NORCET 3 - 2022 (Shif…: A patient undergoes thyroidectomy shows the symptoms of carpopedal spasm. Which medication is to be administe…

NORCET 3 - 2022 (Shift-1)

Medical & Surgical Nursing

Medium

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

Carpopedal spasm after a thyroidectomy is a hallmark sign of acute hypocalcemia, a condition known as tetany.
This complication occurs due to accidental damage or removal of the parathyroid glands during surgery, leading to insufficient parathyroid hormone (PTH) and low blood calcium.
The immediate and standard treatment for symptomatic hypocalcemia is the intravenous administration of calcium gluconate to rapidly correct the deficiency and prevent life-threatening complications like laryngospasm.

Option B: Calcium sulphate is not used clinically for the intravenous correction of hypocalcemia. It is more commonly known as plaster of Paris and is not a suitable or available formulation for this medical purpose.
Option C: While severe hypomagnesemia can cause or worsen hypocalcemia, magnesium is not the primary treatment for tetany caused by post-surgical hypoparathyroidism. The primary issue is a lack of calcium.
Option D: Magnesium sulphate is used to treat conditions like eclampsia, torsades de pointes, and severe asthma. Administering it in this scenario would not correct the underlying hypocalcemia and could potentially worsen symptoms.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacological management of acute hypocalcemia following thyroidectomy to guide bedside assessment, documentation, and the next nursing action.
Nurses must be vigilant in monitoring patients post-thyroidectomy for subtle signs of hypocalcemia, such as perioral tingling or muscle twitching, as these are early warnings of potential tetany and laryngospasm.
A critical nursing responsibility is ensuring that IV calcium gluconate and an emergency tracheostomy kit are readily available at the bedside for any patient who has undergone a total or near-total thyroidectomy.
What if? If the patient had chronic kidney disease, the management would be more complex. In CKD, hypocalcemia is often accompanied by hyperphosphatemia. Treatment would involve not only calcium supplementation but also phosphate binders (like calcium carbonate or sevelamer) and activated vitamin D (like calcitriol) to manage the mineral and bone disorder.

How to Approach the Question

First, identify the core clinical scenario: a patient post-thyroidectomy.
Next, recognize the key symptom: carpopedal spasm. Connect this symptom to a known, common complication of the surgery.
Recall that the parathyroid glands, which regulate calcium, are at risk during thyroid surgery. Injury to these glands causes hypocalcemia.
Recognize that carpopedal spasm (a form of tetany, as shown by Trousseau's sign in the image) is a classic sign of acute, symptomatic hypocalcemia.
Finally, select the medication that directly and immediately treats acute hypocalcemia, which is intravenous calcium gluconate.

Concept Tested & Keywords

Concept Tested: Pharmacological management of acute hypocalcemia following thyroidectomy.
Stem keywords: thyroidectomy, carpopedal spasm
Lead-in keywords: medication to be administered
Clinical cues: The combination of a recent thyroidectomy and the onset of carpopedal spasm strongly points to iatrogenic hypoparathyroidism and resultant hypocalcemia.

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 30-32

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 139-141