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Patients diagnosed with hyperthyroidism and other thyroid disorders that lead to excessively high thyroid hormones in the bloodstream often become candidates to undergo thyroidectomy. Conditions like thyroid cancers, the presence of non-malignant nodules on the thyroid, and goiter are only some of the most common reasons for prescribing a thyroidectomy. Previously a hazardous procedure, thyroidectomy is the surgical removal of the thyroid gland of the patient. This removal may be total or partial, depending on the diagnosis. Most patients who have undergone the procedure require thyroid hormone supplementation, especially those who have undergone total removal of the gland. A nurse caring for a patient who has undergone thyroidectomy must remember that the surgical site (neck) places the patient at a higher risk for airway problems. This is due to the potential for the patient to develop laryngeal edema secondary to the injury to the surrounding tissues. Apart from this, there are also other complications that may arise from the procedure that the nurse must be aware of so that the patient can be safely transitioned from the operating and recovery units to the ward and eventually discharged. One of the primary responsibilities of the nurse in caring for patients who have undergone thyroidectomy is to carefully assess the patient’s vital signs and determine what signs or symptoms need to be reported to the physician immediately. Positioning the patient appropriately is another priority of nursing care, ensuring that the patient is not just able to breathe effectively but that the risk for aspiration is also prevented. Monitoring for bleeding is also a priority of care, as well as assessment for potential problems in speaking. This is due to laryngeal nerve damage that may happen to the patient when there is an accidental injury to the nerve during surgery. While other problems may also be seen on the patient may range from actual to potential problems, the nurse must also remember that there is a need to prioritize the patient’s health needs well. Attending to needs with the highest priority allows the nurse to prevent other more serious complications while also preventing further health problems. Moreover, since patients who have undergone thyroidectomy may need lifetime supplementation of thyroid hormones in some cases, the need to emphasize rehabilitative care and lifetime management should be included in the care plan. Some of the most common problems that nurses can encounter in these patients include:
Listing of all nursing diagnoses would also help the nurse to focus care and ensure that the patient has a good prognosis after surgery. Below are some of the 8 most common nursing diagnoses which can be made after assessing patients post-thyroidectomy.
Below are examples of the most common nursing care plans that can be used for caring for patients who have undergone thyroidectomy. Note that while there are numerous assessment findings included in these care plans, nurses may still add other findings which may be elicited during the assessment of the patient. Acute PainAcute pain related to mechanical trauma to the tissues secondary to surgery (other related factors may also be used such as the presence of postoperative edema, manipulation of the tissues, etc.) as evidenced by:
Desired OutcomesAfter nursing interventions, the patient is expected to:
Ineffective Airway ClearanceIneffective airway clearance related to the presence of (choose one of the following possible factors: laryngeal spasms, tracheal obstruction, mechanical trauma to the trachea, swelling, bleeding operative site) as evidenced by:
Desired OutcomesAfter nursing interventions, the patient is expected to:
Impaired Verbal CommunicationImpaired verbal communication related to (choose one of the following possible factors: injury or damage to the vocal cords; laryngeal nerve damage; mechanical trauma to the tissues) secondary to thyroid removal surgery as evidenced by (other assessment findings may be added to this; however, these are the most common):
Desired OutcomesAfter nursing interventions, the patient is expected to:
Nursing Diagnosis: Knowledge deficit (learning need) regarding disease process, condition, prognosis, treatment, self-care, and discharge needs.
References
What are the nursing management of thyroidectomy?Thyroidectomy requires meticulous postoperative nursing care to prevent complications. Nursing priorities will include managing hyperthyroid state preoperatively, relieving pain, providing information about the surgical procedure, prognosis, and treatment needs, and preventing complications.
What should a nurse assess after a thyroidectomy?We're going to want to monitor for bleeding, so we're going to want to check their dressing and also check behind their neck to make sure there's no blood pooling behind their neck. And then we also want to monitor for signs and symptoms of parathyroid damage.
What do you monitor after thyroidectomy?It is important to monitor both calcium and magnesium levels after total thyroidectomy and to correct deficiencies to facilitate prompt resolution of symptoms.
What is the most important complication to monitor when caring for a patient after thyroidectomy?Hypocalcemia was the most frequent post-thyroidectomy complication, whereas voice changes, seroma, hematoma, and tracheal injury are rare complications. Additionally, total thyroidectomy has the highest risk of postoperative hypocalcemia.
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