Thyroidectomy Nursing Care Plans Diagnosis and Interventions
Thyroidectomy NCLEX Review and Nursing Care Plans
Thyroidectomy is the surgical removal of the thyroid gland, either entirely or partially. The thyroid gland is an organ that has the shape of a butterfly and is situated near the base of the neck. Heart rate and how rapidly a person burns calories are regulated by their body’s hormones.
Depending on the surgery’s indication, the thyroid gland may be partially removed during a thyroidectomy. The thyroid may function normally following surgery if only a portion of it needs to be removed (partial thyroidectomy). To restore the thyroid’s natural function after a total thyroidectomy, the patient must take thyroid hormone every day.
Indications of Thyroidectomy
If the patient has any of the following conditions, their doctor may advise thyroidectomy:
- Cancer. The most prevalent reason for thyroidectomy is cancer. Most likely, one of the treatment options, if a patient has thyroid cancer, is to have most of their thyroid removed.
- Hyperthyroidism. Hyperthyroidism refers to a hyperactive thyroid, as a result, excessive thyroid hormone is being produced. The level of TSH in the blood is reduced by the pituitary gland. The following are typical signs and symptoms of hyperthyroidism:
- heat intolerance
- feeling uneasy or agitated
- rapid heartbeat
- losing pounds without dieting
- tiredness weakened muscles
- Nodules. There are two types of thyroid nodules: solid and cystic (fluid-filled). If someone has nodules, the thyroid gland usually functions normally. The majority of nodules are not malignant. However, the doctor might remove a sample of the nodule’s cells. This is known as fine needle aspiration. To ensure that there are no cancer cells present, this sample will be evaluated.
- Goiter. The thyroid gland has enlarged. The neck may feel swollen or enlarged. The thyroid gland may try to produce more thyroid hormone, which could cause it to grow. Furthermore, rapid cell growth in hyperthyroidism causes the thyroid to enlarge and produce more thyroid hormone than is required by the body. The thyroid gland may be removed entirely or in part, if the enlarged goiter is uncomfortable, interferes with the ability to breathe or swallow, or, in some cases, if the goiter is contributing to hyperthyroidism.
Risk of Thyroidectomy
- Hemorrhage. Due to the thyroid’s extensive blood supply, bleeding after thyroidectomy can be fatal. The patient needs to be constantly monitored for bleeding after this procedure.
- Parathyroid damage. These glands, which are about the size of a rice grain and somewhat in the way during a thyroidectomy, might occasionally suffer unintentional scratch or injury.
- Hypocalcemia. The parathyroid glands secrete parathyroid hormone (PTH), which causes calcium to increase. Hypocalcemia will ensue if the parathyroid glands, whose function is to indirectly increase blood calcium, get destroyed and are unable to perform their duties. The signs and symptoms of hypocalcemia are also indications and symptoms of parathyroid damage, and these include:
- tingling around the mouth
- twitching muscles
- GI distress,
- positive Chvostek’s and Trousseau’s signs,
- Recurrent laryngeal injury. Recurrent laryngeal nerve injury is a well-known risk of thyroidectomy. It may result in vocal fold paresis or paralysis. If an injury occurs, the patient typically complains of postoperative, ongoing hoarseness, trouble swallowing, or aspirating thin liquids.
Check the patient’s wound bandage for blood regularly and check behind their neck to make sure no blood is collecting there.
- Post-surgical infection. The typical presentation of post-surgical infection is superficial cellulitis with warmth, erythema, and discomfort near the surgical incision. A superficial abscess may be present if fluctuance is noticeable. Fever and leukocytosis are two additional infection-related symptoms that, in the absence of cellulitis, may indicate a deep space neck infection or abscess.
Pre-procedure Nursing Care: Preparing the patient for Thyroidectomy
- Before surgery, it is necessary to evaluate the vital signs, physical condition, and previous illnesses of the patients as well as any current signs and symptoms. The team will plan an appropriate nursing intervention considering the evaluation’s results.
- To assess the health of the patient’s heart and lungs, the doctor would require an ECG, a chest x-ray, or a stress test. In addition, evaluation may also involve ultrasonography and/or fine needle aspiration biopsy (FNA) to assess the function and anatomy of the thyroid gland. The nurse must verify that all necessary testing has been carried out.
- After the doctor has explained to the patients the preparation, procedure, and risks of thyroidectomy, the nurse will get informed consent.
- The patient must discuss all current medications, including prescription, over-the-counter, vitamins, supplements, and herbal remedies, with the surgeon or primary care physician before the procedure. It may be necessary to discontinue taking some drugs before surgery as they could induce hemorrhage or interact with anesthesia.
- The surgical team may deliver an antibiotic right before the procedure if the patient has a weakened immune system or another condition that makes them vulnerable to infections. In addition, the patient might receive antiemetic medicine.
- Prior to surgery, the patients are usually required to fast for 12 hours and refrain from drinking anything. The patients were also instructed on how to cough and expectorate, as well as given advice on quitting smoking to lessen respiratory secretions.
What Happens during a Thyroidectomy
- The patient won’t be conscious during the thyroidectomy because a general anesthetic is frequently used by surgeons. The anesthesiologist or anesthetist will either inject a liquid anesthetic into a vein or administer a gas anesthetic by breathing through a mask. The next step is to place a breathing tube in the trachea to help the patient breathe during the procedure.
- The surgical team will put various sensors on the body to help ensure the patient’s heart rate, blood pressure, and blood oxygen levels remain at safe levels throughout the treatment. These monitors consist of a blood pressure cuff on the arm and chest-mounted cardiac monitor wires. An intravenous (IV) line will be placed into the patient’s arm or hands by a medical professional.
- The patient will be in a semi-seated position in the operating room, supported under the neck and shoulders, with or without the chin tilted back. The majority of thyroidectomies are carried out while the patient is unconscious and pain-free. Over the surgery site, a patient’s skin will be cleaned with an antiseptic solution.
- To minimize the visibility of the scar, the surgeon will create a small incision in the neck’s skin as near as possible to a natural wrinkle. The thyroid gland is accessed by cutting a thin layer of muscle, and one or both thyroid lobes, as well as any potentially diseased lymph nodes nearby, are then removed by the surgeon. Depending on the purpose of the surgery, either all or a portion of the thyroid gland is then removed.
- Thyroidectomy procedures typically last one to two hours. Depending on the complexity of the required procedure, it could take longer or shorter.
- A modern approach to this procedure is called scarless transoral thyroidectomy, in which the thyroid gland can be accessed through the mouth. No external neck incision is made during this procedure, so there is no visible scar.
- The surgeon will realign the muscles in the front of the neck. Glue or sutures are used to seal the skin.
Post-Procedure Nursing Care for Thyroidectomy
- Check the wound dressing and the skin on the shoulders, neck, and back frequently for severe bleeding.
- Support the patient’s neck when sitting or shifting the patient’s position. This will help to prevent neck pain brought on by activities.
- To keep the suture line intact, the nurse must support it and maintain its midline. maintain a neutral position by supporting the patient’s head and neck with either sandbags or pillows.
- As prescribed by the doctor, administer pain medication. Most patients only require mild pain medication in the first few days after surgery due to the minimal discomfort at the incision site.
- For the first several days after surgery, tell the patient to avoid speaking much. Following the surgery, the voice may sound strained or fragile, however, this usually passes quickly.
- Raise the head of the bed by 25 to 35 degrees to prevent obstruction in the airway.
- Cold liquid meals may be given to the patient when completely awake. In the absence of nausea on the second day following surgery, the patient may consume a soft diet.
- Inform the patient that, in most situations, walking and daily activities can be resumed a few days following surgery, but that strenuous activities and lifting heavy objects should be avoided for two weeks.
Home Care After Thyroidectomy
- Provide the patient and family members with instructions on how to follow the doctor’s prescription. Remind them not to change any prescription dosage without first talking to their doctor.
- After thyroid surgery, it’s critical to keep the operative area dry and clean. The patient will receive wound care instructions from the physician. Typically, the stitches are removed at a follow-up clinic visit.
- Advise the patient to attend a follow-up appointment with the physician within 1-2 weeks to avoid any complications.
- Advise the patient to contact the doctor or head back to the hospital as soon as possible if any of the listed symptoms or indicators appear:
Nursing Diagnosis for Thyroidectomy
Nursing Care Plan for Thyroidectomy 1
Nursing Diagnosis: Acute Pain related to mechanical tissue damage secondary to thyroidectomy as evidenced by the patient’s complaints of pain at the operation site, agitation, irritability, and elevated vital signs.
- From a previous score of 7 out of 10, the patient’s report of decreased pain intensity was on a pain scale of 3.
- The patient will show their ability to use diversionary activities to lessen their feeling of discomfort.
- The Patient’s vital signs will improve within normal limits.
|Thyroidectomy Nursing Interventions||Rationale|
|Keep track of the patient’s vital signs, paying close attention to the depth, rhythm, and rate of breathing as well as other respiratory function indicators.||This establishes a baseline for patient condition information and aids in the planning of efficient care.|
|Analyze the patient’s experience of pain, paying attention to how he characterizes it on a scale (with 0 indicating no pain and 10 referring to excruciating pain). Examine the PQRST of pain as well. P- perceptionQ- qualityR-radiationS- severityT- time||The nurse can more effectively arrange patient treatment by knowing the patient’s precise perception of their level of discomfort.|
|Place the patient in a Semi-Fowler’s position, with the head and neck supported by sandbags or pillows,||The Semi-Fowler position prevents the neck from extending too far and releases pressure from the suture line. The sandbags or pillows on either side of the neck assist in maintaining the head and neck’s midline alignment.|
|Instruct the patient to place their hands behind their necks and move carefully as needed to support their head and neck throughout motions.||By preventing excessive pressure on the suture line, this technique reduces pain perception while preserving the patient’s head- and neck-moving mobility.|
|Provide cold beverages or popsicles to the patients. Ice cream and sorbet may also be served. Foods that have been softened or mashed may also be offered to the patient if they are already allowed to eat by mouth.||Cooled beverages may help the patient swallow more easily while also relaxing the throat and neck. For patients who have just been permitted to start oral feedings, mashed or softened foods also assist lower the risk of aspiration.|
|Give prescription analgesics and other pain- and/or swelling-relieving drugs as needed.||These drugs may help the patient feel more at ease overall by acting to relieve pain and reduce edema, and other symptoms.|
Nursing Care Plan for Thyroidectomy 2
Risk for ineffective airway clearance
Nursing Diagnosis: Risk for Ineffective Airway Clearance related to laryngeal spasm secondary to thyroidectomy.
- The patient will keep and preserve a patent airway.
- The patient will demonstrate effortless and unlabored breathing with normal respiratory rates.
|Thyroidectomy Nursing Interventions||Rationale|
|Keep track of the patient’s vital signs, paying special attention to respiratory function measures such as depth, and rate.||This sets a baseline for the patient’s health status and aids in the planning of appropriate care.|
|Observe any unexpected sounds, such as crackles, wheezes, rhonchi, and others, upon auscultation of breath sounds. Record these observations.||The degree of airway obstruction may be determined by the existence of adventitious breath noises. Any result should be recorded and utilized as a reference.|
|Evaluate the patient to see whether they have any stridor, crowing(more pronounced during inspiration), or any difficulty breathing||These are suggestive of laryngeal spasms and may require an emergency referral. A laryngeal spasm is a serious condition that can be fatal.|
|Teach the patient the proper deep breathing, coughing, and positioning themselves while paying close attention to prevent the suture line from experiencing undue tension.||Clearing the airway of mucus sometimes with a cough and deep breathing can assist. Breathing exercises are occasionally suggested to clear secretions, albeit they are not typically done for patients who have had a thyroidectomy.|
|Suction the patient’s mouth and trachea if necessary. Make sure that the proper facility procedures are followed and that the sputum’s characteristics are recorded.||Suctioning aids in the removal of viscous secretions from the airway and makes air exchanges easier.|
|In case it’s required, get ready to provide oxygen and other pharmacologic treatments.||Oxygen and medication may be used to ease gas exchange and airway blockage.|
|Patients with serious airway issues that other conservative methods are unable to treat should be prepared to need a tracheostomy.||When other methods are unsuccessful, a tracheostomy is performed to open an airway and make breathing easier for the patient.|
Nursing Care Plan for Thyroidectomy 3
Nursing Diagnosis: Impaired Verbal Communication related to laryngeal nerve damage secondary to thyroidectomy as evidenced by the inability to communicate and use of nonverbal indicators like gestures.
- The patient will demonstrate understandable communication skills.
- The patient will ensure being understood by others by using efficient communication techniques.
- The patient will build a means of communication that enables them to be recognized.
|Thyroidectomy Nursing Interventions||Rationale|
|Evaluate the patient’s verbal and written communication skills prior to and following surgery.||Determine whether there is a communication issue by contrasting the patient’s verbal communication abilities before and after surgery. It is important to analyze and properly record symptoms like hoarseness of voice and sore throat.|
|Maintain brief and straightforward communication with the patient. Employ questions that can be answered with a yes or no.||The patient can relax his voice and the demand on his speech is lessened as a result.|
|Offer the patient various communication tools, such as writing papers, chalkboard boards, and letter/picture signage.||Utilizing these strategies enables the patient to convey his demands more clearly, lessens the strain associated with using his voice to speak, and promotes further relaxation.|
|Include the patient’s family in the care plan, particularly with regard to communication.||This promotes continuity of treatment and aids the family in adjusting to any short-term or long-term changes in communication styles.|
|Visit the patient frequently and pay attention to nonverbal signs to anticipate his requirements.||As a result of not having to verbally explain himself, the patient has less tension and worry. Because he won’t have to shout for help as often, anticipating his requirements also encourages calm.|
Nursing Care Plan for Thyroidectomy 4
Nursing Diagnosis: Risk for Injury related to decreased chemical imbalance: excessive CNS stimulation secondary to thyroidectomy.
Desired Outcome: The patient will exhibit no evidence of injury and further complications are controlled
|Thyroidectomy Nursing Interventions||Rationale|
|Observe the patient’s vital signs and keep track of any cyanosis, tachycardia, high fever, or other irregular heartbeats.||In the course of partial thyroidectomy, the gland may be manipulated, which could cause a thyroid storm due to increased hormone release.|
|Regularly assess reflexes. Check for neuromuscular irritability by looking for twitching, numbness, paresthesias, positive Chvostek’s and Trousseau’s symptoms, and seizure activity.||Hypocalcemia with tetany (typically transitory) may appear 1–7 days after surgery and is an indication of hypoparathyroidism, which can be brought on by accidental injury to or partial–total excision of the parathyroid gland(s) during surgery.|
|Keep the airway at the bedside, bed at of a low position, and the side rails lifted and padded. Stay away from using constraints.||Lessens the possibility of injury in the event of seizures.|
|Check the calcium levels in the blood.||Patients who have levels of less than 7.5 mg/100 mL typically need supplementation therapy.|
|To reduce the risk of the patient accidentally falling, invite family members or close friends to stay with them.||This is to keep the patient safe from harm, falls, and other mishaps. Family members of hospitalized patients have an important impact in assuring safety and defending their loved ones from harm.|
|Encourage the patient to express their feelings and worries about environmental dangers.||By expressing their understanding of the patient’s information and concerns, the nurse can validate the patient’s experience. Additionally, it enhances the bond between the nurse and the patient.|
|Administer medications as directed:|
|Calcium (gluconate, lactate)||This drug fixes deficiencies, which are typically transient but could be irreversible. Because calcium increases cardiac sensitivity to digitalis and amplifies the risk of toxicity, take caution in individuals receiving the medication.|
|Phosphate-binding agent||This drug reduces increased phosphorus levels linked with hypocalcemia.|
|Sedatives||These encourage relaxation while decreasing external stimulation.|
|Anticonvulsants||These drugs limit seizure activity until effective treatment has been received.|
Nursing Care Plan for Thyroidectomy 5
Nursing Diagnosis: Deficient Knowledge related to unfamiliarity with information sources secondary to thyroidectomy as evidenced by incorrect delivery of instructions or the development of avoidable difficulties.
- The patient will express verbally his or her comprehension of the surgical process, the prognosis, and any potential complications.
- The patient will express their awareness of their therapy needs verbally.
- The patient will demonstrate active participation in the treatment program.
|Thyroidectomy Nursing Interventions||Rationale|
|Review the patient’s surgery, how it went, what happened, and what to expect going forward.||This provides the patient with solid information from which to make decisions.|
|When indicated, teach the patient or encourage the patient or family members to demonstrate wound care.||This instruction encourages capable self-care and progressive separation from the care of the doctor.|
|Share with the patient the dangers of interacting with people who are ill or the public, as well as the value of a clean environment.||During their recovery, patients should be kept apart from visitors to help lower the risk of infections.|
|Discuss drug therapy with the patient, including recommended OTC medications and analgesics.||The patient’s full and continuous compliance with the regimen lowers the chance of complications from surgery, including bacterial infection or excruciating pain at the operative site.|
|Let the patient know that some activities are restricted for them.||It is advised that the patient stay still and let the companion or caregiver take care of their requirements to promote recovery and enhance the healing process.|
|Discuss the importance of a well-balanced, nutritious eating plan and, where appropriate, the use of iodized salt.||Helps the patient regain or maintain a healthy weight while fostering healing. Unless salt is restricted for other medical reasons, using iodized salt can frequently meet iodine needs.|
|Recommend avoiding goitrogenic foods, such as excessive consumption of fish, soybeans, and turnips.||These foods should not be consumed after partial thyroid surgery because they interfere with thyroid function.|
|Determine which foods are rich in vitamin D and calcium.||If the parathyroid function is compromised, it enhances calcium supply and absorption.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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