Forty-eight hours after a thyroidectomy, a female client complains of numbness and tingling of the toes and fingers. The nurse notes upper arm and…

The client's symptoms of perioral and extremity numbness and tingling (paresthesia), along with facial and muscle twitching, are classic signs of hypocalcemia. This is a life-threatening complication following a thyroidectomy, often caused by the inadvertent damage or removal of the parathyroid glands, which regulate calcium levels. Hypocalcemia increases neuromuscular excitability, leading to tetany. The nurse's priority is to recognize these critical findings and immediately report them to the physician for prompt intervention, which typically involves intravenous calcium gluconate to prevent laryngospasm and seizures.

B. Assist the client to do range of motion exercises: This is inappropriate as it does not address the underlying electrolyte imbalance and could worsen muscle cramping caused by neuromuscular irritability.

C. Check the client’s potassium level: The clinical presentation is highly specific to hypocalcemia, not a potassium imbalance. While potassium levels are important, checking calcium is the priority.

D. Administer the as-needed dose of phenytoin (Dilantin): Phenytoin is an anticonvulsant. While severe hypocalcemia can cause seizures, this medication does not correct the underlying cause and is not the primary treatment for tetany.

1. Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth's Textbook of Medical-Surgical Nursing (15th ed.). Wolters Kluwer. In Chapter 45, "Management of Patients With Endocrine Disorders," the section on thyroidectomy complications explicitly states that the nurse must monitor for signs of hypocalcemia (tetany, tingling) and immediately report their occurrence.

2. Orloff, L. A., & Evasovich, M. R. (2021). Post-thyroidectomy Hypocalcemia. Otolaryngologic Clinics of North America, 54(2), 369–378. https://doi.org/10.1016/j.otc.2020.11.007. This article details the clinical presentation of post-thyroidectomy hypocalcemia, including paresthesias and muscle twitching (Section: "Clinical Presentation"), and emphasizes the need for prompt recognition and management.

3. University of California San Francisco, Department of Surgery. (n.d.). Thyroid Surgery. UCSF Endocrine Surgery. Retrieved from https://endocrinesurgery.ucsf.edu/conditions--procedures/thyroid-surgery.aspx. Under the "Risks of Thyroid Surgery" section, the document describes hypocalcemia as a potential complication due to parathyroid gland issues, noting symptoms like numbness and tingling, and the necessity of medical treatment.