After thyroid surgery (thyroidectomy) patient shows carpopedal spasm. This sign indicates?

BHU NO - 2015

Medical & Surgical Nursing

Hard

Appeared in: BHU NO - 2015

Explanation

Carpopedal spasm is a hallmark sign of tetany, a state of neuromuscular hyperexcitability.
Tetany is caused by a significant decrease in blood calcium levels (hypocalcemia).
Hypocalcemia is a common and serious complication after thyroidectomy due to the risk of accidental injury or removal of the adjacent parathyroid glands, which regulate calcium.
The parathyroid glands' failure to produce parathyroid hormone (PTH) leads to a rapid drop in serum calcium, triggering the spasms.

Option A: This is a nursing intervention, often used in pediatric care to manage pain, not a diagnosis or an explanation for a physiological sign like carpopedal spasm.
Option B: While a thyroidectomy can affect thyroid hormone levels, very low levels (hypothyroidism) manifest as symptoms like fatigue, weight gain, cold intolerance, and bradycardia, not acute muscle spasms (tetany).
Option C: Decreased metabolism and hypothermia are classic signs of hypothyroidism (low thyroid hormone), not the acute neuromuscular irritability seen in tetany.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Post-operative complications of thyroidectomy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
Post-thyroidectomy, nurses must prioritize monitoring for signs of hypocalcemia, such as perioral numbness, tingling in the fingers/toes, and muscle twitching.
The development of tetany can progress to laryngeal spasm, which is a life-threatening airway emergency. A tracheostomy set and IV calcium gluconate must be kept at the patient's bedside for immediate intervention.
What if the patient only reports mild tingling in their fingertips? The nurse should immediately assess for Trousseau's and Chvostek's signs and notify the provider. These signs indicate latent tetany, which can rapidly progress to overt, life-threatening tetany if not treated.

How to Approach the Question

First, identify the key elements in the question: the procedure (thyroidectomy) and the clinical sign (carpopedal spasm).
Recall the anatomy of the neck, specifically the close relationship between the thyroid and parathyroid glands.
Consider the most common and acute complications of the specified surgery. Injury to adjacent structures is a primary surgical risk.
Connect the function of the parathyroid glands (calcium regulation) to the observed sign. Carpopedal spasm is a classic sign of tetany, which is caused by low calcium.
Evaluate the options. Eliminate those related to thyroid hormone function (hypothyroidism) as they present differently. Select the option that correctly links the anatomical risk (parathyroid injury) to the physiological outcome (hypocalcemia and tetany).

Concept Tested & Keywords

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