Medical Surgical Thyroid #15

Question

The nurse is caring for a postoperative client 24 hours following a partial thyroidectomy for persistent hyperthyroidism. What assessment data should the nurse immediately report to the health care provider?

Answers

  1. Change in Pulse Oximeter from 93% to 91%
    • Rationale:

      This answer is not correct because the change in pulse oximeter reading is not extreme and is still within normal range of 90-100%. No immediate action is required at this time but the client should be monitored closely since a thyroid storm or crisis can lead to great energy and oxygen consumption.

  2. Change in respiratory rate from 30 to 22
    • Rationale:

      This answer is not correct because a change in the respiratory rate from 30 to 22 breaths per minute is an improvement. Nevertheless, the client should be carefully monitored, along with pulse oximetry readings, since a thyroid storm or crisis can lead to great energy and oxygen consumption.

  3. Change in temperature from 99 F to 100.2 F
    • Rationale:

      This answer is correct because the extreme hypermetabolic state of thyroid storm or crisis manifests itself in a high fever and can lead to great energy and oxygen consumption. The client’s temperature change from 99 F to 100.2 F indicates a significant change pointing to thyroid storm or crisis. Thyroid crisis or thyroid storm is a hypermetabolic situation that can occur following a partial thyroidectomy. This condition happens suddenly and is caused by excessive thyroid hormone being released into the bloodstream due to manipulation of the thyroid. Immediate action is needed since not treating the client can lead to heart failure. Symptoms are extreme hyperthyroidism symptoms and can become life threatening. Symptoms include a high fever, shaking, extreme tachycardia (over 140 bpm to atrial fibrillation), sweating, and overwhelming restlessness that can lead to unconsciousness. The extreme hypermetabolic rate manifests itself in a high fever and can lead to great energy and oxygen consumption.

  4. Change in apical heart rate from 72 beats per minute to 94 beats per minute
    • Rationale:

      This answer is not correct because even though an apical heart rate increase from 72 beats per minute to 94 beats per minute (bpm) is a substantial increase, it is still within the normal range of 60-100 bpm. The client should continue to be monitored because symptoms of thyroid storm or crisis include extreme tachycardia (over 140 bpm to atrial fibrillation). Careful telemetry monitoring of the client is important.

Overview

Thyroid crisis or thyroid storm can occur following a partial thyroidectomy for persistent hyperthyroidism. This hypermetabolic state has symptoms including a sudden elevation in temperature.

Explanation

Learning Outcomes

Thyroid crisis or thyroid storm is a hypermetabolic situation that can occur following a partial thyroidectomy. This condition happens suddenly and is caused by excessive thyroid hormone being released into the bloodstream due to manipulation of the thyroid. Immediate action is needed since not treating the client can lead to heart failure. Symptoms are extreme hyperthyroidism symptoms and can become life-threatening. Symptoms include a high fever, shaking, extreme tachycardia (over 140 bpm to atrial fibrillation), sweating, and overwhelming restlessness that can lead to unconsciousness. The extreme hypermetabolic rate manifests itself in a high fever and can lead to great energy and oxygen consumption. Treating the condition involves supportive care and administration of antithyroid medications including propylthiouracil (PTU) or methimazole which will help reduce the continued increase of thyroid hormone. Use of radioactive iodine can be used to destroy the thyroid. This action would involve later removing the destroyed thyroid and placement of the client on lifelong thyroid therapy.

Test Taking Tip

Just like a thunderstorm can occur suddenly, so can a thyroid storm or crisis. Just like how a storm can lead to a tornado, causing severe, sudden damage, a thyroid storm or crisis should be responded to immediately to help prevent damage to the heart and body.

Video Rationale