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 anti-thyroid 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.
Thyroidectomy requires meticulous postoperative nursing care to prevent complications. Nursing priorities will include managing hyperthyroid state preoperatively, relieving pain, providing information about the surgical procedure, prognosis, and treatment needs, and preventing complications.
- Acute Pain
- Risk for Impaired Airway Clearance
- Impaired Verbal Communication
- Risk for Injury
- Deficient Knowledge
Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.
May be related to
- Surgical interruption/manipulation of tissues/muscles
- Postoperative edema
Possibly evidenced by
- Reports of pain
- Narrowed focus; guarding behavior; restlessness
- Autonomic responses
- Client will report relief or control of pain.
- Client will demonstrate the use of relaxation skills and diversional activities appropriate to the situation.
|Assess verbal and nonverbal reports of pain, noting location, intensity (0–10 scale), and duration.||Useful in evaluating pain, choice of interventions, the effectiveness of therapy.|
|Place in semi-Fowler’s position and support head and neck with sandbags or small pillows.||Prevents hyperextension of the neck and protects the integrity of the suture line.|
|Maintain head and neck in a neutral position and support during position changes. Instruct patient to use hands to support the neck during movement and to avoid hyperextension of the neck.||Prevents stress on the suture line and reduces muscle tension.|
|Keep call bell and frequently needed items within easy reach.||Limits stretching, muscle strain in the operative area.|
|Give cool liquids or soft foods, such as ice cream or popsicles.||Although both may be soothing to sore throat, soft foods may be tolerated better than liquids if patient experiences difficulty swallowing.|
|Encourage patient to use relaxation techniques: guided imagery, soft music, progressive relaxation.||Help refocus attention and assist the patient to manage pain and/or discomfort more effectively.|
|Administer analgesics and/or analgesic throat sprays and lozenges as necessary.||Reduces pain and discomfort; enhances rest.|
|Provide ice collar if indicated.||Reduces tissue edema and decreases the perception of pain.|
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Endocrine and Metabolic Care Plans
Nursing care plans related to the endocrine system and metabolism:
- Acid-Base Balance
- - Respiratory Acidosis Nursing Care Plan
- - Respiratory Alkalosis Nursing Care Plan
- - Metabolic Acidosis Nursing Care Plan
- - Metabolic Alkalosis Nursing Care Plan
- Addison's Disease | 3 Care Plans
- Cushing’s Disease | 6 Care Plans
- Diabetes Mellitus Type 1 (Juvenile Diabetes) | 4 Care Plans
- Diabetes Mellitus Type 2 | 13+ Care Plans
- Diabetic Ketoacidosis (DKA) and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) | 4 Care Plans
- Eating Disorders: Anorexia & Bulimia Nervosa | 7 Care Plans
- Fluid and Electrolyte Imbalances | 10 Care Plans
- - Fluid Balance: Hypervolemia & Hypovolemia
- - Potassium (K) Imbalances: Hyperkalemia and Hypokalemia
- - Sodium (Na) Imbalances: Hypernatremia and Hyponatremia
- - Magnesium (Mg) Imbalances: Hypermagnesemia and Hypomagnesemia
- - Calcium (Ca) Imbalances: Hypercalcemia and Hypocalcemia
- Gestational Diabetes Mellitus | 4 Care Plans
- Hyperthyroidism | 7 Care Plans
- Hypothyroidism | 3 Care Plans
- Obesity | 4 Care Plans
- Thyroidectomy | 5 Care Plans