The nurse is caring for a client recovering from a thyroidectomy to treat hyperthyroidism. Which assessment finding would require the nurse to immediately notify the health care provider?

Question

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Thyrotoxicosis (ie, thyroid storm) is a life-threatening condition characterized by an increase in thyroid hormone levels that results in a hypermetabolic state. Most commonly, thyrotoxicosis occurs as an exacerbation of hyperthyroidism and is treated with antithyroid medications and/or surgical removal of the thyroid (thyroidectomy). However, thyrotoxicosis may also occur due to excess thyroid hormone intake from medications and physical manipulation of the thyroid gland. The nurse caring for a client after thyroidectomy must closely monitor for and immediately report any clinical manifestations of thyrotoxicosis (eg, fever, chills, tachycardia), including small rises in body temperature (Option D). After surgery, thyroid hormone levels can remain elevated for several days and may even increase from intraoperative thyroid gland manipulation. Without treatment, thyrotoxicosis can rapidly progress to lethal complications (eg, hyperthermia, ventricular tachycardia). (Options A and C) Expected postsurgical findings (eg, pain, small volume incisional bleeding) do not require notification unless the findings are unresolved by interventions (eg, pain medicine) or excessive (eg, continuous or large volume bleeding). (Option B) Postoperative sore throat is expected due to irritation from the endotracheal tube used during surgery. However, the nurse should monitor for hoarseness or noisy breathing, which may indicate laryngeal stridor and airway compromise. Educational objective: Thyrotoxicosis is a life-threatening, hypermetabolic condition caused by elevated thyroid hormone levels that is treated with antithyroid medications and/or surgery. The nurse providing postoperative thyroidectomy care must monitor for and report clinical manifestations of thyrotoxicosis (eg, chills, fever) because thyroid hormones many remain elevated, or increase, for several days postoperatively.

The Nurse Is Caring for a Client Recovering from a Thyroidectomy