The client has recently returned from having a thyroidectomy. The nurse should keep which of the following at… - IGNOU Post B. SC. Nursing entrance-2019

IGNOU Post B. SC. Nursing entrance-2019

Medical & Surgical Nursing

Medium

Appeared in: IGNOU Post B. SC. Nursing entrance-2019

Explanation

The most immediate and life-threatening risk following a thyroidectomy is airway obstruction.
This obstruction can be caused by swelling (laryngeal edema), bleeding into the neck that forms a hematoma and compresses the trachea, or damage to the recurrent laryngeal nerve.
A tracheostomy set contains the instruments needed to perform an emergency tracheostomy, creating a surgical airway when endotracheal intubation is impossible due to severe swelling.
Keeping this set at the bedside is a critical safety measure to ensure a patent airway can be established immediately in a worst-case scenario.

Option B: A padded tongue blade is ineffective for managing an airway obstructed by laryngeal edema or a hematoma. Its use is also an outdated and potentially harmful practice, especially during seizures.
Option C: While an endotracheal (ET) tube is used to establish an airway, significant post-operative swelling can make it physically impossible to pass the tube through the larynx (failed intubation).
Option D: An oropharyngeal or nasopharyngeal airway is designed to keep the upper airway open by preventing the tongue from obstructing the pharynx. It is useless if the obstruction is lower, at the level of the larynx or trachea, which is the primary risk after thyroid surgery.

Clinical Relevance

Nursing practice connection: Use the key finding related to Emergency preparedness for post-thyroidectomy complications to guide bedside assessment, documentation, and the next nursing action.
A nurse's priority assessment post-thyroidectomy is the patient's airway. Listen for stridor, assess for dyspnea, and ask about neck tightness, as these are early signs of life-threatening compression.
Emergency bedside equipment for a post-thyroidectomy patient always includes a tracheostomy set, suction equipment, and an oxygen source.
What if? The patient reports numbness and tingling around their lips and fingertips 36 hours after surgery. The nurse should recognize these as signs of hypocalcemia (due to potential parathyroid gland injury) and immediately check for Trousseau's and Chvostek's signs, notify the provider, and anticipate an order for IV calcium gluconate.

How to Approach the Question

First, identify the key procedure in the question: a thyroidectomy.
Next, recall the most critical and immediate post-operative complications associated with this specific surgery. Consider the anatomy of the neck: the thyroid gland is very close to the trachea (airway).
The most life-threatening complication is airway obstruction from swelling (edema) or bleeding (hematoma).
Evaluate each option based on its effectiveness in managing a severe airway obstruction where the airway is physically being squeezed shut.
An oropharyngeal airway or ET tube might fail if swelling is severe. A tracheostomy is a surgical opening to bypass the obstruction.
Therefore, the tracheostomy set is the essential emergency equipment that must be at the bedside for this specific, high-risk complication.

Concept Tested & Keywords

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E6 Nursing Fundamentals Taylor p. 736-738

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 49-51