Page 345 - Critical Care Nursing Demystified

330 CRITICAL CARE NURSING DeMYSTIFIED

4. The thyroid gland is then palpated with the index and middle fingers of both
hands placed below the cricoid cartilage on both sides of the trachea.
5. Palpation may be unsuccessful if the patient has a short, heavy neck.
6. An enlarged thyroid found on palpation should be auscultated for systolic
bruits, a positive sign of hyperthyroidism. Accelerated blood flow through thy-
roid arteries produces low, soft vibrations that can be heard by placing the bell
of the stethoscope over one of the lateral lobes.

7. The patient should hold his or her breath while the nurse listens to prevent
tracheal sounds from interfering with the bruits.

8. A bruit can be distinguished from a venous hum as the nurse uses his or her
finger to lightly occlude the jugular vein on the side that the nurse is assessing
while continuing to listen. Interestingly, the venous hum will disappear during
venous compression, but a bruit will not. By definition, a venous hum is pro-
duced by jugular blood flow.

Additional Nursing Considerations Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
1. Obtain daily weights to record changes in body mass.
2. Provide adequate hydration to counter the effects of fluid loss from nausea
and diarrhea and hyperthermia if these complications are evident.
3. Utilize warming or cooling blankets to stabilize either hypo- or hyperthermia.

4. The patient post thyroid surgery may develop risks due to hemorrhage or
laryngeal nerve injury. Particular attention must be paid to airway com-
promises that can occur.
5. Signs of impending thyroid storm need to be assessed and addressed.

6. If the parathyroid gland has been excised or injured, signs of tetany could
also occur.

7. Prescribed medications must be administered such as acetaminophen for
pyrexia and thyroid or antithyroid medications according to the prevailing
condition.
8. Continue to evaluate laboratory outcomes for thyroid gland status, blood
glucose levels, and fluid and electrolyte imbalances.
9. Cardiac monitoring and EKG must be ongoing to identify cardiac dys-
rhythmias such as atrial fibrillation, sinus tachycardia, sinus bradycardia,
and heart block.