Question

A nurse is caring for a client who is 1 day postoperative following a total thyroidectomy.

Laboratory Results:

Sodium 143 mEq/L (136 to 145 mEq/L)
Potassium 3.5 mEq/L (3.5 to 5.0 mEq/L)
Chloride 104 mEq/L (98 to 106 mEq/L)
BUN 15 mg/dl (10 to 20 mg/dl)
Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L)
Total calcium 8.0 mg/dL (9.0 to 10.5 mg/dL)
Phosphate 4.6 mg/dL (3.0 to 4.5 mg/dL)
Glucose 95 mg/dL (74 to 106 mg/dL)
WBC 9,500/mm3 (5,000 to 10,000/mm3)
Nurses' Notes:
0700:

Client alert and oriented x 3. Respirations even and unlabored with no adventitious sounds. Bowel sounds active in all 4 quadrants. Surgical dressing dry, slight edema at incision site noted. Client rates dull pain in neck of 2 on a 0 to 10 scale. Declines pain medication.
1100:
Client alert and oriented to person, place, and time. Respirations even and unlabored with no adventitious sounds. Bowel sounds active in all 4 quadrants. Surgical dressing dry, slight edema at incision site noted. Client reports muscle cramps in legs as a pain level of 5 on a 0 to 10 scale. Morphine 5 mg IV administered. Encouraged client to ambulate with assistance.
1200:
Client alert and oriented to person, place, and time. Respirations even and unlabored with no adventitious sounds. Bowel sounds active in all 4 quadrants. Surgical dressing dry, slight edema at incision site noted. Client ambulated down the hall with assistance. Client reports numbness around lips.
Vital Signs:
0700:

Temperature 37.6°C (99.6°F), Heart rate 65/min, Respiratory rate 16/min, Blood pressure 115/70 mm Hg, Oxygen saturation 98% on room air
0900:
Temperature 37.2°C (99.0°F), Heart rate 72/min, Respiratory rate 18/min, Blood pressure 110/72 mm Hg, Oxygen saturation 100% on room air
1100:
Temperature 37.7°C (99.86°F), Heart rate 76/min, Respiratory rate 16/min, Blood pressure 108/70 mm Hg, Oxygen saturation 100% on room air
Medication Administration Record:
1100:

0.9% Sodium chloride at 150 mL/hr
Morphine sulfate 5 mg IV. A) Hypocalcemia; numbness around lips and total calcium level of 8.0 mg/dL
B) Hypokalemia; muscle cramps in legs and potassium level of 3.5 mEq/L
C) Hypomagnesemia; muscle cramps in legs and magnesium level of 1.5 mEq/L
D) Hypophosphatemia; slight edema at incision site and phosphate level of 4.6 mg/dL

Answer 1

The patient's clinical symptoms and total calcium level of 8.0 mg/dL indicate hypocalcemia. Muscle cramps and numbness around the lips are consistent signs of low calcium levels. Correct management includes monitoring and possibly supplementing with intravenous calcium.

Step-by-step explanation:

After a total thyroidectomy, it is not uncommon for patients to experience changes in electrolyte levels, particularly calcium. The provided case indicates that the patient has a total calcium level of 8.0 mg/dL, which is below the normal range (9.0 to 10.5 mg/dL), fitting the clinical picture of hypocalcemia. The symptoms reported by the patient, including muscle cramps in the legs and numbness around the lips, are consistent with the signs of hypocalcemia. The correct answer to the question is option A) Hypocalcemia; numbness around lips and total calcium level of 8.0 mg/dL.

While the patient does have symptoms like muscle cramps, the potassium level is at the lower limit of the normal range (3.5 mEq/L), thus making hypokalemia less likely. Magnesium levels are also within normal limits, making hypomagnesemia an unlikely diagnosis. The phosphate level is slightly elevated, suggesting hyperphosphatemia, which does not correspond with the patient's clinical signs. Hypophosphatemia is usually associated with a level below the normal range, not above, as is the case here. Therefore, the option D related to phosphate levels does not explain the symptoms.

It is important for the nurse to closely monitor the patient's calcium levels and symptoms, as well as providing appropriate intravenous calcium supplementation if needed to manage the hypocalcemia. Additional blood tests might be necessary to continuously assess the patient's electrolyte balance, and careful observation for signs of tetany or seizures, which can occur with severe hypocalcemia.