NURSING CARE THE CLIENT HAVING A SUBTOTAL …

1 CHAPTER 17 / NURSING care of clients with Endocrine Disorders449because radioactive iodine crosses the placenta and can havenegative effects on the developing fetal thyroid gland. Be-cause the amount of gland destroyed is not readily control-lable, the CLIENT may become hypothyroid and require life-longTH hyperthyroid clients have such enlarged thyroid glandsthat pressure on the esophagus or trachea causes breathing orswallowing problems. In these cases, removal of all or part ofthe gland is indicated. Asubtotal thyroidectomyis usually per-formed. This procedure leaves enough of the gland in place toproduce an adequate amount of TH.

2 A total thyroidectomyisperformed to treat cancer of the thyroid; the CLIENT then requireslifelong hormone surgery, the CLIENT should be in as nearly a euthyroidstate as possible. The CLIENT may be given antithyroid drugs toreduce hormone levels and iodine preparations to decrease thevascularity and size of the gland (which also reduces the risk ofhemorrhage during and after surgery). NURSING care of the clienthaving a SUBTOTAL thyroidectomy is discussed in Box 17 CARETHE CLIENT HAVING A SUBTOTAL THYROIDECTOMYPREOPERATIVE care Administer ordered antithyroid medications and iodine prepa-rations, and monitor their drugs are givenbefore surgery to promote a euthyroid state.

3 Iodine preparationsare given to the CLIENT before surgery to decrease vascularity ofthe gland, thereby decreasing the risk of hemorrhage. Teach the CLIENT to support the neck by placing both handsbehind the neck when sitting up in bed, while moving about,and while the hands behind the neck providessupport for the suture line. Answer questions, and allow time for the CLIENT to the incision is made at the base of the throat, clients (especially women) are often concerned about their ap-pearance after surgery. Explain that the scar will eventually beonly a thin line and that jewelry or scarves may be used to coverthe care Provide comfort measures: Administer analgesic pain medica-tions as ordered, and monitor their effectiveness; place theclient in a semi-Fowler s position after recovery from anesthesia;support head and neck with medications re-duce the perception of pain and reduce physical stress during thepostoperative period.

4 Positioning the CLIENT in a semi-Fowler s posi-tion and supporting the head and neck decrease strain on thesuture line. Perform focused assessments to monitor for dressing (if present) and the area un-der the CLIENT s neck and shoulders for drainage. Monitorblood pressure and pulse for symptoms of hypovolemicshock. Assess tightness of dressing (if present).The vascu-larity of the gland increases the risk of hemorrhage. The loca-tion of the incision and the position of the CLIENT may causethe drainage to run back and under the CLIENT . The dangerof hemorrhage is greatest in the first 12 to 24 hours respiratory rate, rhythm, depth,and effort.

5 Maintain humidification as ordered. Assist theclient with coughing and deep breathing. Have suctionequipment, oxygen, and a tracheostomy set available forimmediate distress may result from hemor-rhage and edema, which may compress the trachea; fromtetany and laryngeal spasms resulting from decreased hor-mones due to removal or damage to the parathyroid glands;and from damage to the laryngeal nerve, causing spasms ofthe vocal cords. Equipment must be immediately available ifthe CLIENT experiences respiratory distress that requires inter-ventions and nerve for the ability to speakaloud, noting quality and tone of location of thelaryngeal nerve increases the risk of damage during thyroidsurgery.

6 Although hoarseness may be due to edema or theendotracheal tube used during surgery and will subside, per-manent hoarseness or loss of vocal volume is a t a n for signs of calcium deficiency, including tin-gling of toes, fingers, and lips; muscular twitches; positiveChvostek s and Trousseau s signs; and decreased serum cal-cium levels. Keep calcium gluconate or calcium chlorideavailable for immediate intravenous use, if glands are located in and near the thyroid gland;surgery of the thyroid gland may injure or remove parathy-roid glands, resulting in hypocalcemia and tetany. Tetany mayoccur in 1 to 7 days after CareHealth PromotionAlthough hyperthyroidism is not preventable, it is important toteach clients the importance of regular health care provider vis-its and medication following data are collected through the health history andphysical examination (see Chapter 16).

7 Further focused assess-ments are described with NURSING interventions below. Health history:other diseases, family history of thyroid dis-ease, when symptoms began, severity of symptoms, intake ofthyroid medications, menstrual history, changes in weight,bowel elimination Physical assessment:muscle strength, tremors, vital signs,cardiovascular and peripheral vascular systems, integu-ment, size of thyroid, presence of bruit over thyroid, eyesand visio