Nursing Care of Thyroid Carcinoma with Acute Respiratory Failure : Case Study

Abstract

Acute respiratory failure  is a life threatening condition that is required immediate life saving management. At King Narai Hospital, the number of thyroid carcinoma patients who had total thyroidectomy was 66,70,and68 from 2017 to 2019 respectively.

In 2019, even though it could be preventable, 1 patient (1.47 percent of those patients) was unexpectedly diagnosed with upper airway obstruction and acute respiratory failure during hospitalization.

A 62 years old female with painless palpable neck mass for 2 years was referred from BanmiHospital  to King Narai Hospital on January 8^th, 2019. 2 months prior, she experienced enlargement of neck mass, hoarseness and difficulty in breathing when in supine position.

The biopsy from Fine Needle Aspiration (FNA) was shown that she had thyroid carcinoma. Fiber Optic Laryngoscope (FOL) was also done and paralysis of left true vocal cord was found. Total thyroidectomy was scheduled and the patient was hospitalized.

During hospitalization prior to the procedure, she suffered from anxiety disorder due to lack of medical knowledge about the operation and disease. After successful total thyroidectomy procedure, she was diagnosed with hypokalemia and anemia from massive blood loss intra-operation (approximate blood loss was 1500 ml.). Close monitoring for any complication was done.

2 day after the patient was extubated, she was unexpectedly diagnosed with upper airway obstruction and acute respiratory failure. She was re-intubated and put on ventilator and then, subsequently, tracheostomy was done on day 7^th after re-intubation. Weaning protocol was successfully done but tracheostomy tube was still needed due to true vocal cord paralysis. The tissue pathology showed she had follicular carcinoma. Discharge planning was performed during rehabilitation and care giver. Empowerment was also done under multidisciplinary care teams. The patient was then planned to refer to Lopburi Cancer Hospital with planned radio-iodine treatment.  Length of stay was 16 days.  This case study can be used as a guide line for future care of thyroid carcinoma patients with unexpected acute respiratory failure.