General Nursing Lecture

1. THYROIDECTOMY
CARE
DR EVA VELIKOSHI-INDONGO
(DIP NURSING/MIDWIFERY, RN/RM/RT,
BNSC (HSM), NED (NDP), MNSC,PHDNSC
(UNAM)), MBCHB (ZAMBIA)
FEB 2020
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2. Outline
 Definition
 Surgical anatomy vs thyroid gland
 Indications
 Types
 Pre operative investigations and care
 Post operative management
 Post operative nursing care general
 Thyroidectomy complications
 Specific nursing care
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3. Thyroidectomy
 Definition
Removal of part of or whole of the thyroid
gland.
 Done under GA
 Usually patient nursed in ICU after op
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4. Thyroid gland surgical anatomy
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5. Surgical anatomy – cont’d
 Important nerves in relation to thyroid
External laryngeal nerve: Close to
superior pole of thyroid.
Injury produces voice weakness
Recurrent laryngeal nerve: Related to
lower pole of gland as it runs upwards
 innervates vocal cords
Injury produces vocal cord paralysis.
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6. Relationships with nerves and
blood vessels
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7. Thyroidectomy – Indications
 Compressive goiter
 Cosmetics
 Carcinoma
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8. Thyroidectomy – Types
 Hemi-thyroidectomy: Removal of half of
thyroid gland (Hemi = Half)
 Lobectomy: Removal of either right of left
lobe of thyroid gland
Both these are done in solitary goitre
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9. Thyroidectomy types – cont’d
 Subtotal thyroidectomy: Removal of a little less
than total; done in multi-nodular goiter
 Near-total thyroidectomy: Almost same as
total, but a little thyroid tissue around one
parathyroid gland is preserved
 Total thyroidectomy: Removal of whole thyroid
gland
This is done in cases of malignancy
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10. Pre-operative care
 Full blood count (CBC)
 Serum Urea, Electrolytes, Creatinine
 Thyroid Profile: T3, T4, TSH  Euthyroid state
 Group and save (Cross-matching)
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11. Pre-operative care
cont…
 Explain procedure , Answer questions, consent-
reduce anxiety ,fear
 Fasting for 6-8 hrs prior surgery
 Administer antithyroid medication – promote a
euthyroid state
 Iodine preparation- decrease vascularity of
the gland and risk of haemorrhage
 Teach how to support the neck- placing both
hand behind the neck
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12. Post-operative nursing care
general
 Patient is kept NPO/NBM till patient full
awake  risk of aspiration
 Vital signs (TPR, BP) chart regularly, 4hly
 Monitor intake and output IV fluids,
drainage from Portvac drain
 Pain due to surgical incision: analgesics
 Wound dressing inspection Bleeding
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13. Thyroidectomy – Possible
complications
 Hemorrhage
 Respiratory distress or stridor
 Hoarseness of voice
 Total vocal cord paralysis – aphonia
 Hypocalcemic tetany (due to accidental
removal of parathyroid glands during total
thyroidectomy)
 Wound infection: This may manifest after 48
hours of surgery
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14. SPECIFIC NURSING CARE PLAN
- Perform focused assessment and monitor
for complications
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15. 1. Haemorrhage
 Assess dressing & area under the patient’s neck
and shoulder for drainage
 Monitor BP ,Pulse  hypovolemic shock
 Assess the tightness of the dressing
 Call MO in charge in case of bleeding
**Vascularity of the gland increases risk of
haemorrhage
***May require BT
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16. 2.Respiratory distress
 Assess respiratory rate, rhythm, depth and effort.
 Assist with coughing deep breathing
 Have suction equipment ,oxygen tracheostomy set
available
 O2 therapy as needed
 Suture cutter and artery clamp ready
**Hematoma and oedema may compress the
trachea  risk of respiratory depression
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17. 3. Laryngeal nerve damage
 Assess the ability to speak aloud, tone of voice.
 Hoarseness may due to oedema or
endotracheal tube used in the surgery -will
subside,
 If permanent loss of vocal volume (aphasia) 
Laryngeal nerve trauma
** Laryngeal nerve location increases the risk of
damage during the surgery
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18. 4. Tetany
 Assess for calcium deficiency
 Including tingling of toes, fingers & lips
 Keep ca gluconate or ca chloride available
for IV use
**Parathyroid glands location  injury or also
removed  hypocalcemia and tetany
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19. 5. Infection
 Monitor temperature regularly
 Aseptic techniques in dressing changing
 Inspect wound/suture line for oozing,
healing progress
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20. Summary
 Thyroidectomy
 Types
 Indications
 Pre-Op and post op general nursing care
 Complications
 Specific Nursing care plan
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21. ****************END**************
 THANK YOU.
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