NORCET 3 - 2022 (Shift-1)
Medical Surgical Nursing
Hard
A patient undergoes thyroidectomy shows the symptoms of carpopedal spasm. Which medication is to be administered for the patient?
Appeared in: NORCET 3 - 2022 (Shift-1)
Explanation
- Carpopedal spasm, as shown in the image, is a sign of tetany, which is caused by acute, severe hypocalcemia.
- A common and serious complication of thyroidectomy is iatrogenic (accidental) damage to or removal of the parathyroid glands, leading to hypoparathyroidism and a subsequent drop in blood calcium levels.
- The immediate, first-line treatment for symptomatic hypocalcemia is the intravenous (IV) administration of Calcium Gluconate to rapidly restore serum calcium levels and prevent life-threatening complications like laryngospasm and seizures.
Why Other Options Were Wrong
- Option B: Calcium sulphate is not used in clinical practice for the intravenous correction of hypocalcemia.
- Option C: This medication is used to treat hypomagnesemia (low magnesium). While low magnesium can impair calcium regulation, the direct cause of hypocalcemia after thyroid surgery is lack of parathyroid hormone, making calcium the primary required replacement.
- Option D: Magnesium sulphate is a treatment for conditions like eclampsia, torsades de pointes, or severe asthma. It is not the first-line treatment for post-thyroidectomy hypocalcemia.
Related Visual
- Visual 1: Diagram - An illustration comparing Trousseau's sign (carpopedal spasm induced by cuff inflation) and Chvostek's sign (facial muscle twitching on tapping the facial nerve), the two classic clinical tests for latent tetany.
- Visual 2: Anatomical Chart - A posterior view of the thyroid gland showing the four small, embedded parathyroid glands. This visual helps explain why the parathyroids are at high risk of injury or removal during thyroid surgery.
Clinical Relevance
- Nursing practice connection: Use the key finding related to Management of acute hypocalcemia following thyroidectomy to guide bedside assessment, documentation, and the next nursing action.
- Post-thyroidectomy, nurses must conduct vigilant monitoring for early signs of hypocalcemia, such as perioral numbness, tingling in the fingers and toes, and muscle cramps.
- Due to the significant risk of laryngospasm (a life-threatening airway complication), emergency equipment including a tracheostomy tray, suction, and oxygen must be immediately available at the bedside of any patient showing signs of tetany.
- What if? If the patient was asymptomatic but a routine post-op lab test showed a mildly low calcium level (e.g., 8.0 mg/dL), the provider would likely prescribe oral calcium supplements with vitamin D, rather than emergency IV calcium, and increase the frequency of monitoring.
How to Approach the Question
- First, identify the clinical context: The patient has just had a thyroidectomy.
- Next, recall the major complications associated with this specific surgery. Inadvertent damage to the parathyroid glands is a well-known risk.
- Interpret the key symptom presented: 'Carpopedal spasm' is a specific term for tetany, a hallmark sign of severe hypocalcemia.
- Connect the surgery, complication, and symptom: Thyroidectomy → Parathyroid Damage → Hypocalcemia → Carpopedal Spasm.
- Finally, access your pharmacology knowledge to determine the standard emergency treatment for acute, symptomatic hypocalcemia.
- Evaluate the options to find the correct intravenous calcium preparation used in this emergency.
Concept Tested & Keywords
- Concept Tested: Management of acute hypocalcemia following thyroidectomy.
- Stem keywords: thyroidectomy, carpopedal spasm
- Lead-in keywords: Which medication
- Clinical cues: patient undergoes thyroidectomy
- Clinical cues: symptoms of carpopedal spasm
Question ID
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Practise the full NORCET 3 - 2022 (Shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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