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Thyroid Surgery Outpatient Inpatient

Dr. Raffe Daniels, Surgeon Hey, Liza, it looks like Mrs. Peters is still a bit groggy. Will she be going to the floor soon I have to get up to the unit. Liza Colby RN Yes, I’m going to call report and she should be up in 15 minutes. Dr. Daniels I added some extra labs to the postop orders. Mrs. Peters may have problems with a drop in her calcium. Her thyroid was just huge, tucked in way beneath the sternum. We didn’t visualize all 4 parathyroid glands, and they might’ve been damaged. She seems okay now, but I want her calcium level checked twice a day.

She’ll need to be monitored for trouble breathing, muscle cramping, and numbness and tingling in her fingers. Liza Okay, I’ll make sure to pass on in report to watch out for hypocalcemia. Dr. Daniels Okay, excellent, If you need anything just page me. Liza Hi, Carla, this is Liza Colby, one of the RNs down in recovery room. Ready for report on Dr. Daniels’ patient, Mrs. Angie Peters Angie Peters, 54 years old, going to Room 416 Bed 2 on 4 East. Status post total thyroidectomy this morning. Doing well now, BP 120 over 85, heart rate 80, temp 37 degrees Celcius, O2 is up to 97 on 2 liters, and pain is 2 out of 10.

Surgery was remarkable for a large thyroid. No preop issues. She’s a Jehovah’s Witness so no blood products, but she is a full code. Her advanced directives are in the front of the chart. We have one safety concern, hypocalcemia. Dr. Daniels, the attending, ordered calcium levels q 12 hours because she’s worried about possible hypocalcemia, so monitor for pins and needles, muscle cramps, and shortness of breath. You’ll need to review these symptoms when she’s fully awake. Normal saline IV is running at 100cchour. Meds are metoprolol 50 milligrams prior to surgery and we just gave her 4 milligrams of morphine.

Inpatient Surgical Successful Outcome With TeamSTEPPS techniques

Urine output is good. Foley’s to be dc’d in the morning. I’ll let transport team know to ask for you, that is Carla Lopez, right What else can I tell you Oh. Yes, that’s right. You’ve got all the information right. Good question. There are no known drug allergies. Carla Lopez RN Okay, Angie, I have one more important thing to go over with you before we let you get some rest. Have you noticed any numbness or tingling in your fingers or toes, any cramping in your muscles, or tightness around your throat since you came out of surgery.

Carla I’m asking you these questions because very rarely after thyroid surgery, the calcium level in your blood can drop. Linda Reese, Patient’s Daughter Oh, is that serious Carla It’s easy for us to fix, but we can’t let it go. A low calcium level that isn’t treated can cause serious problems. Mrs. Peters I see. Dr. Daniels asked me those questions in recovery. I thought I was dreaming. Carla If you experience any of those symptoms at any time, let us know right away, okay Mrs. Peters Okay. But this is making me nervous.

Carla I’m not trying to scare you. Dr. Daniels just wants to be safe. Low calcium levels are rare, and they’re easy to treat. We’ll be checking your blood tests, and if you have any symptoms, we’ll contact Dr. Daniels immediately. We just want you to be aware of what we’re looking out for, so that you’ll let us know. Mrs. Peters Okay, so tightness in my throat, tingling, and what was the third one Linda Muscle cramps, right Carla That’s right. It’s nice to have your daughter here to help keep an eye on you, right. Do either of you have any questions.

Linda No, I think we’ll be okay for a while. Carla Here’s your call button. Get some rest, and I’ll be back to check on you in a little bit. Carla Hey Miriam, you have rooms 12, 13, 15, and 16. Here’s the rundown on the patients. Mrs. Peters, a 54yearold woman. She’s in room 128. Carla Here’s the chart. Miriam Silver RN Do we have Mr. Smith’s most recent labs Carla No we don’t. That’s actually a great point for us to start today’s brief. Hey everyone, let’s spend a minute talking about things for us to be aware of today on the unit.

The lab’s backed up with an analyzer down. They’re doing urgent and stats only. We’re at 80 occupancy and down one LPN. Janice will be picking up that coverage. Miriam Who’s backing up Janice Carla I think you can handle that. Miriam Sure. What’s the ER status tonight Carla We’re back on divert again. I think that’s it. Anything else critical Carla Watch Mrs. Peters for possible hypocalcemia, and Mr. Smith who just started on the beta blockers. Both are currently stable. Miriam Got it. I’ll check back on Mrs. Peters’ calcium levels and symptoms and monitor Mr. Smith for hypotension. Carla Perfect. Okay. Thank you.

Mrs. Petersthru speaker Can you please tell the nurse I’m having cramping and numbness in my fingers Miriam Mrs. Peters, this is Miriam. I’m right outside. I’ll be in shortly to check on you. Billie, can you check if we got Mrs. Peters’ labs back from this afternoon Miriamto herself Her calcium was 0.78. Boy, that’s right on the wire for a critical value. Let me see what her preop value was. to nursing station Who’s on the board for Dr. Daniels tonight Amy Dr. Ashley George. Dr. Ashley George, Resident Hi, this is Dr. George, I’m taking care of Angie Peters, a postop thyroid patient in room 416 on 4 East.

De. George She’s been dropping her calcium level pretty fast and she has symptoms too. We’re going to need to treat her, but she’s not tolerating PO meds. Can you help me with the IV dosing Martin Boyd Okay, you’re going to need to write for 1 gram of calcium gluconate, diluted in 100 milliliters of normal saline IV for an hour. Dr. George Let me confirm that. One gram of calcium gluconate, diluted in 100 milliliters of normal saline IV over an hour. Martin Boyd Correct. IV calcium has to be a slow infusion. If it’s given too fast you risk vascular damage.

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