Which sign or symptom is an early indication of hypocalcemia that the nurse should monitor for in a postoperative thyroidectomy patient?

A) Tingling sensation in fingertips

A patient who recently underwent a subtotal thyroidectomy is experiencing a slight tingling sensation in the fingertips and lips. Which of the following is the nurse's priority action?

B) Administer calcium supplementation as prescribed

A) Encourage the patient to increase fluid intake

B) Administer calcium supplementation as prescribed

C) Apply warm compresses to the surgical site

D) Instruct the patient to perform deep breathing exercises

A patient is experiencing mild hypocalcemia with symptoms of tingling in the fingertips and lips. Which dietary advice should the nurse provide to help manage the patient's condition?

B) Increase intake of foods high in calcium, such as dairy products and leafy green vegetables.

A) Increase intake of foods high in potassium, such as bananas and oranges.

B) Increase intake of foods high in calcium, such as dairy products and leafy green vegetables.

C) Increase intake of foods high in sodium, such as processed meats and canned soups.

D) Increase intake of foods high in protein, such as chicken and fish.

Which dietary recommendation should the nurse include in the patient's education plan to help manage the mild hypocalcemia?

A) Increase intake of foods high in calcium, such as dairy products.

B) Avoid foods high in potassium, such as bananas and oranges.

C) Limit fluid intake to prevent fluid overload.

D) Consume more foods high in fiber to regulate digestion.

Which dietary recommendation should the nurse provide to the patient to help maintain an upward trend in calcium levels?

B) Consume more dairy products and fortified cereals

A) Increase intake of foods high in vitamin C

B) Consume more dairy products and fortified cereals

C) Avoid foods containing vitamin D

D) Limit intake of leafy green vegetables

What dietary recommendation should the nurse provide to a patient to support calcium absorption?

C) Include foods high in vitamin D

A) Increase intake of foods high in vitamin C

B) Consume more foods rich in vitamin K

C) Include foods high in vitamin D

D) Avoid foods containing potassium

A patient recovering from surgery has a serum calcium level of 8.6 mg/dL. What is the primary reason for the nurse to continue emphasizing dietary adherence to calcium-rich foods?

C) To decrease the risk of infection

What is the most appropriate nursing action to address the patient's mild fatigue post-surgery?

B) Encourage the patient to maintain adequate hydration and rest

A) Increase the patient's activity level immediately

B) Encourage the patient to maintain adequate hydration and rest

C) Suggest the patient discontinue calcium supplements

D) Advise the patient to avoid calcium-rich foods

What is the most likely reason for the patient's mild fatigue following surgery?

C) Infection at the surgical site

subtotal thyroidectomy - Nursing Case Study

Pathophysiology

• Primary mechanism: Subtotal thyroidectomy involves removing a significant portion of the thyroid gland, which decreases the production of thyroid hormones (T3 and T4), crucial for metabolism and energy regulation in the body.

• Secondary mechanism: The surgery can inadvertently damage the parathyroid glands, which are responsible for calcium regulation, leading to potential disturbances in calcium balance.

• Key complication: Hypocalcemia may occur due to parathyroid gland damage, causing symptoms like tingling, muscle cramps, and in severe cases, cardiac issues, requiring close monitoring and possible supplementation.

Patient Profile

Demographics:

45-year-old male, office manager

History:

• Key past medical history: Diagnosed with multinodular goiter

• Current medications: Levothyroxine 50 mcg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Neck swelling

• Key symptoms: Mild difficulty swallowing, slight hoarseness of voice

• Vital signs: Blood pressure 120/80 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon admission to the postoperative unit, the patient is resting comfortably in bed. His vital signs remain stable with a blood pressure of 118/76 mmHg, heart rate of 70 bpm, respiratory rate of 16 breaths per minute, and an oxygen saturation of 98% on room air. The surgical site is clean, dry, and intact with minimal swelling observed around the incision. The patient reports mild discomfort at the incision site, which is well-controlled with prescribed analgesics. During the assessment, the patient mentions experiencing a slight tingling sensation in his fingertips and lips, a potential early sign of hypocalcemia.

The nurse conducts a focused assessment, including a Chvostek's sign test, which shows a slight twitching response when the facial nerve is tapped. The patient is also instructed to perform a Trousseau's sign test, which does not elicit any carpal spasm within the 3-minute timeframe. The patient is alert and oriented, able to engage in conversation without significant hoarseness, though he occasionally clears his throat due to a slight sensation of fullness. Given these findings, the nurse prioritizes monitoring the patient's calcium levels closely, considering the potential for hypocalcemia due to the recent subtotal thyroidectomy. The healthcare team is informed to consider timely laboratory evaluations and calcium supplementation if necessary.

Section 2

As the patient progresses through the initial postoperative phase, the nurse continues to monitor him closely for any changes in his condition. The next morning, the lab results return, revealing a total serum calcium level of 7.8 mg/dL, which is slightly below the normal range of 8.5-10.5 mg/dL. This finding confirms the initial suspicion of mild hypocalcemia. In response, the healthcare team decides to initiate an oral calcium supplement to prevent further decline and address the patient's symptoms of tingling in his fingertips and lips.

Throughout the day, the patient's vital signs remain stable, with blood pressure at 116/78 mmHg, heart rate at 72 bpm, respiratory rate at 18 breaths per minute, and oxygen saturation at 97% on room air. The nurse continues to assess the surgical site, which remains clean and intact with no signs of infection or increased swelling. The patient reports that the tingling sensation has decreased since starting the calcium supplements, and he feels more comfortable overall. He is encouraged to maintain a diet rich in calcium and vitamin D to support his recovery and prevent further complications.

The nursing team educates the patient and his family on the signs and symptoms of hypocalcemia and the importance of adhering to the prescribed calcium regimen. With this proactive approach, the patient is expected to achieve stable calcium levels and continue on a positive trajectory toward recovery. The nurse plans to reassess the patient's calcium levels in the coming days to ensure they are within the normal range and to adjust the treatment plan as necessary.

Section 3

As the patient continues to progress through the postoperative phase, the nurse conducts a follow-up assessment to evaluate the patient's response to the calcium supplementation. The patient reports feeling more energetic and notes that the tingling in his fingertips and lips has significantly diminished. Encouraged by these improvements, the nurse documents the patient's current vital signs: blood pressure remains stable at 114/76 mmHg, heart rate is a steady 70 bpm, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. The surgical site is inspected and continues to heal appropriately, with no signs of infection or abnormal swelling.

Later in the day, new lab results are received, indicating an improvement in the patient's serum calcium level, which now measures 8.3 mg/dL, just below the normal range. This change suggests a positive response to the oral calcium supplements. The nurse discusses these results with the healthcare team, and they decide to continue the current calcium regimen while incorporating dietary recommendations to maintain the upward trend in calcium levels. The patient is advised to consume foods high in calcium and vitamin D, such as dairy products, leafy greens, and fortified cereals, to further support his recovery.

The nurse also provides additional education to the patient and his family about recognizing potential signs of calcium imbalance, such as muscle cramps or increased tingling, and stresses the importance of adhering to follow-up appointments. With these measures in place, the patient is on a steady path to recovery. The healthcare team plans to reassess his calcium levels in a few days to ensure they have stabilized within the normal range, allowing for any necessary adjustments to his treatment plan.

Section 4

A few days later, the patient arrives for a scheduled follow-up appointment. The nurse conducts a thorough assessment to evaluate the patient's progress. The patient reports feeling more energetic and free from the tingling sensations he previously experienced. He also mentions that he has been following the dietary recommendations closely, incorporating more calcium-rich foods into his meals. Vital signs are taken, revealing a blood pressure of 116/78 mmHg, a heart rate of 72 bpm, a respiratory rate of 18 breaths per minute, and an oxygen saturation of 98% on room air. The surgical site is healing well, with no signs of infection, erythema, or abnormal swelling, confirming the patient's recovery is on track.

The nurse reviews the latest lab results, which show a further improvement in the patient's serum calcium level, now at 8.6 mg/dL, entering the normal range. This positive trend indicates that the combination of calcium supplementation and dietary adjustments is effectively stabilizing the patient's calcium levels. The healthcare team decides to maintain the current treatment plan, with an emphasis on continued dietary adherence and monitoring for any symptoms of calcium imbalance.

The patient is reminded of the importance of reporting any new symptoms, such as muscle cramps or tingling, as they could indicate a change in calcium levels. The healthcare team schedules the next follow-up to reassess the situation and ensure that the patient's calcium levels remain stable. With these plans in place, the patient is optimistic about his recovery and committed to following his care regimen. As he leaves the clinic, the nurse feels confident that the patient is well-supported in his recovery journey, with all necessary measures in place to address any future challenges.

Section 5

A week later, the patient returns for a follow-up visit and is greeted by the nurse for an initial assessment. The patient mentions experiencing mild fatigue over the past few days but denies any muscle cramps or tingling sensations. He continues to adhere to his dietary recommendations, focusing on calcium-rich foods and maintaining his supplement regimen. Upon examination, the nurse notes the patient's vital signs are stable: blood pressure is 118/76 mmHg, heart rate is 75 bpm, respiratory rate is 18 breaths per minute, and oxygen saturation remains at 98% on room air. The surgical site continues to heal well without any signs of infection or abnormal swelling.

The nurse reviews the latest lab results with the patient. The results show that the patient's serum calcium level has stabilized at 8.8 mg/dL, further confirming the effectiveness of the dietary and supplementation plan. Thyroid function tests reveal a slight decrease in TSH levels, which the healthcare team anticipated as part of the post-surgery adjustment period. While the TSH level is still within the normal range, the nurse discusses the importance of continued monitoring to ensure the thyroid hormone levels remain balanced.

Given the patient's mild fatigue, the nurse collaborates with the healthcare team to consider a possible adjustment in the patient's activity level and dietary intake to enhance energy levels. The patient is advised to maintain adequate hydration, incorporate small, frequent meals, and ensure sufficient rest. The healthcare team schedules a follow-up appointment in two weeks to reassess the patient's energy levels and ensure ongoing stabilization of calcium and thyroid hormone levels. The patient expresses understanding of the plan and remains committed to adhering to his care regimen, feeling assured by the support of his healthcare team on his recovery journey.