post operative management of thyroidectomy ppt

this gives minimum scarring. Many surgical procedures are now performed in a day surgery setting, and the patient is never admitted to the hospital. The PowerPoint PPT presentation: "Management of Acute Postoperative Pain" is the property of its . Other (Patient/Disease); - BMI/ Gland size/ Medication/ etc Post-Thyroidectomy Haemorrhage Technology has allowed: Better control of bleeding during thyroid surgery General reduction in surgical blood loss While Intra-operative Mortality risk has "disappeared", Post-operative Haemorrhage remains life-threatening Arch Surg. Advancing Patient Recovery with Post-operative Care (1) - Post-operative care involves the care received after a surgical procedure and often includes pain management and wound care as part of the healing process. Thyroid Surgery Practice & Operative Techniques- Updated Current Trends in Thyroid Surgery Workshop Moi Teaching & Referral Hospital (MTRH) Eldoret, Kenya Prof. John Adwok MBBS, MMED(Surg. [ 1] Initial Evaluation Evaluation of thyroid disease should include specific inquiry about personal and family history, clinical characteristics, and symptoms. According to a previous study, known causes of post-thyroidectomy hematoma include slipping of ligatures on major vessels, reopening of cauterized veins, retching and vomiting, Valsalva maneuver, increased blood pressure, and continuous exudation from the original thyroid location, in the postoperative period. 40. Parenteral opioids are effective analgesic regimen but are associated with adverse effects such as respiratory depression, postoperative nausea and vomiting (PONV), pruritus, urinary retention, and ileus. sutures usually removed on 5 th post-operative day. ; Hemithyroidectomy or thyroid lobectomy: This involves the removal of one of the two lobes of the thyroid gland. Attend to the post-operative trip for suture/staple evaluation and removal. • After surgery, radioactive iodine. Here are five (5) nursing care plans and nursing diagnosis for thyroidectomy: Acute Pain Risk for Impaired Airway Clearance Impaired Verbal Communication Risk for Injury Deficient Knowledge 1. Preoperative fluid management strategies aim to avoid the patient arriving in the operating room in a hypovolemic or dehydrated state. Permanent in 0.8 to 3% post-total thyroidectomy (hypocalcaemia) . Patient Profile Name XYZ Age 23 years Gender Male Profession Serving DOA 23.01.2013 43 ; 43. However, an . 1) Hypocalcemia Incidence is 3-5%. multifactorial etiology. surgical division nairobi hospital 8/23/2013 thyroidectomy workshop--kampala f disclosures evidence-based presentations on the principles and practice of thyroid surgery. What is your differential diagnosis? Calcium levels should be routinely checked within 24 hours and hypocalcaemia treated appropriately. Regression Analysis Thyroid Size (weight) p = 0.0072 [OR 1.05 (per 10 gms)] 95% CI = 1.01 - 1.09 Highest post-op Systolic BP p = 0.016, [OR: 1.39 (per 10 mmHg)] 95% CI=1.09-1.76 Statistical Issues Surgical Team: there is some statistical effect of surgical team - inclusion improves the fit for the statistical model Thyroid Weight: non-normal distribution skewed to larger thyroids weight loses . Assessing the patient Monitor vitals-pulse volume and regularity, depth and nature of respiration. Post-operative Management of follicular Cell Derived Thyroid Cancer Thyroglobulin monitoring Thyroglobulin Monitoring (ATA 2009) • Every 6-12 months initially then yearly depending on risk • Even if not a TT or remnant ablation Post Operative Management of follicular Cell Derived Thyroid Cancer Withdrawal or rhTSH stimulation testing 42 CASE II PRESENTATION Management of Complicated Papillary Thyroid Carcinoma ; 42. Wong Chun Lam United Christian Hospital - A free PowerPoint PPT presentation (displayed as an HTML5 slide show) on PowerShow.com - id: 7dbe9a-YTI1Y. Thyroidectomy is a well-described procedure used to excise the thyroid gland. Gross extrathyroidal extension Primary tumor > 4 cm Postoperative Tg >5-10 ng/ml Known or suspected distant metastases Differentiated use of radioiodine Do you recommend radioiodine therapy? Early ambulation is invited to reduce your risk of greater risk of blood clots and pneumonia. demonstrate the use of innovative hand-held instruments introduced in recent years that have had a positive impact on performing surgery in general. Administration of prophylactic antibiotics for clean neck dissections is reasonable Predicting post-operative vocal cord function ; A large bulky dressing is worn overnight and if after inspection, there is no evidence of bleeding, this is removed and the patient is allowed to shower. Description. The patient is 3 days post-op and is complaining of pain around his surgical site in his groin. Postoperative care in the first week Any non-absorbable sutures are removed, and skin tape is applied to reduce tension. Aug 04 . MTRH Eldoret Surgical Strategy Extent of thyroidectomy Hemithyroidectomy •Positioning •Access to the gland •Closure . Rapid haematoma formation, even with small volumes, can result in significant airway obstruction requiring emergency intervention. This extract is from the Pre and Post-Operative Care tutorial authored by Sally Moyle, BNurs, MNurs, RN, CNS. Pediatric Thyroid Cancer. NURSING MANAGEMENT IN POST OP UNIT To provide care until the patient has recovered from the effect of anesthesia. Preoperative physical examination. BMI/ Gland size/ Medication/ etc Post-Thyroidectomy Haemorrhage Technology has allowed: Better control of bleeding during thyroid surgery General reduction in surgical blood loss While Intra-operative Mortality risk has . patient during handoff of care, postanesthesia care that may include analgesia, management of postoperative nausea and vomiting (PONV), airway management and resuscitation, discharge from the postanesthesia care unit (PACU), development of policies, and continuous quality improvement for staff education and improved processes. UT AnesthesiologyGrand RoundsMarch 31st 2005. In this topic, we discuss various surgical aspects of thyroidectomy, including preoperative evaluation and preparation, operative management, postoperative care, and complications. Post OP Management 41 7th Post op day - Shifted to ward 10th Post op day - Fibreoptic laryngoscopy - Decannulation 14th Post op day - Grillos sutures removed ; 41. Thyroidectomy -Lyfboat - Thyroid gland is a gland which is present in the neck region. Randle RW, Bates MF, Long KL, et al. Toggle navigation. tyroidectomy without exposure to oral flora is considered a clean procedure. Preoperative care involves many components, and may be done the day before surgery in the hospital, or during the weeks before surgery on an outpatient basis. Case History 19 year old Hispanic female presents for a left hemithyroidectomy. Neuromonitoring in Thyroidectomy Is neuromonitoring useful in preventing recurrent laryngeal nerve injury? 49-2, p. 1159) Post-op care includes interventions to decrease intracranial pressure and monitoring surgical drainage for cerebrospinal fluid (indicated by increased glucose) o Mustache dressing - if CSF leak (glucose in drainage from nose - tastes sweet):notify provider STAT o Limit coughing, straining o Oral rinses and flossing - no toothbrushing o Position high-Fowlers, avoid bending the surgical techniques discussed in this … In general, a postop-erative PTH level <15pg/mL indicates increased risk for acute hypoPT. Effective management of mild to moderate potential or actual postoperative hypoPT can be achieved by administering either empiric/prophylactic oral calcium and vitamin D, selective oral calcium, and vitamin D based on rapid postoperative PTH level (s), or serial serum calcium levels as a guide. Endoscopic thyroidectomy (ET) allows surgeons to remove a thyroid tumor from a remote site, while providing excellent results from a cosmetic viewpoint. The page reads: 42yo male. . Slow growing painless . It . The gland plays a major role in regulating the metabolism of our body and has a direct control over the growth of our body. also be monitored in the postoperative period and cor rected iflow. In men it is more prominent and can be seen protruding out; informally referred to as Adam's apple. Management of postoperative agitation: Crying and agitation in the PACU exacerbates stridor and difficulty in breathing. INFECTIONINFECTION Aerodigestive tract entry is the single most important factor that contributes to the risk of wound infection. Postoperative care is the care you receive after a surgical procedure. Airway Complications and Management after Thyroidectomy Jose M. Soliz, M.D. However, there was an increase in the rate of post-operative atrial fibrillation in the subclinical hypothyroidism group.18 One retrospective study analyzed the outcome of anesthesia and surgery in 59 hypothyroid patients compared with 50 COMPLICATIONS Wound hemmorhage Wound infection Superior laryngeal N injury Recurrent laryngeal N injury Unilateral RLN injury Bilateral RLN injury Hypocalcemia Thyroid storm 38. A 4-year-old male status post inguinal hernia repair develops post-operative stridor in the postanesthesia care unit (PACU). ), FCS(ECSA), FRCS, FACS, PhD. Skin colour. (28-30) - Strong recommendation, moderate quality evidence . When a patient comes back from having their thyroidectomy surgery, place them in a semi-fowler's position. Postoperative care Definition Postoperative care is the management of a patient after surgery. Thyroid, 25(7), 716-759. . the surgical … Avoid use of restraints. 8/23/2013 thyroidectomy workshop--kampala fbranches of the sln the … 6d post op (L femur # ORIF). 13,14 The guidelines are based on a meta-analysis of randomized trials that reports a . Pre-operative; Peri-operative; Post-operative; For example: "You are called to see an obese diabetic 50-year-old patient following their open mesh inguinal hernia repair. Here are five (5) nursing care plans and nursing diagnosis for thyroidectomy: Acute Pain Risk for Impaired Airway Clearance Impaired Verbal Communication Risk for Injury Deficient Knowledge 1. 14 This is of increased concern considering that postoperative pain management regimens commonly use opioids which independently promote constipation. department of surgery nairobi hospital f disclosures evidence-based presentations on the principles and practice of thyroid surgery. . A complaint of numbness and tingling in the extremities may be a warning symp-tom. Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer. Aftertotal thyroidectomy, transient hypocalcemia has been reported in 6 . A Am J Otolaryngology. Assessment of patient's O2 saturation. Thyroidectomy -Lyfboat - Thyroid gland is a gland which is present in the neck region. Hypocalcaemia following thyroidectomy for treatment of Graves' disease: implications for patient management and cost-effectiveness. - A free PowerPoint PPT presentation (displayed as an HTML5 slide show) on PowerShow.com - id: 7d0d6-ZDc1Z operative intact PTH levels following thyroidectomy can help guide patient management. it runs in close proximity to the superior thyroid artery and is therefore vulnerable when the vessels of the superior pole are ligated, even when this pole is not enlarged. Postsurgical hypoparathyroidism has been defined as the presence of serum levels of iPTH below 15 pg/mL in the postoperative period [11- 13], in the presence of CSC values < 8.0 mg/dL (2.0mmol/L), or ionized calcium below 1.1 mmol/L (4.4 mg/dL) with or without symptoms of hipocalcemia [11,13-20]. Step one Operative procedure Technical considerations Hemostasis will be secured as the procedure progresses Usually via Bovie May clamp and tie some vessels May use ligating clips • The incision is made and extended through the subcutaneous tissues and the platysma muscle. Temp is now 38.0 C and pt is tachycardic not responding to fluids. At one week after the surgery, the tensile strength across an incision is only 3% of that of uninterrupted skin. the thyroidectomy, is a terrifying ex-perience to the patient and disconcerting to the surgeon. The gland plays a major role in regulating the metabolism of our body and has a direct control over the growth of our body. The nurse reports some swelling at the site and a foul odour." KEEP MONITORING VITALS 11. Symptoms usually de-velop about the third or fourth day, at a time when the patient has weathered the immediate dangers of the operation. David Terris Post Total Thyroidectomy Calcium Regimen Give OsCal Taper over 3 weeks post op - begin the evening of surgery 1) Take 1000mg OsCal + Vit D po TID x 7 days 2) Then, take 1000mg OsCal + D BID x 7 days 3) Then, take 1000mg OsCal + D QD x 7 days 4) Take 1000mg OsCal + D Q 30 minutes if develop perioral or hand numbness/tingling. Recurrent laryngeal nerve injury . its excretion through the gastrointestinal . The two most common early complications of thyroid surgery are hypocalcemia (20-30%) and recurrent laryngeal nerve injury (5-11%). A large prospective study has shown that about 60-70% of patients recover normal parathyroid function within 4-6 weeks after thyroidectomy (transient PO-HypoCa); the remaining will require continued treatment for additional time (protracted PO-HypoCa), and about 15-20% of them will develop permanent/chronic PO-HypoCa. Factors that increase the chance of extensive dissection such as presence of a large/substernal goiter, thyroid malignancy, or repeat operation increase the likelihood of parathyroid injury and subsequent hypocalcemia. To administer post-operative oral calcium supplementation to patients post-thyroidectomy to avoid transient hypocalcemia. recommendations in management of post-thyroidectomy hoarseness • causes of hoarseness other than recurrent laryngeal nerve palsy need to be considered • best timing to investigate still a controversy • first study between post-op 2 weeks to post-op 4 weeks • close follow-up to to 6 months, repeat examination in 1 year • follow-up for minimum of 1 … Presentation Transcript. Thyroidectomy: Preoperative and Postoperative Nursing Care 244 The American Journal of Nursing the thyroidectomy, is a terrifying ex- perience to the patient and disconcerting to the surgeon. Symptoms usually de- velop about the third or fourth day, at a time when the patient has weathered the immediate dangers of the operation. Postoperative airway management should be an informed decision that incorporates preoperative information and pre-extubation assessment in conjunction with knowledge gained from techniques that were successful and those that were unsuccessful during the initial management of the patient's airway. Preoperative hyperthyroidism causing parathyroid suppression and/or thyrotoxic osteodystrophy should also be considered as causes. Drains placed post thyroidectomy with neck dissection can also be useful in monitoring for chyle . also be monitored in the postoperative period and cor rected iflow. Relates to the management of contralateral lobe. It may continue even after the patient's discharge, therefore, it is imperative for the provider to teach the patient about the potential side effects and complications of the . Thyroidectomy: complications Definition Major postoperative complications include wound infection, bleeding, airway obstruction (compressing hematoma, tracheomalacia), hypocalcemia, thyroid storm (uncommon, usually associated with Grave's disease) and recurrent laryngeal nerve injury. Postoperative recovery and hospital stay may prolong if those unwanted side effects occur ( 49 ). The type of postoperative care you need depends on the type of surgery you have, as well as your health history. Start off using 1-2 cubes a day and increase as tolerated. Laparoscopic Adrenalectomy / Open Adrenalectomy Post-Operative Instructions - 3 - milk) for at least 4 weeks or as directed by your physician. (2015). Types. Spasm of the hands and feet, and, The patient underwent a right hemithyroidectomy six weeks previously for a thyroid nodule. • Diagnosis: thyroid hormone, biobsy • Management • The treatment of choice surgical removal. Factors affecting airway management strategy History Hughes OR, Scott-Coombes DM. Christiane Vogt-Harenkamp, M.D. This figure increases to 20% by the third week when remodeling begins and to 80% after three months. Diagnostic scan: Uptake in several neck lesions and diffuse uptake in both lungs Therapy with 175 mCi 131iodine TSH suppressive therapy Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication (occurring in less than 0.1% of cases that requires emergency management. POST OPERATIVE MANAGEMENT Thyroid hormone replacement Radioactive iodine treatment External beam radiotherapy and chemotherapy 39. After total or near total thyroidectomy patients should be commenced on suppressive doses of levothyroxine (2 µg/kg) or liothyronine 20 mcg tds in accordance with local protocols. … Keep side rails raised/padded, bed in low position, and airway at bedside. Total or near-total thyroidectomy is performed if possible. No sexual activity. Usually, there is mild discomfort immediately postoperatively and pain medications will be prescribed. Acute Pain ADVERTISEMENTS Acute Pain Nursing Diagnosis Acute Pain May be related to Surgical interruption/manipulation of tissues/muscles Postoperative edema 14 This is of increased concern considering that postoperative pain management regimens commonly use opioids which independently promote constipation. Fever >72h - DVT!!! Modified neck dissection or more extensive radical neck dissection is performed if there is lymph node involvement. Introduction Transient hypocalcemia is commonly seen following thyroidsurgery and isespecially commonafter totalornear total thyroidectomy where bilateral tracheoesophageal groove dissectionisperformed. Purpose Sitting totally upright would put the patient at a 90 degree angle, but in a semi-Fowler's position they are angled between 15 and 45 degrees. Surgeons cannot apply a new approach without perfect precise pre- and post-operative management of . Minimally invasive surgery is widely employed for the treatment of thyroid diseases. In men it is more prominent and can be seen protruding out; informally referred to as Adam's apple. We restrict activities that cause stretching of the neck for about 3 weeks after surgery. The complete tutorial on Pre and PostoOperative Care discusses the information presented here in more detail and covers preoperative preparation, surgical risk factors, preoperative checklist including consent, patient with special . Surgery 2018; 163:68. These activities may include lots of twisting or vacuuming. Total or near-total thyroidectomy: This involves the removal of all or most of the thyroid gland.This surgery is often indicated for large thyroid cancers, large goiters, and Graves' disease. - * DIABETES INSIPIDUS A disorder of the posterior . dry dressings sufficient every alternate day, if suture line is clean and dry. A New Molecule for Post Operative Pain Management - A New Molecule for Post Operative Pain . 2nd Week post op craniotomy nursing care. 2009;144(12):1167 … Abstract. demonstrate the use of innovative hand- held instruments introduced in recent years that have had a positive impact on performing surgery in general. 17. + + + PREOPERATIVE CONSIDERATIONS + + . Decreased gastrointestinal motility, which is most commonly manifested as constipation in hypothyroid patients, increases the tendency for postoperative ileus. Sedation and pain control prevent crying and agitation and . Level > 2ng/mL = Recurrence/Persistent . Effective management of mild to moderate potential or actual postoperative hypoPT can be achieved by a dministering either empiric/prophylactic oral calcium Female:male ratio is 2:1 Mean age of presentation is 30 to 40 yrs. Avoid activities that would make you tense or strain your abdominal muscles for at least 4 weeks or as directed by your physician. Check the level of consciousness. Decreased gastrointestinal motility, which is most commonly manifested as constipation in hypothyroid patients, increases the tendency for postoperative ileus. Urgent management of symptomatic hypocalcemia requires iv Ca 2+ salts in two steps: one or two ampules of a 10% solution of calcium gluconate, containing 90-180 mg elemental calcium in 50 mL of 5% dextrose, over 10 to 20 minutes followed by a slower infusion of calcium gluconate, 0.5 to 1.5 mg/kg/h over an 8- to 10-hour period. INDICATIONS Thyroidectomy may be performed for a number of benign and malignant conditions, including: Thyroid nodules. Post-operative management. post operative mgt • half-hourly observation until conscious • at the bed side • michel clip remover in case of respiratory distress due to hematoma • 10ml of 10% calcium gluconate in case of acute hypocalcamia • keep semi-recumbent • review indirect laryngoscopy (especially if there is cord impairment on extubation) • serum calcium regularly in … Introduction Transient hypocalcemia is commonly seen following thyroidsurgery and isespecially commonafter totalornear total thyroidectomy where bilateral tracheoesophageal groove dissectionisperformed. Ipsilateral lobectomy Subtotal Thyroidectomy Near-total Thyroidectomy Total Thyroidectomy Papillary Carcinoma Most common Thyroid carcinoma (80%) Related to radiation exposure in I-sufficient areas. . this muscle is responsible for tensing the vocal cords and its injury leads to weakness of voice. This option may be indicated if a thyroid nodule is small and localized to one side of the . Impact of potassium iodide on thyroidectomy for Graves' disease: Implications for safety and operative difficulty. • Superior and inferior flaps are mobilized and retractors are placed Checkout this page to get all sort of ppt page links associated with perioperative management of thyroid disease ppt. Post-operative Management Thyroid hormone Replacement therapy Suppression of TSH release At 0.1 μU/L in Low-risk group 0.1 μU/L in High-risk group Thyroglobulin measurement At 6-months interval then annually when disease-free 2ng/mL in total or near-total + Hormones 5ng/mL in hypothyroid patients. Takeaway. post-operative management initial dressing changed after 48-72 hours (to inspect for infection of suture line), unless there is soakage, when it should be removed earlier. . It is a common procedure in modern medicine and may be used to treat malignancy, benign disease, or hormonal disease that is not responsive to medical management. Acute Pain ADVERTISEMENTS Acute Pain Nursing Diagnosis Acute Pain May be related to Surgical interruption/manipulation of tissues/muscles Postoperative edema Postoperative haemorrhage is a well-recognised complication of thyroid surgery with an incidence between 0.45% and 4.2% [ 1 - 4 ]. Rationale: Hypocalcemia with tetany (usually transient) may occur 1-7 days postoperatively and indicates hypoparathyroidism, which can occur as a result of inadvertent trauma to/partial-to-total removal of parathyroid gland (s) during surgery. 10. This includes care given during the immediate postoperative period, both in the operating room and postanesthesia care unit (PACU), as well as during the days following surgery. Postoperative+calcium+supplementationinpatients+undergoing+thyroidectomy.+ + + + + Wang+TS,+Roman+SA,+Sosa+JA.+Curr+Opin+Oncology+2012;+24(1);+22F28+ POST THYROIDECTOMY / PARATHYROIDECTOMY CORRECTED CALCIUM LEVELS Check within 12h postoperatively no symptoms no treatment required symptoms of hypocalcaemia Multiple international guidelines, including those from the American Society of Anesthesiologists, allow unrestricted intake of clear fluids up to 2 h before elective surgery. KeywoRDS: perioperative management, hypothyroid, hyperthyroid, thyrotoxicosis ReCeIVeD: August 29, 2016. . POST-OP THYROIDECTOMY NURSING CARE POSTOP . [1] . Aftertotal thyroidectomy, transient hypocalcemia has been reported in 6 . - Infection - Wound - UTI - Pulmonary 5 Ws - Wind - Water - Wound - Walking - Wonder drugs Case example 4 60 yo male presents d5 post laparotomy with urine output of .