Report on Anaesthetic Nursing Procedures for Hemithyroidectomy Patient

This report presents a comprehensive case study focusing on anaesthetic nursing care for a 60-year-old female patient undergoing a hemithyroidectomy. The report details the patient's presentation with shortness of breath, relevant medical history including coronary artery disease, diabetes, and hyperthyroidism. It outlines anaesthetic nursing responsibilities, including pre-operative preparation, patient assessment, and the administration of general anaesthesia, including the use of endotracheal tubes and IV fluids. The report addresses potential risks and advantages of procedures, pain management strategies in the post-anaesthetic recovery unit (PARU), and the determination of the need for planned anaesthesia. Furthermore, it emphasizes the significant role of perioperative nurses in patient care, adhering to standards set by organizations like ACORN and WHO, discussing the challenges and complexities of surgical episodes and patient management in the context of hyperthyroidism and related conditions. The report concludes with a summary of the key concepts, standards, and the overall strategic plan for improved patient outcomes.

Assessment 2
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Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY..................................................................................................................................3
Overview about the patient’s health condition/ presentation......................................................3
Relevant medical history of patient.............................................................................................4
How can perform the anaesthetic nursing sides..........................................................................4
Perform the kind of anaesthesia...................................................................................................5
Identifying the risk of using endotracheal tube and advantage...................................................6
Explain using IV fluid running during procedure to maintain hydration and blood pressure.....6
Patient to be recover in PARU (Post Anaesthetic recover unit), identifying pain level and pain
management.................................................................................................................................6
How long patient on recovery unit before sending to their room and how manage pain level
and stabilize patient.....................................................................................................................6
Determine the need for planned anaesthesia and surgical intervention.......................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9
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INTRODUCTION
The report is based on the case study about the patient, who are becoming as 60 years old
female presenting to emergency department with acute onset shortness of breath. The patient
going to have a “hemithyroidectomy” surgery and interacted with medical professionals. This
documentation review pathology, which are associated with hyperthyroidism and describe the
causes of hormonal imbalance, glandular function, and ectopic production of thyroid stimulating
proteins by neoplasms causing hyper function. Hyperthyroidism is a condition that occurs when
the thyroid gland of a person produces too much of thyroxine, a hormone (Hyperthyroidism
(overactive thyroid), 2020). The condition can increase the metabolism of one’s body which
causes an unintentional loss in weight. It can also lead to an irregular heart beat and irritability.
Common symptoms of the same include unexpected weight loss and shortness of breath
(Hyperthyroidism. 2020). People who suffer with hyperthyroidism requires a medical diagnosis.
The condition is not permanent and can be treated by a medical professional through a surgery.
The documentation will explain the view point of patient, might be feeling about the surgery and
fear of procedures that mainly followed by surgeons. Furthermore, it will be outlined the
patient’s presentation, identifying problem of shortness of breath, patient will decide to remove
thyroid gland with the help of relevant “hemithyroidectomy” surgery.
MAIN BODY
Overview about the patient’s health condition/ presentation
According to case study, the patient is 60 years old female representing the emergency
department with suffering from shortness of breath. The patient going to have a
“hemithyroidectomy” surgery and meet with medical professionals. She had generated similar
symptoms approximately one year ago with chronic (Abbas and Hamdan, 2019). The patient is
presenting this problem with along with a shortness in breath and dysphagia. Hyperthyroid,
which directly increased the problem of chronic obstructive pulmonary diseases. Generally, she
always used the BiPAP ventilator support during might, when they are sleeping. After few years,
it had increased the complex situation and requested to use emergency department due to
shortness of breath. She has reported the difficulty breathing at rest, feeling chilled require
blankets, increase the urinary frequency and swelling in her bilateral lower extremities.
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Relevant medical history of patient
As per case study, the past relevant medical history is significant for coronary artery
disease, diabetes mellitus, hypothyroidism, obesity and excessive usage of tobacco. In past
decade, it has been performed the surgical operation such as cardiac catheterization with stent
placement and other type of nephrectomy.
Importance of surgery for hyperthyroidism - A total thyroidectomy is also advisable
when hyperthyroidism occurs in the setting where the thyroid gland is very large, has nodules
that may be concerning for a cancer, or when significant eye changes (ophthalmopathy) exist
with Graves' disease. In addition to this, it is important for doctors and nurse to use anesthesia
which will be fine of the patient suffering from Hyperthyroidism (Ayaz and Ustun, 2020).
Because anesthetic drugs may affected by the hypermetabolic state of hyperthyroidism.
Moreover, Radioactive iodine is the most widely-recommended
permanent treatment of hyperthyroidism. This treatment takes advantage of the fact
that thyroid cells are the only cells in the body which have the ability to absorb iodine. In
fact, thyroid hormones are experts at doing just that.
How can perform the anaesthetic nursing sides
Nurse anaesthetists usually work in hospital operating room but it handle the combination
of nursing skills and knowledge of anaesthetics (Cirkovic and et. al., 2020). Surgery is an
important method that can be opted for in order to treat hyperthyroidism. The surgery method is
referred to as thyroidectomy, which helps in curing the condition and other conditions that are
related to thyroid gland.
 Duties include getting supplies and equipment’s ready for operational procedure before
surgery.
 It may be called upon to explain each and every thing about the procedures to patients,
putting more efforts to secure cooperation and also increased the confidence level of
patient, going to have a “hemithyroidectomy” surgery.
 It assists in tracking or monitoring the initial potential sign, symptoms and also interacts
with physician (NSQHS Standards Australian health service, 2018)
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 Anaesthetic nursing are performed physical examine that reveals temperature, heart rate,
saturation, Blood pressure and respiratory rate.
 Nurse anaesthetists was performed the testing which mainly include CT scan of chest.
TSH and T4 evaluate hypothyroidism. In order to check allergies, alerts, identifying any
surgical complication in past history.
Perform the kind of anaesthesia
In general anaesthesia can be used, anesthesiologist is basically start transition from
normal awake state to sleepy state (Demetriou, Nassar and Subramonia, 2020). This type of
process is also known as induction, which is mainly done by injecting medicine through inhaling
gases.
By using general anesthesia, specialist will monitor or tack the signs, symptoms and
continue to provide anesthesia. It always keep as provide comfortable to patient as possible
throughout surgical operation. Also, in order to prevent DVT or Deep Venous Thrombosis,
anticoagulation thrombosis is generally used. Two anticoagulants include warfarin and heparin
(Deep Vein Thrombosis Medication Options, 2020).
To provide the better breathe that help for deliver general anesthesia during operation (Eriksson,
Lindgren and Lindahl, 2020). It might be used endotracheal tube, which is made of plastic that
placed into windpipe through nose. Another way, it also used the laryngeal mast airway for
helping the patient in smooth breathe.
Consequences of hypothermia in surgery - The consequences of perioperative
hypothermia are significant and may include increased intraoperative blood loss, increased
chance of surgical wound infection, increased length of PACU and overall hospital stay,
decreased patient comfort, and increased rates of cardiac events.
Condition of patient after surgery and its recovery – Condition of patient will not get
good immediate after surgery as well as it takes long time in getting recover appropriately. Apart
from this, it will be important for patient and there family members to take care properly because
there is requirement of getting recover which need proper routine of each and every thing.
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Identifying the risk of using endotracheal tube and advantage
The complication that can be occurred during placement of an endotracheal tube which
include nasal trauma and upper airway. These are considered as short-term and long-term risk
associated with endotracheal tube (Gyurászová and et. al., 2020). Identifying the possible risks
such as bleeding, infection, temporary hoarseness when tube is removed, and injury to the
mouth.
Another way, the advantage is to control or maintain the oxygen level while maintain the
stability of patient during surgical operation.
In this process, it can be used general anesthetic because it help for removing natural
response to pain, also preventing the overall brain functionality from processing pain.
Explain using IV fluid running during procedure to maintain hydration and blood pressure
Anaesthetic nursing have a responsible for regulating or monitoring the large amount of
IV fluids being infused. This procedure can be used to regulate the infusion rate of patient, also
using clamp on the IV tubing which help for maintain both hydration as well as blood pressure at
the time surgical operations.
Patient to be recover in PARU (Post Anaesthetic recover unit), identifying pain level and pain
management
At the time of Post Anaesthetic recover unit, it can be followed the procedures by medical
professional before performing surgical operations. It help for maintain the coordination with
current position of patient (Jansson, Harjumaa, Pikkarainen, 2020). The entire procedure might
have to take approximately 1-hour.
After successfully performing the surgical operation where nurses should make a
medications charted for the patient and check the improvement progress. Sometimes, it can be
used the Anaphylaxis option such as anticoagulants and teds sticking on the patients. this will
help for preventing blood clot in proper manner
How long patient on recovery unit before sending to their room and how manage pain level and
stabilize patient.
The patient may recovered on the basis of their medications. Next level, when moving the
patient into room that will require to manage the pain and stabilize through different injections,
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medications. In this way, it help for patient to pain relief after surgery. In additional, it takes 1-
month recover in PARU (Post Anaesthetic recover unit). There are also various pain killers that
are available for providing relief to the patients when needed. This is because after a surgery, a
person can feel pain in the area (Pain Medications, 2020). Therefore, it is important to provide
effective pain killers like opioids, antidepressants etc. Effective pain management can help in
lowering down the pain of the patient.
Determine the need for planned anaesthesia and surgical intervention
The planning of anaesthesia or sedation, which means that consider different factors for making
an effective plan. The anaesthetic needs to give proper safety during surgery otherwise, it has
been increased the physiological impact on patient during surgery (Murphy and Batchelor,
2019). Moreover, it may indicate the relative suitability of local as well as regional manner.
Discuss with potential regarding pre-operatively will elucidate medical, psychological factors.
Continuous antibiotics can be used in order to prevent any kind of infection developing and
harming the patients. One of the antibiotics that is used is named as prophylaxis.
Identifying three potential problem and include pathophysiology
The primary causes are considered as intrinsic problem related to shortness of breath
function whereas secondary causes are related to the failure of organs and increases the Diabetes
disease, CVD. After evaluation, it can be identified the low body temperature, doctor will be
giving the hypothermia as medical emergency when it has occurred the body loses heat faster
than it can produce heat (Spellman and Liston, 2020). Sometimes, it causing a dangerously low
temperature as compare with normal. Thus integrated with large amount of information on the
basis of their current health report. Discuss about the significant role of perioperative or
perianesthetic nurse in context of surgical episode and care of patient
The significant role of perioperative nursing contribution in care of patient and surgical episode.
Perioperative practice is considered as demanding, complex and highly technical so that it can
easily compared with different settings. The medical professionals are responsible for aseptic,
infectious prevention and complication measure through technical method.
According to ACORN (Australian college of perioperative nurses) The primary vision of nurses
to provide the better quality of health care service. Australian patients have to receive safest and
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highest quality perioperative care in the global world. Generally, upholding the standards for
practice define as community perioperative nursing professionals (Torres, Relf and Tuazon,
2020). As per ACRON standards for perioperative nursing constitute the speciality knowledge of
health care services. In this way, professionals are accepted standards on the basis of nursing
practices, regularly performing their significant role towards patient (Yilmaz, Toğaç and Toğaç,
2020). WHO standard should be used by nurses and perform the significant role in the surgical
episode and health care. It facilitates complete and well-structured core health indicators
prioritised by global community. In order to give a response towards health situation and trends.
CONCLUSION
From above discussion, it has summarized about the concepts, standards and different
problem or issue through ACRON standards. In this documentation, it has been outlined the
patient’s presentation. Furthermore, it can be used the better strategic plan related the anesthesia
and surgical intervention in term of progressive health improvement. However, different medical
professionals, perioperative or perianesthetic nurse can perform the significant role in context of
surgical episode and care of patient. It can be said that hyperthyroidism has become more
prevalent than it earlier was. There are different symptoms of the condition that can be identified
in a person. This helps the healthcare professionals in treating the same effectively. Also, there
are certain pain killers that should be given to the patient in order to manage their pain more
effectively. It is very important to receive the consent of the patient and inform them about the
different antibiotics that would be used for treating their condition. Lastly, the patients should be
provided with the highest quality of treatment so that they can get back to being healthy in a
faster manner. Thus, if the condition is diagnosed early, it can be treated more effectively and in
a better way.
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REFERENCES
Book and Journals
Abbas, H.A. & Hamdan, K.H., (2019). The Role of Quality Standards (ISO) and International
Auditing Standards in the Control and Auditing of the Quality of the Gas
Industry. JOURNAL OF MADENAT ALELEM COLLEGE. 11(2).
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differently polymerized denture base acrylic resins. Nigerian Journal of Clinical
Practice. 23(3). p.304.
Cirkovic, A. & et. al., (2020). Systematic review supports the role of DNA methylation in the
pathophysiology of preeclampsia: a call for analytical and methodological
standardization. Biology of sex Differences. 11(1). 1-17.
Demetriou, G., Nassar, A., & Subramonia, S. (2020). The pathophysiology, presentation and
management of ischaemic colitis: a systematic review. World journal of surgery. 44(3).
927-938.
Eriksson, J., Lindgren, B. M., & Lindahl, E. (2020). Newly trained operating room nurses’
experiences of nursing care in the operating room. Scandinavian Journal of Caring
Sciences.
Gyurászová, M. and et. al., (2020). Oxidative stress in the pathophysiology of kidney disease:
implications for noninvasive monitoring and identification of biomarkers. Oxidative
Medicine and Cellular Longevity. 2020.
Jansson, M. M., Harjumaa, M. & Pikkarainen, M. (2020). Patients’ satisfaction and experiences
during elective primary fast‐track total hip and knee arthroplasty journey: A qualitative
study. Journal of Clinical Nursing. 29(3-4). 567-582.
Murphy, C. and Batchelor, T., 2019. Responding to contemporary challenges: A key component
of the ACORN standards. Journal of Perioperative Nursing. 32(4). p.47.
Spellman, T., & Liston, C. (2020). Toward circuit mechanisms of pathophysiology in
depression. American Journal of Psychiatry. 177(5). 381-390.
Torres, G. C. S., Relf, M. V., & Tuazon, J. A. (2020). The mediating role of pre‐operative patient
readiness on surgical outcomes: A structural equation model analysis. Journal of
Advanced Nursing. 76(6). 1371-1383.
Yilmaz, E., Toğaç, H. K. & Toğaç, S. (2020). A qualitative study of the operating room
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adventure”. Nursing & Health Sciences.
Online
Deep Vein Thrombosis Medication Options. 2020. [Online]. Available through:<
https://www.healthline.com/health/dvt/dvt-medications#drug-differences >.
Hyperthyroidism (overactive thyroid). 2020. [Online]. Available through:<
https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-
20373659>.
Hyperthyroidism. 2020. [Online]. Available through:<
https://www.healthline.com/health/hyperthyroidism>.
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NSQHS Standards (Australian health service) 2018. [online] Available through:<
https://www.safetyandquality.gov.au/standards/nsqhs-standards>.
Pain Medications. 2020. [Online]. Available through:< https://www.webmd.com/pain-
management/guide/pain-relievers#1 >.
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