Physiological Integrity Q 46
A client had a total thyroidectomy yesterday. The client is complaining of tingling around the mouth and in the fingers and toes. What would the nurse’s next action be?
A. Obtain a crash cart
B. Check the calcium level
C. Assess the dressing for drainage
D. Assess the blood pressure for hypertension
Correct Answer: B. Check the calcium level
The parathyroid glands are responsible for calcium production and can be damaged during a thyroidectomy. The tingling is due to low calcium levels. Evaluate reflexes periodically. Observe for neuromuscular irritability: twitching, numbness, paresthesias, positive Chvostek’s and Trousseau’s signs, seizure activity.
Option A: The crash cart would be needed in respiratory distress but would not be the next action to take. Hypocalcemia with tetany (usually transient) may occur 1–7 days postoperatively and indicates hypoparathyroidism, which can occur as a result of inadvertent trauma to or partial-to-total removal of the parathyroid gland(s) during surgery.
Option C: The drainage would occur in hemorrhage. Check dressing frequently, especially the posterior portion. If bleeding occurs, the anterior dressing may appear dry because blood pools dependently.
Option D: Hypertension occurs in a thyroid storm. Monitor vital signs noting elevated temperature, tachycardia, arrhythmias, respiratory distress, cyanosis. Manipulation of the gland during subtotal thyroidectomy may result in increased hormone release, causing thyroid storm.