ENDOCRINE DISORDERS CASE STUDY
SCENARIO
You are working on the postoperative unit and will be receiving a patient
from the recovery room. The post-anesthesia care unit nurse calls and gives
the following report: C.P. is a 50-year-old woman with a subtotal
thyroidectomy for papillary carcinoma. The estimated blood loss was 25mL.
Vital signs (VS) are 130/82, 80 to 90, 20, and Sao2 94% on room air. She has a
peripheral IV of PNSS with 20mEq KCl infusing at 100mL/hr. She has
received a total of 3mg morphine sulfate IV push, and she remains awake, but
drowsy, and fully oriented. C.P.'s past medical history includes a total
abdominal hysterectomy for fibroids and low-level radiation treatments to the
neck 30 years ago for eczema. Her medications include lovastatin (Mevacor)
and levothyroxine (Synthroid). Both parents are living; her father had a
myocardial infarction at 70 years of age; her mother has hypothyroidism but
never had thyroid tumors.
1. What preparations will you make before C.P. arrives?
2. You receive C.P. from the recovery room. How will you focus on your
initial assessment, and why?
3. During your initial assessment, you document negative Chvostek's and
Trousseau's signs. Describe data that would support this conclusion.
4. Identify the major risk factor that might have contributed to the
development of thyroid adenoma in C.P.
5. List four complications that C.P. is at risk for postoperatively, and then
describe actions you should include in C.P.'s postoperative care related to
each complication.
6. Identify measures that reduce the risk for postoperative swelling.
7. After surgery, C.P.'s thyroid hormone levels are elevated, and the physician
orders propranolol (Inderal) 80mg ER orally twice daily for “surgically
induced thyrotoxicosis.” Is this reaction expected following thyroid surgery,
or did something go wrong during surgery? Explain.
8. Eighteen hours after surgery, C.P. calls you into her room complaining of
numbness around her mouth and tingling at the tips of her fingers and
jitteriness. She appears restless. What is the significance of these findings?
9. Realizing that C.P. might be experiencing hypocalcemia, you notify the
physician. What will you do in the interim before the physician returns your
call?
10. The physician orders you to give C.P. 1 g calcium gluconate IV over 15
minutes now, and then initiate an infusion of 2 g calcium gluconate in 500mL
D5W over 12 hours. After the bolus is complete, at what rate will you set the
IV pump?
11. What precautions do you need to take while administering the calcium
gluconate infusion?
CASE STUDY PROGRESS
C.P. is given supplemental calcium gluconate and recovers without further
complications. You are preparing her for discharge 2 days postoperatively.
12. As part of your discharge instructions to C.P., you would teach her:
(Select all that apply.)
the importance of taking her thyroid replacement therapy as prescribed.
to not return to work until her thyroid hormone is normalized.
to avoid being in extremely warm environments until she is euthyroid.
the importance of keeping follow-up medical appointments.
proper care of the incision and signs of infection to report to the physician.
f. to avoid foods containing iodine because they increase her risk of recurrent
cancer