Med-Surg Endocrine System, part 16: Thyroidectomy: Nursing Care

by Cathy Parkes August 01, 2020

Full Transcript

Alright. In this video, we are going to talk about nursing care of patients who require a thyroidectomy. And this could be due to thyroid cancer or hyperthyroidism, such as you would have with Graves' disease. So after your patient comes back from the OR, from having their thyroidectomy, you want to place your patient in a semi-Fowler's position. And then you want to support their head and neck using either sandbags or pillows to keep it in a neutral position. So we don't want them to hyper-extend their neck or have their neck go down like this. We really want to support it and keep it midline to avoid disruption of the suture line. 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. So during a thyroidectomy, the parathyroid gland can be damaged as well which can cause hypocalcemia. So signs and symptoms of parathyroid damage are going to be signs and symptoms of hypocalcemia. So this includes numbness and tingling around the mouth as well as muscle twitching. You also may have a positive Chvostek sign. So the Chvostek sign is where you tap the cheek and that's how I remember this sign because Chvostek starts with C-H, and cheek also starts with C-H. So you tap their cheek and if you get twitching of the facial muscles, then that is a positive Chvostek sign and they indicate that the patient has hypocalcemia.

Also if they have a positive Trousseau sign that is also indicative of hypocalcemia. So that's where you inflate a blood pressure cuff on their upper arm, and it causes spasms in their hand and fingers. It causes their hands and fingers to kind of go like this due to the ischemia. So if your patient is exhibiting that, then that is definitely a strong indicator that they may have sustained parathyroid gland damage. And then if your patient does have hypocalcemia that's confirmed with a blood test, then we can provide them with calcium gluconate to help address that.

In terms of patient teaching, we want to reinforce that they need to avoid extreme neck extension or flexing, right? They want to keep their head in a midline position. You also need to reinforce that the patient will need to take thyroid replacement for the rest of their lives, right? The thyroid gland is gone, so it is not going to be producing T3 and T4. So the patient will need to take a medication such as levothyroxine every day for the rest of their lives. And just as a reminder about that medication, we do give that on an empty stomach, about an hour before breakfast with a full glass of water. Okay. And that is it for nursing care after a thyroidectomy. In my next video, we will cover hypoparathyroidism as well as hyperparathyroidism. Thank you so much for watching!

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