Question

A client with shortness of breath (SOB) and neck pressure following a thyroidectomy. What is a priority nursing intervention for the registered nurse (RN)?

1) Elevate the head of the bed (HOB), remove dressing, and stay with the client
2) Call a code, open the trach set, and position the client supine
3) Have the client say "EEE" to check for laryngeal integrity and assess for Chvostek's sign
4) Call the primary care physician (PCP) and assess vital signs

Answer 1

The initial nursing intervention for a client experiencing shortness of breath following thyroidectomy is to elevate the head of the bed, remove the neck dressing to reduce pressure, and stay with the client to closely monitor their condition.

Step-by-step explanation:

The priority nursing intervention for a client with shortness of breath (SOB) and neck pressure following a thyroidectomy is Option 1: Elevate the head of the bed (HOB), remove dressing, and stay with the client. This action aids in reducing pressure on the neck, which can alleviate symptoms of airway obstruction, and allows the nurse to continuously monitor the client's condition.

Post-thyroidectomy, respiratory distress may occur due to swelling, bleeding, or injury to structures in the neck, thus necessitating immediate assessment and intervention. Elevating the HOB can help improve ventilation, and staying with the client ensures that the nurse is available to provide immediate care and reassurance.

If the situation worsens or if there is a clear indication, further measures, such as calling a code or contacting the primary care physician, would be appropriate next steps. However, the initial priority is to address the airway concern.