Four
years ago I underwent a total thyroidectomy. I can remember waking up in the
recovery room and being transported to my room. The first thing I said to my
husband when I got to my room was this: “Look on my night stand and make sure you see a trach kit and
a box of calcium gluconate.” Even though I was half out of it, I wanted to make
sure that the nurses were prepared to handle the two most common complications
of a thryoidectomy – hemorrhage and hypocalcemia.
I
won’t spend time talking about hemorrhage but basically, if your patient
hemorrhages, you may need to trach him/her emergently.
The
other complication (or villain) is hypocalcemia. To understand how this
occurs, you need to understand the role calcium plays in the body (beyond bone
strength).
Calcium
Calcium
acts as a sedative at the neuromuscular junction. So, the more calcium you
have, the more sedated your cells are. The lower your calcium levels gets, the more
excited or stimulated your cells become.
The Role of the Parathyroid Glands
It
is the parathyroid glands that manage the balance of calcium in the
bloodstream. When someone (like me) undergoes a thyroidectomy, sometimes the
parathyroid glands either get inadvertently removed or just get ticked off and
decide to stop working for a bit. When this happens, calcium levels can
plummet!
Hypocalcemia
When calcium levels get
super low, we worry about the patients having spasms. Evidence of hypocalcemia
presents as Chvostek’s sign (tap the cheek and watch the facial nerve twitch)
or Trousseau’s sign (pump up a blood pressure cuff and watch the patient’s arm
spasm – which hurts!).
But,
what we REALLY worry about in our thyroidectomy patients is that they will have
a laryngospasm. If this happens, they will lose their airway. The treatment?
Immediate administration of Calcium Gluconate. You may need to repeat this
until the parathyroid glands decide to start working or the patients gets
placed on calcium replacement therapy.
Bottom
line: post thyroidectomy patient? Always, always make sure you are prepared
with Calcium Gluconate AND trach kit (just in case).
I’m
happy to report that my husband confirmed that yes…there was a lovely box of
Calcium Gluconate and trach kit. I’m even happier to report that they remained
unopened.
I hope these tips help you take great care of your post-thyroidectomy patients.
Thanks
for becoming a nurse. Take care and stay connected!
Renee
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I love this! We just had an exam on endocrine this Monday and this was emphasized in our lecture. What a coincidence! I got 100% on it too!!!
ReplyDeleteThis is definitely a very important tip! Always have a suction, airway and trach kit along with calcium gluconate!
~Carli Gaetano
Thanks Carli. It was fate!!! You're going to become an amazing nurse :-).
ReplyDeleteRenee