Scenario You are working on the surgical

Scenario You are working on the surgical floor and will be receiving a patient from the post anesthesia care unit. The nurse calls and gives the following report: C.P. is a 55-year-old woman who underwent a subtotal thyroidectomy for papillary carcinoma. Estimated blood loss was 25 mL. Vital signs (VS) are 130/82, 80 to 90, 20, and Sao2 94% on room air. She is receiving a peripheral intravenous (IV) infusion of D5.45NS at 100 mL/hr. She has received a total of 3 mg morphine sulfate IV push, and she remains awake, but drowsy, and fully oriented. C.P.’s past medical history includes a total abdominal hysterectomy for fibroids and low-level radiation treatments to the neck 30 years ago for eczema. Both parents are living; her father had a myocardial infarction at 70 years of age; her mother has hypothyroidism but never had thyroid tumors. 1. What specific preparations will you make before C.P. arrives? 2. You receive C.P. from the recovery room. How will you focus your initial assessment, and why? 3. During your initial assessment, you document negative Chvostek and Trousseau signs. Describe data that would support this conclusion. 4. Identify the major risk factor that might have contributed to the development of thyroid adenoma in C.P. 5. Identify interventions to use to reduce the risk of postoperative swelling. 6. List four complications that C.P. is at risk for postoperatively. Describe actions you should include in C.P.’s plan of care related to each complication. 7. Which assessment findings would indicate C.P. has laryngeal nerve damage? Select all that apply. a. Stridor b. Hoarseness c. Breathy voice d. Circumoral numbness e. Difficulty swallowing 8. After surgery, C.P.’s thyroid hormone levels are elevated. The physician orders propranolol (Inderal) 80 mg ER orally twice daily for “surgically induced thyrotoxicosis.” Is this reaction expected after thyroid surgery, or did something go wrong during surgery? Explain. CASE STUDY PROGRESS Eighteen hours after surgery, C.P. calls you into her room complaining of numbness around her mouth, tingling at the tips of her fingers, and jitteriness. She appears restless but denies any pain at the operative site. She is able to swallow and speak without difficulty. 9. What is your immediate concern and why? 10. What actions do you need to take based on this concern? 11. The physician orders you to give C.P. 1 gram of calcium gluconate intravenously over 15 minutes now, and then initiate an infusion of 2 grams of calcium gluconate in 500 mL D5W over 12 hours. After the bolus is complete, at what rate will you set the IV pump? 12. What precautions do you need to take while administering the calcium gluconate infusion? CASE STUDY PROGRESS Six hours after initiation of the calcium gluconate infusion, C.P. is no longer complaining of numbness around her mouth or tingling in her fingertips and toes. Chvostek and Trousseau signs remain negative. Chart View Laboratory Test Results Serum calcium 7.4 mg/dL Ionized calcium 3.4 mg/dL Parathyroid hormone (PTH) <3.0 pg/mL 13. Has C.P.'s status improved or not? Defend your response. CASE STUDY PROGRESS C.P. is started on oral calcium gluconate. Her calcium levels stabilize within 24 hours and she recovers without further complications. Two days postoperatively, you are preparing her for discharge. 14. As part of your discharge instructions, what would you teach C.P.? Select all that apply. a. Keep her head raised while sleeping for 3 -4 days b. The importance of keeping follow-up medical appointments c. Not to return to work until her thyroid hormone level is normal d. Cover her incision with clothing or sunscreen when she is in the sun e. Proper care of the incision and signs of infection to report to the physician f. To avoid foods containing iodine because they increase her risk of recurrent cancer SCIENCE HEALTH SCIENCE NURSING NURSING MISC

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