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Thyroidectomy, although rare, may be performed for patients with thyroid cancer, hyperthyroidism, and drug reactions
to antithyroid agents; pregnant women who cannot be managed with drugs; patients who do not want radiation therapy;
and patients with large goiters who do not respond to antithyroid drugs. The two types of thyroidectomy include:
Total thyroidectomy: The gland is removed completely. Usually done in the case of malignancy. Thyroid replacement
therapy is necessary for life.
Subtotal thyroidectomy: Up to five-sixths of the gland is removed when antithyroid drugs do not correct
hyperthyroidism or RAI therapy is contraindicated.

Inpatient acute surgical unit

Hyperthyroidism (thyrotoxicosis, Graves’ disease)
Psychosocial aspects of care
Surgical intervention

Patient Assessment Database
Refer to CP: Hyperthyroidisim (Thyrotoxicosis, Graves’ Disease), for assessment
Discharge plan DRG projected mean length of inpatient stay: 2.4 days
Refer to section at end of plan for postdischarge considerations.

1. Reverse/manage hyperthyroid state preoperatively.
2. Prevent complications.
3. Relieve pain.
4. Provide information about surgical procedure, prognosis, and treatment needs.

1. Complications prevented/minimized.
2. Pain alleviated.
3. Surgical procedure/prognosis and therapeutic regimen understood.
4. Plan in place to meet needs after discharge.

NURSING DIAGNOSIS: Airway Clearance, risk for ineffective
Risk factors may include
Tracheal obstruction; swelling, bleeding, laryngeal spasms
Possibly evidenced by
[Not applicable; presence of signs and symptoms establishes an actual diagnosis.]
Respiratory Status: Airway Patency (NOC)
Maintain patent airway, with aspiration prevented.

Investigate reports of difficulty swallowing. noting color and Edema/pain may impair patient’s ability to clear own characteristics of sputum. Indicators of tracheal obstruction/laryngeal spasm. drooling of May indicate edema/sequestered bleeding in tissues oral secretions. Assist with/prepare for procedures. surrounding operative site. pain/discomfort Possibly evidenced by Impaired articulation. e. Although and/or coughing as indicated. Rhonchi may indicate airway obstruction/accumulation of copious thick secretions. Respirations may remain somewhat rapid. Check dressing frequently. but development of respiratory distress is indicative of tracheal compression from edema or hemorrhage. requiring prompt evaluation and intervention. Assess for dyspnea. Maintains clear airway and ventilation. Keep tracheostomy tray at bedside. Auscultate breath sounds. depth. it may be needed to clear secretions. and work of breathing.: Tracheostomy. NURSING DIAGNOSIS: Communication. support head with Reduces likelihood of tension on surgical wound. impaired verbal May be related to Vocal cord injury/laryngeal nerve damage Tissue edema. Suction mouth and trachea as indicated. Assist with repositioning.” and cyanosis. use of nonverbal cues such as gestures DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Communication Ability (NOC) Establish method of communication in which needs can be understood. noting presence of rhonchi.ACTIONS/INTERVENTIONS RATIONALE Airway Management (NIC) Independent Monitor respiratory rate. May be necessary to maintain airway if obstructed by edema of glottis or hemorrhage. “crowing. . especially posterior portion. “routine” coughing is not encouraged and may be painful. does not/cannot speak. If bleeding occurs. Note quality of voice. Caution patient to avoid bending neck. Collaborative Provide steam inhalation. Return to surgery. pillows. deep breathing exercises. airway. Compromised airway may create a life-threatening situation requiring emergency procedure. humidify room air. Reduces discomfort of sore throat and tissue edema and promotes expectoration of secretions. stridor. May require ligation of bleeding vessels.g. anterior dressing may appear dry because blood pools dependently.

Manipulation of gland during subtotal thyroidectomy may tachycardia (140–200 beats/min). Enhances ability to hear whispered communication and reduces necessity for patient to raise/strain voice to be heard. risk for [tetany] Risk factors may include Chemical imbalance: excessive CNS stimulation Possibly evidenced by [Not applicable.. NURSING DIAGNOSIS: Injury. causing thyroid respiratory distress.ACTIONS/INTERVENTIONS RATIONALE Communication Enhancement: Speech Deficit (NIC) Independent Assess speech periodically. appropriate. Provide alternative methods of communication as Facilitates expression of needs. e. Keep communication simple. edema/HF). Post notice of patient’s voice limitations at central station Prevents patient from straining voice to make needs and answer call bell promptly. Visit patient frequently.] DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Safety Status: Physical Injury (NOC) Demonstrate absence of injury with complications minimized/controlled. Reduces demand for response. presence of signs and symptoms establishes an actual diagnosis. result in increased hormone release. dysrhythmias. Anticipate needs as possible. Reduces anxiety and patient’s need to communicate. ask yes/no questions. Maintain quiet environment. cyanosis (developing pulmonary storm. Hoarseness and sore throat may occur secondary to tissue edema or surgical damage to recurrent laryngeal nerve and may last several days.g. letter/picture board. . known/summon assistance. Place IV line to minimize interference with written communication. ACTIONS/INTERVENTIONS RATIONALE Surveillance (NIC) Independent Monitor vital signs noting elevating temperature. slate board. Permanent nerve damage can occur (rare) that causes paralysis of vocal cords and/or compression of the trachea. encourage voice rest. promotes voice rest.

lactate). positive Chvostek’s and Trousseau’s signs. guarding behavior. reducing exogenous stimulation.ACTIONS/INTERVENTIONS RATIONALE Surveillance (NIC) Independent Evaluate reflexes periodically. Demonstrate use of relaxation skills and diversional activities appropriate to situation. Corrects deficiency. numbness. Avoid use of restraints. hypoparathyroidism. Sedatives. inadvertent trauma to/partial-to-total removal of parathyroid gland(s) during surgery. Patients with levels less than 7. Controls seizure activity until corrective therapy is successful.g. and Reduces potential for injury if seizures occur. Anticonvulsants. ND: Trauma/Suffocation. e. . Observe for Hypocalcemia with tetany (usually transient) may occur neuromuscular irritability. acute May be related to Surgical interruption/manipulation of tissues/muscles Postoperative edema Possibly evidenced by Reports of pain Narrowed focus.) Collaborative Monitor serum calcium levels. which can occur as a result of seizure activity. CP: Seizure Disorders. Administer medications as indicated: Calcium (gluconate.. risk for. potentiating risk of toxicity. Note: Use with caution in patients taking digitalis because calcium increases cardiac sensitivity to digitalis. twitching. which is usually temporary but may be permanent. Phosphate-binding agents.5 mg/100 mL generally require replacement therapy. Helpful in lowering elevated phosphorus levels associated with hypocalcemia. Keep side rails raised/padded. Promotes rest. NURSING DIAGNOSIS: Pain. bed in low position. restlessness Autonomic responses DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Pain Control (NOC) Report pain is relieved/controlled. (Refer to airway at bedside. 1–7 days postoperatively and indicates paresthesias.

. treatment. prognosis. of the suture line. Collaborative Administer analgesics and/or analgesic throat Reduces pain and discomfort. deficient [Learning Need] regarding condition. Initiate necessary lifestyle changes. Helps refocus attention and assists patient to manage guided imagery. soft foods popsicles. statement of misconception Inaccurate follow-through of instructions/development of preventable complications DESIRED OUTCOMES/EVALUATION CRITERIA—PATIENT WILL: Knowledge: Disease Process (NOC) Verbalize understanding of surgical procedure and prognosis and potential complications.. sprays/lozenges as necessary. muscle strain in operative area. self-care. Participate in treatment regimen. e. Instruct patient to use hands to support tension. soft music. intensity (0–10 scale). NURSING DIAGNOSIS: Knowledge. may be tolerated better than liquids if patient experiences difficulty swallowing. enhances rest. Maintain head/neck in neutral position and support during Prevents stress on the suture line and reduces muscle position changes. such as ice cream or Although both may be soothing to sore throat. request for information. neck during movement and to avoid hyperextension of neck. Encourage patient to use relaxation techniques. progressive relaxation. misinterpretation Unfamiliarity with information resources Possibly evidenced by Questions. noting location.g. Keep call bell and frequently needed items within easy Limits stretching. Useful in evaluating pain. Knowledge: Treatment Regimen (NOC) Verbalize understanding of therapeutic needs. Place in semi-Fowler’s position and support head/neck Prevents hyperextension of the neck and protects integrity with sandbags or small pillows. choice of interventions. reach.ACTIONS/INTERVENTIONS RATIONALE Pain Management (NIC) Independent Assess verbal/nonverbal reports of pain. Reduces tissue edema and decreases perception of pain. Provide ice collar if indicated. pain/discomfort more effectively. and discharge needs May be related to Lack of exposure/recall. Give cool liquids or soft foods. effectiveness of therapy. and duration.

Discuss need for well-balanced. rotation. sudden weight loss. fortified dairy products. fever. continued/purulent wound drainage.. Contraindicated after partial thyroidectomy because these excessive ingestion of seafood.. e. Alteration in vocal cord function may cause changes in pitch and quality of voice. turnips.. .ACTIONS/INTERVENTIONS RATIONALE Teaching. constipation. e. Discuss possibility of change in voice. egg yolks.g. and enhance circulation and healing process. when Promotes healing and helps patient regain/maintain appropriate. lateral movement of head and neck. many as 43% of patients with subtotal thyroidectomy will weight gain.g. facilitating recovery of general well-being. In patients with subtotal thyroidectomy. Disease Process (NIC) Independent Review surgical procedure and future expectations. Use of iodized salt is often sufficient to meet iodine needs unless salt is restricted for other healthcare problems. dairy products) and Maximizes supply and absorption of calcium if vitamin D (e. soybeans. Recommend the use of loose-fitting scarves to cover scar. Identify signs/symptoms requiring medical evaluation. e. Softens tissues and may help minimize scarring. insomnia. exercise can stimulate the thyroid gland and production of hormones. surgical removal of gland. nutritious diet and. HF. precipitating infections of suture line. Review drug therapy and the necessity of continuing even If thyroid hormone replacement is needed because of when feeling well.. develop hypothyroidism in time. intolerance to cold. liver). avoiding Effects of hyperthyroidism usually subside completely. Identify foods high in calcium (e. cleansing.g.. flexion. parathyroid function is impaired. Review postoperative exercises to be instituted after Regular ROM exercises strengthen neck muscles. nausea/vomiting. Provides knowledge base from which patient can make informed decisions. which may be temporary or permanent. Encourage progressive general exercise program. chills. Note: As intolerance to heat. diarrhea. but it takes some time for the body to recover. extension. Review importance of rest and relaxation. e. prevent progression to life-threatening situation. gaps in wound edges.g. foods inhibit thyroid activity. Apply cold cream after sutures have been removed. or hypothyroidism may erythema.g.g. Covers the incision without aggravating healing or avoiding the use of jewelry. appropriate weight. hyperthyroidism. application. stressful situations and emotional outbursts. Early recognition of developing complications such as e. patient needs to understand rationale for replacement therapy and consequences of failure to routinely take medication. fatigue.. infection. incision heals.g. dressing Enables patient to provide competent self-care. drowsiness. Instruct in incisional care. Recommend avoidance of goitrogenic foods.. inclusion of iodized salt.

ACTIONS/INTERVENTIONS RATIONALE Teaching. personal resources. . physical condition/presence of complications. and life responsibilities) Fatigue—decreased metabolic energy production. Provides opportunity for evaluating effectiveness of therapy and prevention of complications. altered body chemistry (hypothyroidism) Refer to Potential Considerations in Surgical Intervention plan of care. Disease Process (NIC) Independent Stress necessity of continued medical follow-up. POTENTIAL CONSIDERATIONS following acute hospitalization (dependent on patient’s age.