Question

The nurse is preparing to make rounds after shift report. Which client requires further assessment by the nurse? A. A 40-year-old 12 hours post-thyroidectomy experiencing numbness in the face B. A 34-year-old laparoscopic cholecystectomy with a temperature of ${99.8}^{\circ }\mathrm{F}$ C. A 22-year-old being discharged after an appendectomy D. A 56-year-old diabetic postop colon resection with a blood sugar of 128

Short answer

Answer: Client A - A 40-year-old 12 hours post-thyroidectomy experiencing numbness in the face.

Step-by-step solution

Read and understand the clients' situations

Carefully read each client's scenario to grasp the potential risks or issues each of them may be facing. A. A 40-year-old 12 hours post-thyroidectomy experiencing numbness in the face B. A 34-year-old laparoscopic cholecystectomy with a temperature of ${99.8}^{\circ }\mathrm{F}$ C. A 22-year-old being discharged after an appendectomy D. A 56-year-old diabetic postop colon resection with a blood sugar of 128

Rank the scenarios based on urgency

In this step, evaluate each scenario's potential risks or complications and prioritize them, from most to least urgent. - Client A is experiencing facial numbness, which could be a sign of a serious complication such as hypocalcemia. This client, therefore, needs immediate assessment by the nurse. - Client B's temperature of ${99.8}^{\circ }\mathrm{F}$ may indicate an infection, but it is not critical at this point. - Client C is ready to be discharged, which indicates that there are no urgent issues for the nurse to assess. - Client D's blood sugar level is 128, which is in the target range for a diabetic post-operationally. This client doesn't need urgent assessment.

Choose the correct answer based on the ranking

Based on our ranking, the client that requires further assessment by the nurse is Client A (a 40-year-old 12 hours post-thyroidectomy experiencing numbness in the face).

Key concepts

Post-Thyroidectomy Care

After a thyroidectomy, a patient needs careful postoperative care to ensure a smooth recovery and to monitor for any complications. Nurses play a pivotal role in this stage. A critical aspect of post-thyroidectomy care involves evaluating the patient's calcium levels, as the thyroid gland is located near the parathyroid glands, which regulate calcium. Numbness in the face can be a sign of hypocalcemia, a condition where calcium levels in the blood are low, and this can occur if the parathyroid glands are inadvertently damaged or removed during surgery.

It is essential to monitor the patient's airway for signs of obstruction due to swelling, which can be life-threatening. The nurse should also assess for signs of bleeding or hematoma formation at the surgical site, as this can also compromise the airway. Regular assessment of vital signs, pain levels, and overall comfort are equally important.

Education for the patient is another key component of care. This includes instructions on how to support the neck while moving, pain management strategies, and the importance of taking prescribed medications, such as calcium supplements or thyroid hormone replacements.

Nursing Assessment Priorities

The nursing assessment of a postoperative patient, especially after thyroid surgery, should prioritize potential life-threatening complications. The presence of numbness or tingling sensations, particularly in the face or hands, can illuminate urgent concerns like hypocalcemia or tetany, requiring rapid intervention. Assessing for signs of respiratory distress is also critical, as swelling can lead to airway compromise.

Other priorities include monitoring for signs of infection, such as fever, which could result from surgical site infection or systemic issues. The nurse should continuously assess the incision site for signs of hemorrhage or hematoma. Evaluating the patient's ability to speak may also provide clues to recurrent laryngeal nerve damage, which can happen during thyroid surgery.

• Closely monitor vital signs
• Check calcium levels
• Observe neck swelling or discomfort
• Assess pain and administer analgesics as prescribed
• Monitor for signs of infection or bleeding
• Ensure understanding and adherence to discharge instructions

Postoperative Complications

Postoperative complications can pose significant risks to patients and need to be promptly identified and managed. After thyroidectomy, the most common complications include hypocalcemia due to accidental parathyroid gland injury, bleeding, hematoma, infection, and airway obstruction. Manifestations to look for include numbness in the face or extremities, changes in voice, difficulty breathing, swelling in the neck, excessive pain, and signs of infection like fever.

The nurse's ability to detect these complications early is crucial for successful intervention and patient outcomes. In the case of hypocalcemia, immediate administration of calcium is often necessary. For bleeding and hematoma, maintaining a patent airway and preparing for potential surgical intervention to relieve a hematoma may be required. Prompt recognition and treatment of infection with appropriate antibiotics is also vital. Comprehensive postoperative care aims to manage these complications and support the patient's recovery process adequately.