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Thyroidectomy Nursing Care Plan & Management

Notes

Definition
  • Removal of all or a share of the thyroid gland.
  • The proceeding is usually executed to discourse multiform distemper of the thyroid gland that may not be discourseed effectively by chemotherapy or medication.
  • A whole thyroidectomy is implied for undeniable carcinomas and to succor tracheal or esophageal compression.
Position
  • Supine delay rolled towel or sandbag between the scapulae, hyperextending the neck. If consultation is placed in countertransmute Trendelenberg predicament, a padded sole consideration should be used to obviate the enduring from slipping down inedge the end of the consultation.
Pack/ Drapes
  • Laparotomy throng delay feeble fenestrated sheet
  • Rolled sheet/ towels
Instrumentation
  • Major Lap tray
  • Thyroid tray
  • Lahey clamps
  • Spring retractor
Supplies/ Equipment
  • Basin set
  • Suction
  • Blades
  • Needle counter
  • Dissector sponge
  • Small parch
  • Solutions
  • Sutures
Procedure Overview
  1. The incision is made aloft the sternal cavity.
  2. The platysma muscle is incised and retracted.
  3. The band muscles are separated or disconnected, and discourage and acid dissections are populated until the thyroid is unprotected.
  4. The gland is then mobilized, and all or sunder is removed depending on the implicated pathology.
  5. Hemostasis is obtained, and the mortify is irrigated delay fiery remarkable.
  6. A parch may be inserted, and the incision is settled in layers by an intermittent system.
Peribinding Nursing Consideration
  1. The surgeon may ask a artistic silk rectitude to use to trace the incision continuity.
  2. The verbiage is usually certain by a thyroid collar using a towel contracted in thirds concurrently. The towel is placed encircling the neck and crisscrossed in face, then fastened delay tape.
  3. The purge individual should sustain the waste of the tail consultation/ Mayo until the enduring is extubated and alert is stabilized.
  4. An difficulty tracheostomy tray allure heed the enduring to the postanesthesia preservation ace and following to the enduring’s ground until alert is unlabored and the fortuity of airway hinderance consequenceant to edema has passed.

Nursing Preservation Plan

Nursing Priorities
  1. Reverse/handle hyperthyroid particularize preoperatively.
  2. Prevent complications.
  3. Relieve indisposition.
  4. Provide notification encircling surgical proceeding, prognosis, and discoursement wants.
Nursing Diagnosis: Airway Clearance, destroy for ineffective
Risk factors may include
Tracheal hinderance; protuberance, bleeding, laryngeal spasms
Possibly evidenced by
[Not applicable; closeness of signs and symptoms establishes an actual singularity.]
Desired outcomes/evaluation criteria—enduring allure:
Respiratory Status: Airway Patency Maintain obvious airway, delay wish obviateed.
Nursing Interventions
Independent
  • Monitor respiratory rebuke, profundity, and product of alert.
    • Rationale: Respirations may accrue slightly quick, but bud of respiratory embarrass is telling of tracheal compression from edema or hemorrhage.
  • Auscultate inspiration sounds, noting closeness of rhonchi.
    • Rationale: Rhonchi may point-out airway hinderance/accumulation of noble-minded inarticulate secretions.
  • Assess for dyspnea, stridor, “crowing,” and cyanosis. Note property of words.
    • Rationale: Indicators of tracheal hinderance/laryngeal spasm, requiring active evaluation and interposition.
  • Caution enduring to shun compliant neck; living mind delay pillows.
    • Rationale: Reduces show of stiffness on surgical mortify.
  • Assist delay repositioning, abstruse alert trainings, and/or coughing as implied.
    • Rationale: Maintains disentangled airway and scent. Although “routine” coughing is not succourse and may be indispositionful, it may be wanted to disentangled secretions.
  • Suction hole and trachea as implied, noting perversion and characteristics of sputum.
    • Rationale: Edema/indislie may diminish enduring’s power to disentangled own airway.
  • Check verbiage regularly, in-particular subsequent share.
    • Rationale: If bleeding follow-places, prior verbiage may retort dry owing rank pools dependently.
  • Investigate reports of difficulty gluttony, drooling of garrulous secretions.
    • Rationale: May point-out edema/sequestered bleeding in structures excluded binding term.
  • Keep tracheostomy tray at bedside.
    • Rationale: Compromised airway may generate a life-threatening predicament requiring difficulty proceeding.
Collaborative
  • Provide steam inhalation; humidify ground air.
    • Rationale: Reduces dissoothe of spirited throat and structure edema and promotes expectoration of secretions.
  • Assist delay/prepare for proceedings: Tracheostomy
    • Rationale: May be expedient to sustain airway if bound by edema of glottis or hemorrhage.
  • Return to surgery.
    • Rationale: May ask-for ligation of bleeding vessels.

Nursing Diagnosis: Communication, diminished verbal
May be allied to
  • Vocal row defective/laryngeal firmness defective
  • Tissue edema; indisposition/discomfort
Possibly evidenced by
  • Impaired knee, does not/cannot speak; use of nonverbal cues such as gestures
Desired outcomes/evaluation criteria—enduring allure:
Communication Ability  Establish system of message in which wants can be implicit.
Nursing Interventions
Communication Enhancement: Oration Deficit
Independent
  • Assess oration periodically; succor words intermission.
    • Rationale: Hoarseness and spirited throat may follow-place consequenceant to structure edema or surgical defective to intermittent laryngeal firmness and may decisive sundry days. Beaming firmness defective can follow-place (rare) that agents paralysis of garrulous rows and/or compression of the trachea.
  • Keep message simple; ask yes/no questions.
    • Rationale: Reduces ask-for for response; promotes words intermission.
  • Provide opinion systems of message as embezzle, e.g., slate consideration, letter/picture consideration. Place IV continuity to minimize suspension delay written message.
    • Rationale: Facilitates indication of wants.
  • Anticipate wants as practicable. Visit enduring regularly.
    • Rationale: Reduces apprehension and enduring’s want to adjoin.
  • Post heed of enduring’s words limitations at convenient residuum and retort circumvent bell actively.
    • Rationale: Prevents enduring from percolation words to frame wants known/summon protection.
  • Maintain soothe environment.
    • Rationale: Enhances power to heed whispered message and reduces want for enduring to raise/defecate words to be heedd.

Nursing Diagnosis: Injury, destroy for [tetany]
Risk factors may include
Chemical imbalance: immoderate CNS stimulation
Possibly evidenced by
[Not applicable; closeness of signs and symptoms establishes an actual singularity.]
Desired outcomes/evaluation criteria—enduring allure:
Safety Status: Physical Injury  Demonstrebuke scarcity of defective delay complications minimized/controlled.
Nursing Interventions
Independent
  • Monitor material signs noting elevating weather, tachycardia (140–200 beats/min), dysrhythmias, respiratory embarrass, cyanosis (developing pulmonary edema/HF).
    • Rationale: Manipulation of gland during subwhole thyroidectomy may consequence in increased hormone acquit, causing thyroid swagger.
  • Evaluate reflexes periodically. Observe for neuromuscular excitability, e.g., twitching, allureousness, paresthesias, actual Chvostek’s and Trousseau’s signs, booty ghost.
    • Rationale: Hypocalcemia delay tetany (usually fugitive) may follow-place 1–7 days postoperatively and point-outs hypoparathyroidism, which can follow-place as a consequence of painsless trauma to/partial-to-whole resistance of parathyroid gland(s) during surgery.
  • Keep edge rails raised/padded, bed in low predicament, and airway at bedside. Shun use of intermissionraints.
    • Rationale: Reduces immanent for defective if bootys follow-place.
Collaborative
  • Monitor serum calcium levels.
    • Rationale: Patients delay levels less than 7.5 mg/100 mL openly ask-for rectification therapy.
Administer medications as implied:
  • Calcium (gluconate, lactate);
    • Rationale: Corrects imperfection, which is usually specific but may be beaming. Note: Use delay calculation in endurings gate digitalis owing calcium increases cardiac sensitivity to digitalis, potentiating destroy of toxicity.
  • Phosphate-binding agents
    • Rationale: Helpful in threatening noble phosphorus levels associated delay hypocalcemia.
  • Sedatives
    • Rationale: Promotes intermission, reducing exogenous stimulation.
  • Anticonvulsants.
    • Rationale: Controls booty ghost until alterative therapy is fortunate.

Nursing Diagnosis: Pain, acute
May be allied to
  • Surgical interruption/manipulation of structures/muscles
  • Postbinding edema
Possibly evidenced by
  • Reports of indisposition
  • Narrowed focus; compensating behavior; intermissionlessness
  • Autonomic responses
Desired outcomes/evaluation criteria—enduring allure:
Pain Control
  • Report indislie is succord/controlled.
  • Demonstrebuke use of intermission skills and diversional activities embezzle to predicament.
Nursing Interventions
Pain Management
Independent
  • Assess verbal/nonverbal reports of indisposition, noting residuum, force (0–10 flake), and period.
    • Rationale: Useful in evaluating indisposition, valuable of interpositions, agency of therapy.
  • Place in semi-Fowler’s predicament and living mind/neck delay sandbags or feeble pillows
    • Rationale: Prevents hyperexstiffness of the neck and protects rectitude of the rectitude continuity.
  • Maintain mind/neck in uninterfering predicament and living during predicament transmutes. Instruct enduring to use hands to living neck during motion and to shun hyperexstiffness of neck.
    • Rationale: Prevents burden on the rectitude continuity and reduces muscle stiffness.
  • Keep circumvent bell and regularly wanted items delayin comfortable penetrate.
    • Rationale: Limits stretching, muscle defecate in binding area.
  • Give propitious liquids or balmy foods, such as ice marrow or popsicles.
    • Rationale: Although twain may be mellow to spirited throat, balmy foods may be tolerated rectify than liquids if enduring experiences difficulty gluttony.
  • Encourage enduring to use intermission techniques, e.g., guided imagery, balmy still n ess, newfangled intermission.
    • Rationale: Helps refocus watchfulness and assists enduring to handle indisposition/dissoothe more effectively.
Collaborative
  • Administer analgesics and/or analgesic throat sprays/lozenges as expedient.
    • Rationale: Reduces indislie and disquiet; improves intermission.
  • Provide ice collar if implied.
    • Rationale: Reduces structure edema and decreases discernment of indisposition.

Nursing Diagnosis: Knowledge, short [Learning Need] touching term, prognosis, discoursement, self-care, and execute wants
May be allied to
  • Lack of exposure/recall, misinterpretation
  • Unfamiliarity delay notification resources
Possibly evidenced by
  • Questions; ask for notification; particularizement of misconception
  • Inaccurebuke follow-through of instructions/bud of obviateable complications
Desired outcomes/evaluation criteria—enduring allure:
Knowledge: Distemper Process 
  • Verbalize discernment of surgical proceeding and prognosis and immanent complications.
Knowledge: Comlie Regimen 
  • Verbalize discernment of therapeutic wants.
  • Participate in discoursement victuals.
  • Initiate expedient lifestyle transmutes
Nursing Interventions
Teaching; Distemper Process
Independent
  • Review surgical proceeding and forthcoming expectations.
    • Rationale: Provides notice low from which enduring can frame cognizant decisions.
  • Discuss want for equable, beneficial nutriment and, when embezzle, inclusion of iodized salt.
    • Rationale: Promotes salutiferous and succors enduring regain/sustain embezzle consequence. Use of iodized salt is repeatedly adequate to coalesce iodine wants normal salt is intermissionricted for other healthpreservation problems
  • Recommend shunance of goitrogenic foods, e.g., immoderate ingestion of seafood, soybeans, turnips.
    • Rationale: Contraimplied following sunderial thyroidectomy owing these foods bar thyroid ghost.
  • Identify foods noble in calcium (e.g., dairy products) and vitamin D (e.g., brawny dairy products, egg yolks, liver).
    • Rationale: Maximizes afford and aridity of calcium if parathyroid part is diminished.
  • Encourage newfangled open training program.
    • Rationale: In endurings delay subwhole thyroidectomy, training can stimulate the thyroid gland and genesis of hormones, facilitating reinstatement of open weal.
  • Review postbinding trainings to be established following incision heals, e.g., flexion, extension, reversion, and followingal motion of mind and neck.
    • Rationale: Regular ROM trainings fortify neck muscles, improve publicity and salutiferous way.
  • Review burden of intermission and intermission, shuning burdenful predicaments and tender outbursts.
    • Rationale: Effects of hyperthyroidism usually subedge entirely, but it follows some season for the organization to cure.
  • Instruct in incisional preservation, e.g., determine, verbiage application.
    • Rationale: Enables enduring to collect competent self-care.
  • Recommend the use of loose-fitting scarves to clothe scar, shuning the use of jewelry.
    • Rationale: Covers the incision delayout aggravating salutiferous or precipitating epidemic of rectitude continuity.
  • Apply calm marrow following rectitudes bear been removed.
    • Rationale: Softens structures and may succor minimize scarring.
  • Discuss possibility of transmute in words.
    • Rationale: Alteration in garrulous row part may agent transmutes in cast and property of words, which may be specific or beaming.
  • Review garbage therapy and the want of constant equal when emotion courteous.
    • Rationale: If thyroid hormone rectification is wanted owing of surgical resistance of gland, enduring wants to conceive rationale for rectification therapy and consequences of scarcity to routinely follow medication.
  • Identify signs/symptoms requiring medical evaluation, e.g., ferment, chills, continued/purulent mortify parchage, erythema, gaps in mortify edges, unanticipated consequence missing, superstition to warmth, nausea/vomiting, diarrhea, insomnia, consequence mould, harass, superstition to calm, constipation, swoon.
    • Rationale: Early remembrance of lay-opening complications such as taint, hyperthyroidism, or hypothyroidism may obviate rate to life-threatening predicament. Note: As abundant as 43% of endurings delay subwhole thyroidectomy allure lay-open hypothyroidism in season.
  • Stress want of continued medical follow-up.
    • Rationale: Provides convenience for evaluating agency of therapy and obviateion of complications.

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