Makeup med surg case study spring 2021

Makeup med surg case study spring 2021

1. What specific preparations will you make before C.P. arrives?

-          C.P.'s airway might become compromised because of edema from the surgery or internal hemorrhage at the surgical site. You should make certain there is a tracheostomy tray and intubation tray at the bedside.

-          Humidified oxygen and suction equipment should be at the bedside and operational-

-          Place a sutureremoval set in the room (to relieve respiratory obstruction if internal hemor rhage occurs.

-          Place an IV infusion pump in the room. An extra liter of normal saline should be availabl e for rapid infusion in the event of hemorrhage.

-          Place an ampule of calcium gluconate at the bedside (in the event tetany develops).

2. You receive C.P. from the recovery room. How will you focus on your initial assessment and why?

-          Airway: Assess for hoarseness and weak voice because of edema or damage to the recurrent laryngeal nerve; ask C.P. to immediately report any sensation of swelling or tightening in airway.

-          Breathing: Assess for any signs of respiratory distress, such as stridor, and ask C.P. to immediatelyreport any choking sensation or difficulty breathing or swallowing.

-          Circulation: Assess patency and adequacy of the IV access to accommodate rapid IV infusion orthe irritant calcium gluconate as needed. Assess for hemorrhage into the neck tissues; check thesurgical site and dressing; note swelling or ecchymosis; monitor VS.

-          Check for tetany (calcium deficiency secondary to parathyroid tissue removal). - Check to see whether the ice bag needs to be refilled

3.   During your initial assessment, you document negative Chvostek and Trousseau signs. Describe data that would support this conclusion.

-          Negative Chvostek sign: No contraction of the upper lip, nose, or side of the face when the facialnerve is tapped adjacent to the ear

-          Negative Trousseau sign: No sign of carpopedal spasm, marked by adduction of the thumb andextension of the fingers, when you inflate a blood pressure (BP)cuff and occlude the arterialblood flow for 1 to 4 minutes

4.   Identify the major risk factor that might have contributed to the development of thyroid adenoma in C.P.

A history of radiotherapy to the neck 38 years ago

                                       5.   Identify interventions to use to reduce the risk of postoperative swelling.

-          Use semi-Fowler position

-          Prevent hyperextension or flexion of the head or neck

-          Position sandbags at both sides of the neck to limit movement

Stuvia.com - The Marketplace to Buy and Sell your Study Material

-          Teach C.P. to support her neck with her hands while getting out of bed

-          Apply ice as directed

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.

-          Respiratory distress: Advise C.P. to talk as little as possible to prevent swelling; keep head of bed(HOB) elevatedand apply an ice bag to her throat; instruct C.P. to notify you if she experiencesany signs and symptoms of airway obstruction (swelling or difficulty breathing). Frequentlyassess respiratory rate and for signs of dyspnea and restlessness. Nebulizer equipment andbronchodilators, corticosteroids, or racemic epinephrine can be ordered for standby at thebedside.

-          Hypocalcemia (tetany or convulsions): Monitor calcium levels; keep an ampule of calcium gluconateat the bedside to be used as prescribed; keep side rails upwhile in C.P. is in bed; note anymuscular irritability; test for tetany.

-          Hemorrhage at the surgical site: Visualize her neck and incision site when you take her VS, andhave her report any pressure sensation in her neck or throat. Confirm that an active type andcrossmatch is on file in the blood bank and thatcrossmatched blood is available as prescribed.IV normal saline or lactatedRinger's solution should be available for initial management ofhemorrhage.

-          Injury to the laryngeal nerve: When C.P. does speak, you should note any voice changesthat mightindicate injury to the laryngeal nerve.

7. Which assessment findings would indicate C.P. has laryngeal nerve damage? Select all that apply.

-          Stridor

-          Hoarseness

-          breathy voice

-          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.

This is a common postoperative reaction. Manipulation of the thyroid gland during surgeryreleases stored thyroid hormones and causes a surgically inducedthyrotoxicosis. The patient mightexperience tachycardia, dysrhythmias, hypertension, confusion and agitation, fever, tremor, andsymptoms of nervousness. Some patients might also experience nausea, vomiting, severe diarrhea,and abdominal pain. Propranolol is given to counteract these symptoms, which can persist forseveral days.Eighteen hours after surgery, C.P. calls you into her room complaining of numbnessaround her mouth,tingling at the tips of her fingers, and jitteriness. She appearsrestless but denies any pain at the operativesite. She is able to swallow and speak without difficulty.

9.      What is your immediate concern and why?

Because of C.P.'s symptoms, it is likely she has sustained either damage or inadvertent removal of the parathyroid glands, resulting in hypocalcemia.