Thyroidectomy (Preop Teaching by Nursing)
See Surgical Protocol: Thyroidectomy and Thyroid Lobectomy
ROUTINE PREOPERATIVE TEACHING OF THE ADULT PATIENT
- Objective:
- Patient/family will verbalize understanding of routine preoperative instructions.
- Content:
- Refer to clinic policy Routine Preoperative Teaching for the Adult Patient.
DIET
- Objective:
- Patient/family will verbalize understanding of postoperative diet.
- Content:
- Nausea/vomiting may be present the first 24 hours after surgery as a side effect of general anesthetic agents.
- Antiemetics will be ordered on a PRN basis IV/PO/PR.
- Postoperative diet will begin with clear liquids and advance as tolerated when nausea/vomiting resolves.
ACTIVITY
- Objective:
- Patient/family will verbalize understanding of postoperative positioning and activity.
- Content:
- HOB is elevated 30°.
- Patient will be encouraged to ambulate and sit in chair when fully awake and alert (UAL).
- It may be helpful to support head and back of neck when rising to sitting position or lying down.
PAIN MANAGEMENT
- Objective:
- Patient/family will verbalize understanding of pain assessment and medication administration.
- Content:
- Introduce and explain use of pain assessment scales (Simple Descriptive, 0-10 Numeric). Identify patient's preference.
- Establish acceptable level of pain.
- Reassure that patient will be assessed frequently for pain.
- Pain medication will be administered intravenously on PRN basis while IV access is available.
- Oral pain medications will be available when patient is taking PO.
WOUND MANAGEMENT
- Objective:
- Patient/family will verbalize understanding of wound management.
- Content:
- Describe location of incision on anterior neck: will extend to upper lateral neck if neck dissection.
- A light dressing may be applied initially or after drains are removed.
- Closed wound drainage:
- Drain is surgically placed under skin and attached to suction.
- Purpose: to facilitate healing by preventing fluid accumulation under skin flap.
- Duration: usually 2 to 3 days, then discontinued when drainage decreases.
- 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
- Objective:
- Patient/family will verbalize understanding of IV.
- Content:
- Necessary to administer fluids until oral intake adequate.
- IV necessary to administer antibiotics as needed and to provide access for administration of analgesics, antiemetics, and calcium supplements.
HYPOPARATHYROIDISM (HYPOCALCEMIA)
- Objective:
- Patient will verbalize understanding of signs/symptoms and interventions for hypocalcemia.
- Content:
- Symptoms of low calcium levels are numbness or tingling of the fingers, toes, and/or around the mouth; weakness; fatigue; emotional instability; anxiety; depression.
- Nursing will assess for hypocalcemia by the following:
- The above symptoms listed in A.
- 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.
- Trousseau's sign: applying and inflating blood pressure cuff on upper arm and observing for hand spasms.
- Serum calcium levels; frequency will depend on the surgical procedure; usually daily if total thyroidectomy is performed.
- Oral and/or IV calcium may be ordered if symptomatic or low serum calcium levels.
NECK DISSECTION
- Objective:
- Patient/family will verbalize understanding of assessments and interventions related to postoperative neck dissection care.
- Content:
- Skin flap will be assessed for adequate circulation.
- Avoid constrictive clothing around neck.
- Neck may have a sunken or depressed appearance on side of dissection.
- Patient may experience loss of sensation to posterior scalp, neck, and shoulder. Reinforce safety measures to protect skin from injury:
- Use caution with heat-producing appliances such as hair dryers and hot rollers.
- Do not use hot water bottles or heating pads on this area.
- Use protective covering in cold weather to prevent frost bite.
- Use sunscreen (SPF 15 or greater) and protective covering to prevent sunburn.
- Use electric razor to avoid cutting skin.
- 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.
- Postoperative pain manifested primarily by headache.
DISCHARGE INSTRUCTIONS
- Objective:
- Patient/family will verbalize understanding of home care instructions.
- Content:
- Discharge instructions per B-19b1--Thyroidectomy.
- Discharge instructions per B-19b1--Neck Dissection (if indicated).
- Discharge instructions per B-19b1--Suture Line Care.