Which of the following is a cause of concern during early post operative period after thyroidectomy?

RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Medical & Surgical Nursing

Hard

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2018

Explanation

Carpal spasm when a blood pressure cuff is inflated is known as a positive Trousseau's sign.
Trousseau's sign is a classic indicator of hypocalcemia, a dangerously low level of calcium in the blood.
After a thyroidectomy, hypocalcemia can occur due to accidental damage to or removal of the parathyroid glands, which are responsible for calcium regulation.
This condition is a medical emergency because it can rapidly progress to tetany, seizures, and life-threatening laryngospasm (airway obstruction) or cardiac dysrhythmias.

Option A: A sore throat is a common, expected, and minor side effect following endotracheal intubation for general anesthesia. It does not indicate a life-threatening complication.
Option B: Pain at the surgical site is an expected and normal finding after any operation. It is managed with prescribed pain medication and is not a sign of a systemic, life-threatening complication.
Option D: A temperature of 101°F (38.3°C) in the early postoperative period is a concern and requires monitoring, but it is most commonly caused by atelectasis. While it needs to be addressed, it is not as immediately life-threatening as the airway and cardiac risks associated with acute hypocalcemia.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Recognition of postoperative complications after thyroidectomy as background academic context rather than a clinical decision trigger.
A nurse's ability to differentiate between expected postoperative findings and signs of a life-threatening complication like hypocalcemia is critical for patient safety.
Prompt identification of Trousseau's sign requires immediate escalation to the surgeon and preparation for emergency intervention, including IV calcium administration and securing the airway.
An emergency tracheostomy set and IV calcium gluconate should always be kept at the bedside of a post-thyroidectomy patient as a standard safety precaution.

How to Approach the Question

First, identify the core of the question: you need to find the most serious or alarming sign among the options for a patient who has just had a thyroidectomy.
This is a prioritization question. Use the ABCs (Airway, Breathing, Circulation) framework to evaluate the potential threat of each option.
Consider the specific risks of thyroid surgery. The parathyroid glands, which control calcium, are located on the thyroid and can be easily damaged.
Evaluate Option A (sore throat) and Option B (incisional pain). These are expected discomforts after surgery and do not pose an immediate threat to life.
Evaluate Option D (mild fever). This is common post-op, often from atelectasis. It needs attention but is not an immediate ABC emergency.
Evaluate Option C (carpal spasm). Recognize this as Trousseau's sign, indicating hypocalcemia. Hypocalcemia can cause laryngospasm (a critical Airway problem) and cardiac arrhythmias (a critical Circulation problem). Therefore, this is the most urgent and concerning finding.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 27-29