Thyroidectomy (Preop Teaching by Nursing)

See Surgical Protocol: Thyroidectomy and Thyroid Lobectomy

ROUTINE PREOPERATIVE TEACHING OF THE ADULT PATIENT

1. Objective:
   1. Patient/family will verbalize understanding of routine preoperative instructions.
2. Content:
   1. Refer to clinic policy Routine Preoperative Teaching for the Adult Patient.

DIET

1. Objective:
   1. Patient/family will verbalize understanding of postoperative diet.
2. Content:
   1. Nausea/vomiting may be present the first 24 hours after surgery as a side effect of general anesthetic agents.
   2. Antiemetics will be ordered on a PRN basis IV/PO/PR.
   3. Postoperative diet will begin with clear liquids and advance as tolerated when nausea/vomiting resolves.

ACTIVITY

1. Objective:
   1. Patient/family will verbalize understanding of postoperative positioning and activity.
2. Content:
   1. HOB is elevated 30°.
   2. Patient will be encouraged to ambulate and sit in chair when fully awake and alert (UAL).
   3. It may be helpful to support head and back of neck when rising to sitting position or lying down.

PAIN MANAGEMENT

1. Objective:
   1. Patient/family will verbalize understanding of pain assessment and medication administration.
2. Content:
   1. Introduce and explain use of pain assessment scales (Simple Descriptive, 0-10 Numeric). Identify patient's preference.
   2. Establish acceptable level of pain.
   3. Reassure that patient will be assessed frequently for pain.
   4. Pain medication will be administered intravenously on PRN basis while IV access is available.
   5. Oral pain medications will be available when patient is taking PO.

WOUND MANAGEMENT

1. Objective:
   1. Patient/family will verbalize understanding of wound management.
2. Content:
   1. Describe location of incision on anterior neck: will extend to upper lateral neck if neck dissection.
   2. A light dressing may be applied initially or after drains are removed.
   3. Closed wound drainage:
      1. Drain is surgically placed under skin and attached to suction.
      2. Purpose: to facilitate healing by preventing fluid accumulation under skin flap.
      3. Duration: usually 2 to 3 days, then discontinued when drainage decreases.
   4. Suture line care 2 to 4 times daily when dressing not in place; continued until sutures removed postoperative day 5 to 7.

INTRAVENOUS (IV) SOLUTIONS/MEDICATIONS

1. Objective:
   1. Patient/family will verbalize understanding of IV.
2. Content:
   1. Necessary to administer fluids until oral intake adequate.
   2. IV necessary to administer antibiotics as needed and to provide access for administration of analgesics, antiemetics, and calcium supplements.

HYPOPARATHYROIDISM (HYPOCALCEMIA)

1. Objective:
   1. Patient will verbalize understanding of signs/symptoms and interventions for hypocalcemia.
2. Content:
   1. Symptoms of low calcium levels are numbness or tingling of the fingers, toes, and/or around the mouth; weakness; fatigue; emotional instability; anxiety; depression.
   2. Nursing will assess for hypocalcemia by the following:
      1. The above symptoms listed in A.
      2. Chvostek's sign: tapping the branches of the facial nerve in front of the ear and observing for facial muscle twitching about the lips and eye.
      3. Trousseau's sign: applying and inflating blood pressure cuff on upper arm and observing for hand spasms.
      4. Serum calcium levels; frequency will depend on the surgical procedure; usually daily if total thyroidectomy is performed.
   3. Oral and/or IV calcium may be ordered if symptomatic or low serum calcium levels.

NECK DISSECTION

1. Objective:
   1. Patient/family will verbalize understanding of assessments and interventions related to postoperative neck dissection care.
2. Content:
   1. Skin flap will be assessed for adequate circulation.
   2. Avoid constrictive clothing around neck.
   3. Neck may have a sunken or depressed appearance on side of dissection.
   4. Patient may experience loss of sensation to posterior scalp, neck, and shoulder. Reinforce safety measures to protect skin from injury:
      1. Use caution with heat-producing appliances such as hair dryers and hot rollers.
      2. Do not use hot water bottles or heating pads on this area.
      3. Use protective covering in cold weather to prevent frost bite.
      4. Use sunscreen (SPF 15 or greater) and protective covering to prevent sunburn.
      5. Use electric razor to avoid cutting skin.
   5. Patient may experience weakness, discomfort, and limited mobility to affected shoulder. Patient will be assessed during postoperative clinic visits and may be instructed on exercises or referred to physical therapy.
   6. Postoperative pain manifested primarily by headache.

DISCHARGE INSTRUCTIONS

1. Objective:
   1. Patient/family will verbalize understanding of home care instructions.
2. Content:
   1. Discharge instructions per B-19b1--Thyroidectomy.
   2. Discharge instructions per B-19b1--Neck Dissection (if indicated).
   3. Discharge instructions per B-19b1--Suture Line Care.