護理師護理一位甲狀腺切除術後的病人,應監測哪些發現以預防潛在併發症?(選所有適合的)
A nurse is caring for a client who is post-operative following a thyroidectomy. Which findings should the nurse monitor for to identify potential complications? (Select all that apply.)
- ATingling around the mouth and fingers✓ 正解口周及手指感覺異常
- BHoarseness when speaking✓ 正解說話時聲音沙啞
- CHigh-pitched respiratory sounds✓ 正解高調呼吸音
- DDifficulty swallowing吞嚥困難
- EPositive Trousseau sign✓ 正解Trousseau 徵象陽性
甲狀腺切除術後需密切關注副甲狀腺損傷引起的低血鈣(口周/指尖發麻、Trousseau 徵象陽性)及喉返神經損傷(聲音沙啞)。此外,術後出血造成的氣管壓迫可導致高頻呼吸音(Strider),需隨時準備氣切設備以備急需。
After a thyroidectomy, the nurse must closely monitor for hypocalcemia caused by parathyroid injury (perioral and fingertip tingling, positive Trousseau sign) and damage to the recurrent laryngeal nerve (hoarseness). In addition, postoperative bleeding can compress the trachea and cause high-pitched respiratory sounds (stridor), so tracheostomy equipment must be available at all times for emergencies.
美國護理師常執行 Chvostek 與 Trousseau 檢查,台灣護理師較少執行此類評估,多由醫師執行。