laboratory and clinical booklet - Fort Scott Community College

NUR 2509 – CASE STUDY #3 - ENDOCRINE
You are working on an oncology unit and will be receiving a client from recovery room.
The PACU RN gives the following report: 50-year-old female, total thyroidectomy
(multinodular goiter), left superior and right inferior parathyroidectomy because of
adenoma. Estimated blood loss of 25 ml. Vital Signs: 130/82, 88, 20. Peripheral IV of
D5 ½ NS + 20 mEq KCL and 10 mEq calcium gluconate infusing at 100 ml/hr. Has
received total of 50 mg Demerol IVP. PMH: TAH for fibroids and low-level radiation
treatments to neck 38 years ago for eczema. Medications include estradiol, lovastatin,
and levothyroxine. Preop labs: Ca 11.2 mg/dl, phosphorus 2.4 mg/dl, Cl 106 mmol/L,
alkaline phosphatase 162 U/L, elevated parathyroid hormone (PTH) and TSH levels,
creatinine 1.4 mg/dL.
1. What preparations will you take before CP arrives?
2. You receive CP from the recovery room. How will you focus your initial assessment
and why?
3. During your initial assessment, you document negative Chvostek‟s and Trousseau‟s
signs. Describe data that would support this conclusion.
4. Explain why CP would have been taking Synthroid preoperatively.
5. Why would the alkaline phosphatase be elevated?
6. Identify the major risk factor that may have contributed to the development of
parathyroid adenoma in CP.
7. Identify 4 nursing issues related to CP‟s care.
8. Identify 4 nursing actions you should include in the post-op care of CP.
9. Identify nursing care measures that reduce the risk for post-op swelling.
10. Twenty-four hours after surgery, CP calls you to her room c/o numbness around her
mouth and tingling at the tips of her fingers. She appears restless but is AAO.
Realizing that CP may be experiencing hypocalcemia, you decide to notify the
physician. What should you do in the interim before the physician returns your call?
11. What emergency equipment should you gather?
12. CP is given supplemental calcium gluconate and recovers. Now being discharged 48
hours post-op. She states that she can‟t wait until she can stop taking Synthroid.
How would you respond to her statement?
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