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discuss the patho physiology of their presenting
condition, and using evidence based literature explore current surgical treatment options
for your patient

NRSG258 Acute Care Nursing 1, Semester 1 2016/Case Study A: Louise (Graves’ disease – Thyroidectomy)

Louise is a 32 year old woman who works as a Registered Nurse in the Emergency
Department of a large public hospital. Louise is the sole provider for her two young
children, who are in primary school. She has been separated from her husband for six
months and he has moved interstate.
Louise has recently been diagnosed with Graves’ disease. Her endocrinologist referred
her to an surgeon who recommended a total thyroidectomy.
On admission to hospital Louise told the ward nurse that she had lost a lot of weight
recently and had been feeling very tired. Louise stated that she currently smokes but she
is “trying to quit”. She appeared anxious and was constantly fiddling with her mobile
phone, handbag and clothes. Louise said that she is very worried about having time off
work and that she is concerned that her parents will not be able to cope with looking
after her two children while she is in hospital.
Louise returned to the Post Anaesthesia Recovery Unit (PARU) having undergone a
total thyroidectomy. She received a general anaesthetic and the surgery was
uneventful. There was no visible ooze on the small dressing covering the incision site,
which has been sutured using a subcuticular stitch to hold the wound edges together
and a Redivac drain in situ with 50mls of blood in it.
Initially Louise was noted to be drowsy but when she started to rouse spontaneously
her voice was hoarse and she complained that she was cold and that her neck felt tight
and painful. Louise was positioned in a high Fowler’s position and was receiving
oxygen, via a Hudson mask, at 6L/min. Her vital signs were as follows: BP 110/56, HR
105bpm, Temp 35.5oC, RR 12, Sp02 95%.
Louise returned to the ward after 60 minutes in PARU. She remained drowsy but was
easy to rouse. Louise had an intravenous infusion of 1000mls 0.9% Sodium Chloride
running at 125ml/hr and was ordered IV/Oral Paracetamol 1g 8/24, Tramadol Oral 50mg
6 hourly PRN and IV Ondansetron 4mg 8/24 PRN. Louise was given a discharge
prescription for oral thyroxine 150mcg daily and oral tramadol 100mg q8h PRN.
The next day Louise was assessed as ready for discharge. Her Redivac drain was
removed but her subcuticular suture was to remain in place for 7 days. Her voice
remained hoarse and she told the nurse that her neck “felt weird” and that she “just
couldn’t bear to look at it”. Louise said that her car is parked outside and asked if she
can drive straight to her parents’ house to pick up her children.
NRSG258 Acute Care Nursing 1, Semester 1 2016
QUESTIONS
Please refer to the rubric on page 11-12 of the Unit Outline for full marking criteria.
Question 1 (10%)
In relation to your chosen patient, discuss the patho physiology of their presenting
condition, and using evidence based literature explore current surgical treatment options
for your patient
Question 2 (15%)
Critically discuss the assessment of ventilation, circulation and consciousness prior to
the patient’s discharge from PARU. Discussion must relate to the effects of anaesthesia
and surgery on these three physiological functions, and be directly related to your chosen
patient.
Question 3 (10%)
Develop a discharge plan to support your chosen patient on discharge home. Include
any education you deem relevant, any referrals to allied health professional/s required,
and discuss your rationale.