of airway leading to stridor

if it happens tracheostomy is done to safeguard the airway

- hypocalcaemic tetany is another complication , parathyroid glands are in close association with the thyroid glands during surgery it may be accidental removed or manipulated ,leading to calcitonin hormonal level changes in blood leading to tetany --in order to treat tetany calcium gluconate is kept ready

c. Why is it important to support the client's head and neck with sandbags and
pillows?

-to prevent slippage of sutures

- to be comfortable

-to prevent torrential haemorrhage
d. Develop a plan of care for this patient two (2) actual and two (2) potential

care plan	interventions
1 Assess pain, noting location, intensity (0–10 scale), and duration .	Useful in evaluating pain, choice of interventions, the effectiveness of therapy.
2. give analgesics and/or analgesic throat sprays and lozenges as necessary	to reduce pain and discomfort; enhances rest.
1. keep everything ready for intubation	if sudden haemorrhage occurs, to save the life of patient
2.inspect for stridor	assessing respiratory movements