Inpatient Surgical: Successful Outcome With TeamSTEPPS techniques

Summary

Dr. Daniels discusses post-op care for Mrs. Peters after a thyroidectomy, noting potential hypocalcemia due to possible parathyroid damage. Nurse Liza relays the instructions to monitor calcium levels and symptoms like muscle cramps and numbness. Mrs. Peters experiences cramping and numbness, prompting a treatment with IV calcium gluconate under the guidance of Dr. George and pharmacist Martin Boyd.

Takeaways

• 🏥 Dr. Raffe Daniels is a surgeon concerned about post-operative Mrs. Peters' condition, suspecting potential hypocalcemia due to her thyroid surgery.
• 💼 Liza Colby, an RN, is coordinating Mrs. Peters' transfer to the floor and is informed about the additional lab tests ordered by Dr. Daniels.
• 🩺 Mrs. Peters underwent a total thyroidectomy, and her post-op vitals are stable, but she requires monitoring for symptoms of hypocalcemia.
• 🚫 Mrs. Peters is a Jehovah's Witness, which means no blood products can be used in her treatment, but she has a full code status.
• 📋 The nursing staff is aware of Mrs. Peters' advanced directives and the need for close monitoring of her calcium levels.
• 📝 Dr. Daniels ordered calcium level checks every 12 hours due to the risk of hypocalcemia, a potential complication of thyroid surgery.
• 👩‍⚕️ Carla Lopez, another RN, is briefed on Mrs. Peters' case and is prepared to monitor her for symptoms of low calcium levels.
• 👨‍👩‍👧 Mrs. Peters and her daughter, Linda Reese, are informed about the risks and symptoms of hypocalcemia post-surgery.
• 📉 The lab is experiencing delays due to an analyzer being down, which could impact the timely monitoring of Mrs. Peters' calcium levels.
• 📉 Mrs. Peters experiences cramping and numbness in her fingers, symptoms indicative of hypocalcemia, prompting immediate medical attention.
• 💊 Dr. Ashley George, the resident on call, needs to treat Mrs. Peters' hypocalcemia with IV calcium gluconate due to her intolerance to oral medications.

Q & A

What is the concern regarding Mrs. Peters' post-surgery condition?

Mrs. Peters may have problems with a drop in her calcium levels due to the large thyroid surgery, which could potentially damage the parathyroid glands.

What specific symptoms should be monitored for hypocalcemia in Mrs. Peters?

Symptoms to monitor include trouble breathing, muscle cramping, and numbness and tingling in her fingers.

How often should Mrs. Peters' calcium levels be checked according to Dr. Daniels' orders?

Her calcium levels should be checked twice a day.

What is the significance of Mrs. Peters being a Jehovah's Witness in her care?

It means she does not accept blood products, but she is a full code, indicating that all measures should be taken to keep her alive.

What is the current status of Mrs. Peters' vital signs after surgery?

Her blood pressure is 120/85, heart rate is 80, temperature is 37 degrees Celsius, oxygen saturation is 97% on 2 liters, and her pain level is 2 out of 10.

What is the importance of the advanced directives mentioned in Mrs. Peters' chart?

They provide instructions for her healthcare in case she is unable to make decisions for herself, which is crucial for her care.

What is the current status of the lab at the hospital?

The lab is backed up due to an analyzer being down, and they are only processing urgent and stat tests.

What is the occupancy rate of the hospital unit mentioned in the script?

The unit is at 80% occupancy.

What is the role of the nurse Miriam Silver in the care of Mrs. Peters?

Miriam Silver is an RN who will be checking back on Mrs. Peters' calcium levels and symptoms.

What is the treatment plan for Mrs. Peters' low calcium levels?

Dr. George plans to treat her with 1 gram of calcium gluconate diluted in 100 milliliters of normal saline IV over an hour to address her symptoms and low calcium levels.

Why is it important that the IV calcium is given slowly?

IV calcium must be given slowly to avoid the risk of vascular damage if infused too quickly.