Total Thyroidectomy

Paramedics bring a 66-year-old woman to the ED. Her blood pressure is 104/58 mmHg, pulse rate 44 beats/minute, respiratory rate 14 breaths/minute, and temperature 92.4o F (33.6oC). No medical history is available, except for the patient’s statement of not feeling well for the past month. Physical examination reveals a lethargic, thin woman with dry skin and periorbital and facial edema. Bilateral pulmonary congestion is noted. EKG monitoring shows sinus bradycardia. The physician diagnoses impending myxedema coma. The patient remains hypothermic, with a temperature of 95o F (35oC). The nurse would anticipate the treatment for this patient to include all of the following except:

A 65-year-old woman is brought to the ED by ambulance after fainting. Physical examination reveals central-type obesity with a fatty buffalo hump in the neck, hirsutism, thin and fragile extremities with ecchymotic areas, hypertension, and mild congestive heart failure. She informs the nurse that she has experienced extreme weakness and fatigue during the past month and that her sleep patterns have become altered. The nurse realizes that the patient’s signs and symptoms are characteristic of:

Which diagnostic test is the best indicator for a patient with adrenal crisis?

An obese patient with Addison’s disease is admitted to the ED after ambulatory surgery. The paramedics report that the patient has a fever, pallor, rapid weak pulse, signs of dehydration, headache, confusion, restlessness, and a blood pressure of 90/50 mmHg. Laboratory findings reveal a serum potassium level of 6.5 mEq/L, white blood cell count, 15,000/mm3 serum glucose level 55 mg/dL, and serum sodium level 124 mEq/L. The physician diagnoses adrenal crisis. The nurse suspects that this patient’s adrenal crisis probably resulted from:

A 47-year-old man is brought to the ED. His family reports that he had become confused over the past 72 hours and suffered a seizure while on the way to the hospital. Upon arrival, the patient is minimally responsive. His respiratory rate is 32 breaths/minute, pulse rate 110 beats/minute, and blood pressure 120/90 mmHg. Immediate laboratory work reveals an abnormal sodium level of 117 mEq/L. The patient’s chest X-ray reveals a mass in the right mid-lung field. The nurse suspects that the underlying factor responsible for this patient’s change in mental status is related to:

The nurse knows that emergency management of a comatose patient with hypoglycemia includes:

A 58-year-old man arrives at the ED, diaphoretic and complaining of severe pain in the right side. He informs the nurse that he had been walking his dog when he suddenly felt a horrible pain. Assessment findings reveal that his blood pressure is 160/70 mmHg, pulse 124 beats/minute and regular, temperature 98.6o F (37oC), and respiratory rate 24 breaths/minute. His abdomen, when palpated, reveals tenderness in the right flank. Urinalysis indicates RBCs in the urine. The patient has a history of hypertension and no known allergies. The physician diagnoses renal calculi and requests a consultation with the urologist. The nurse would expect the history of a patient with renal calculi to reveal a previous diagnosis of:

Which electrolyte imbalance would the nurse expect a patient to have in myxedema coma?

The nurse would expect the initial treatment of this patient to include all of the following except:

Prevention of which potential complication is the goal of nursing care for a patient with SIADH: