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Question

Difficulty: MediumReduction of Risk Potential

During the afternoon shift, a client is transferred back to the surgical unit four hours after undergoing a total thyroidectomy. Which interventions must the practical nurse implement to minimize the risk of postoperative complications? Select all that apply.

  1. Maintain the client in a semi-Fowler's position while using pillows to support the head and neck.Answer
  2. Verify that emergency suction equipment and a tracheostomy set are immediately accessible in the room.Answer
  3. Inspect the posterior aspect of the client's neck and the bed linens for dependent pooling of blood.Answer
  4. D
    Instruct the client to frequently hyperextend the neck to prevent cervical muscle stiffness.
  5. E
    Delegate the evaluation of the client's swallowing reflex to the unlicensed assistive personnel (UAP).
  6. F
    Administer prescribed oral pain medication before fully evaluating a new onset of respiratory stridor.

Answer

The correct interventions include maintaining the client in a semi-Fowler's position with head support, ensuring emergency airway equipment is at the bedside, and assessing the back of the neck for dependent bleeding.
Following a total thyroidectomy, clients are at significant risk for airway obstruction, hemorrhage, and hypocalcemia. Maintaining a semi-Fowler's position with the head supported minimizes tension on the suture line and reduces surgical site edema. Because airway compromise can occur rapidly from swelling or bleeding, emergency suction and a tracheostomy set must be readily available. Additionally, checking the back of the neck and linens is crucial because blood from the surgical site can pool dependently without being visible on the anterior dressing.

Step-by-Step Solution

1
Identify the surgical procedure and the postoperative timeframe.
The client is 4 hours post-total thyroidectomy.
The early postoperative phase carries the highest risk for acute hemorrhage and airway compromise.
2
Determine the priority risks associated with a thyroidectomy.
Risks include airway obstruction from laryngeal edema, acute hemorrhage, and hypocalcemia.
The anatomical location of the thyroid gland near the trachea and major blood vessels creates specific localized risks.
3
Evaluate each intervention against these risks and the practical nurse's scope of practice.
Positioning, emergency equipment preparation, and assessing for bleeding actively reduce risks. Neck hyperextension, UAP delegation of assessment, and ignoring airway sounds increase risks.
Appropriate nursing interventions must actively prevent complications, prioritize physiological stability, and remain within safe delegation boundaries.

Key Concept

Postoperative Thyroidectomy Care and Complication Prevention
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Topics

Reduction of Risk Potential

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