N212: Health Differences Across the Life Span 2

Health Differences Across the Lifespan 2 Study Guide Positive signs of Tetany: • Trousseau’s sign: spasm of hand and wrist when a blood pressure cuff is inflated for three minutes in the upper arm • Chvostek’s sign: twitching or spasm of the eye, nose, or mouth when a facial nerve is tapped anterior to the ear and near the angle of the jaw • Peroneal sign: foot dorsiflexes when the peroneal nerve is tapped Treatment: medical treatment or surgical removal of part of the thyroid gland (partial or total thyroidectomy); ethionamide drugs for life to reduce the secretion of thyroid hormone; ablative therapy with radioactive Iodine-131; thyroid gland absorbs I-131, which destroys some thyroid cells over a period of 6- weeks (not recommended for pregnant women); radiation precautions are not required for small doses (less than 30mCi of I-131); instruct client to drink solution with straw to minimize exposure to buccal cavity; monitor lab values, report weight gain, fatigue, decreased pulse, and lowered BP (signs of excessive effects); keep environment cool and free from distractions and stress; monitor visual acuity and ability to close eyes with exophthalmos; assist nutritional state by weighing client daily; provide diet high in CHO, protein, and between meal snacks (variation of six smaller meals rather than three large meals); assist client to cope with body image changes with goiter and exophthalmos; monitor labs such as serum prealbumin, albumin, transferrin, and total lymphocyte count Lugol’s solution: reduces size and vascularity of thyroid gland Preoperative preparation for thyroidectomy: • Review deep breathing exercises and appropriatecoughing • Instruct the patient to hold hands behind the neck when coughing, sitting, turning, or getting up to reduce postoperative pain and neck muscle strain • Instruct the patient on how to self-administer prescribed anti-thyroid drugs to decrease vascularity and size of thyroid and minimize risk of surgical hemorrhage Postoperative care following thyroidectomy: • Provide comfort, analgesics, and use semi-fowlers position with neck and head supported by pillows to prevent muscle strain; ice collar to wound area for comfort and to prevent edema • Monitor for hemorrhage; monitor for tightness of dressing; sanguineous exudate on anterior or posterior neck dressing or on the skin of the neck, upper chest, upper back, shoulders, or back of neck; auscultate trachea for stridor (indicating edema and narrowed airway); first 24 hours postoperative is time of greatest risk • Promote patent airway by elevating the head of bed 30 degrees; monitor respiratory distress; keep oral and sterile suction supplies and emergency tracheostomy tray with tracheostomy kit and IV calcium gluconate or calcium chloride; maintain humidification of inspired air if ordered; encourage deep breathing exercises and incentive spirometer hourly; cough only if needed to clear secretions ©2017 Achieve Test Prep Page 69 of 140

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