A client develops vocal cord palsy after thyroid surgery. This condition occurs due to injury to the?& x20; - UPRVUNL - 2021

UPRVUNL - 2021

Medical & Surgical Nursing

Easy

Appeared in: UPRVUNL - 2021

Explanation

The Recurrent Laryngeal Nerve (RLN) runs in the tracheoesophageal groove, in close anatomical proximity to the thyroid gland, making it highly susceptible to injury during thyroidectomy.
The RLN provides motor innervation to all intrinsic muscles of the larynx (except the cricothyroid), which are responsible for the abduction (opening) and adduction (closing) of the vocal cords.
Injury to this nerve impairs vocal cord movement, leading to vocal cord palsy, which typically manifests as hoarseness or a weak, breathy voice.
Bilateral RLN injury is a medical emergency as it can cause severe airway obstruction and stridor, because both vocal cords may remain in a closed or partially closed position.

Option B: The vagus nerve is the parent nerve from which the RLN branches. While a high vagal nerve injury would cause vocal cord palsy, it is less common and would typically present with a wider range of symptoms, such as difficulty swallowing (dysphagia) and palatal drooping, not just isolated vocal cord palsy.
Option C: The superior laryngeal nerve (specifically its external branch) innervates the cricothyroid muscle, which tenses the vocal cords to control pitch. Injury to this nerve causes voice fatigue and an inability to produce high-pitched sounds, not the more severe vocal cord paralysis (impaired movement).
Option D: The phrenic nerve innervates the diaphragm, the primary muscle of respiration. It is not located within the surgical field of a thyroidectomy and has no function related to the vocal cords.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Anatomical complications of thyroid surgery in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A key nursing responsibility after thyroid surgery is to assess the patient's voice. Any hoarseness, weakness, or change in voice quality must be documented and reported, as it is a primary indicator of RLN injury.
Nurses must monitor for respiratory distress, including stridor (a high-pitched breathing sound), which can signal bilateral RLN injury and airway compromise. This is a medical emergency.
Standard post-operative protocol for thyroidectomy includes keeping an emergency tracheostomy tray and suction equipment at the bedside in case of acute airway obstruction from bilateral nerve injury or hematoma.

How to Approach the Question

First, identify the core elements of the question: a specific procedure (thyroid surgery) and a resulting complication (vocal cord palsy).
The question asks for the anatomical cause of the complication. This requires knowledge of the structures located near the thyroid gland.
Think about the anatomy of the neck. Visualize or recall the nerves that pass near the thyroid gland.
Evaluate each option based on its anatomical location and function.
Option A (RLN) is known to be in the surgical field and controls vocal cord movement. This is a strong candidate.
Option B (Vagus) is the parent nerve. Consider if an injury to a branch is more specific and likely than an injury to the main trunk.

Concept Tested & Keywords

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