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Difficulty: MediumReduction of Risk Potential

Following a total thyroidectomy, an adult client is admitted to the surgical step-down unit. To minimize the potential for severe postoperative complications, which actions and assessments must the nurse include in the plan of care? Select all that apply.

  1. Maintain the client in a semi-Fowler's position with the head and neck supported by pillows.Answer
  2. Verify that a tracheostomy tray, oxygen, and suction equipment are present at the bedside.Answer
  3. C
    Encourage the client to actively extend and flex the neck to prevent postoperative muscle stiffness.
  4. Monitor the client for reports of circumoral numbness, tingling, or muscle twitching.Answer
  5. E
    Delegate the hourly evaluation of the client's voice quality and swallowing ability to the nursing assistant.
  6. F
    Delay inspecting the posterior neck for bleeding as long as the anterior surgical dressing remains dry.

Answer

The correct interventions include maintaining a semi-Fowler's position with neck support, ensuring emergency airway equipment is at the bedside, and monitoring for signs of hypocalcemia such as circumoral numbness.
Following a thyroidectomy, clients are at extremely high risk for airway compromise, hemorrhage, and hypocalcemia. Maintaining a semi-Fowler's position reduces edema and minimizes tension on the anterior neck incision. Having a tracheostomy tray and suction equipment readily available is essential for immediate airway management if a rapid hematoma develops. Furthermore, monitoring for circumoral numbness or muscle twitching allows for early detection of hypocalcemia, a common complication resulting from inadvertent parathyroid gland injury.

Step-by-Step Solution

1
Identify the primary life-threatening complications associated with a total thyroidectomy.
The major risks are airway obstruction (from edema or hematoma), severe hemorrhage, and acute hypocalcemia (from parathyroid damage).
Understanding the specific risks guides the nurse in prioritizing appropriate reduction strategies.
2
Determine the optimal positioning to reduce surgical site complications.
The client should be placed in a semi-Fowler's position with the head and neck carefully supported by pillows or sandbags.
This position promotes venous return to reduce swelling and prevents hyper-extension of the neck, which could tear the suture line.
3
Select interventions that prepare for sudden airway emergencies.
A tracheostomy tray, suction equipment, and oxygen must be immediately accessible at the bedside.
If a hematoma rapidly expands and compresses the trachea, an emergency tracheostomy may be required to save the client's life.
4
Identify early clinical markers of parathyroid gland injury.
The nurse must assess for circumoral numbness, tingling in the extremities, and muscle twitching (Chvostek's or Trousseau's signs).
Inadvertent removal or trauma to the parathyroid glands during surgery causes a sudden drop in serum calcium, requiring immediate calcium gluconate administration.

Key Concept

Thyroidectomy Postoperative Care and Complication Mitigation
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Topics

Reduction of Risk Potential

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