A nurse on a postpartum unit is receiving change-of-shift report for 4 clients. Which of the following clients should the nurse plan to see first?

Rationale:

 • Seizures: The client’s significantly elevated T3 (230 ng/dL), T4 (3.4 ng/dL), and TSI (150%) levels, along with symptoms such as anxiety, heat intolerance, insomnia, and irritability, suggest hyperthyroidism and risk for thyroid storm. This hypermetabolic state can lead to neurological complications including seizures due to increased cerebral excitability.

 • Pneumonia: The client has no respiratory distress, maintains a clear airway, has normal respiratory rate and oxygen saturation, and shows no pulmonary abnormalities. There are no signs to suggest a risk for infection or hypoventilation.

 • Paralytic ileus: There are no gastrointestinal symptoms such as abdominal distension, absent bowel sounds, or nausea. The client has normal GI function with a good appetite and soft brown stools, ruling out risk of ileus.

 • thyroid storm: The clinical picture unplanned weight loss, exophthalmos, goiter, hyperreflexia (suggested by irritability), and insomnia aligns with Graves’ disease and severe thyrotoxicosis. Surgery can precipitate a thyroid storm if thyroid hormone levels are not well controlled beforehand.

 • hypoparathyroidism: While this is a known risk after thyroidectomy due to parathyroid injury, the client has not yet had surgery at the time of the lab results and symptoms. No signs of hypocalcemia (e.g., tingling, cramps) are present either.

 • laryngeal nerve damage: This is an intraoperative complication, generally presenting as hoarseness or voice changes. There are no findings suggesting vocal cord involvement, and it would not lead to seizures.

Rationale:

• Administer aspirin for fever: Aspirin can increase circulating thyroid hormones by displacing T4 and T3 from protein-binding sites. In a hyperthyroid or recently post-thyroidectomy patient, this may precipitate or worsen a thyroid storm. Acetaminophen is a safer antipyretic choice.

• Apply cooling blanket: The client’s postoperative fever (38.3°C), elevated heart rate (98/min), and history of hyperthyroidism indicate a risk for thyroid storm. External cooling is a supportive measure to manage hyperthermia during this critical period.

• Monitor vital signs every 4 hours: This is anticipated to detect signs of complications such as thyroid storm, hemorrhage, or airway compromise. Postoperative clients require close observation to identify early changes in temperature, pulse, or respiration.

• Place client on telemetry: Cardiac monitoring is essential after thyroidectomy in clients with a history of hyperthyroidism. Increased metabolic demand, fever, and potential for arrhythmias justify continuous cardiac observation.

• Palpate thyroid area to assess for hematoma: A neck hematoma is a potentially life-threatening complication of thyroid surgery. It can lead to airway obstruction. Palpation and inspection for swelling or firmness around the incision site are critical nursing assessments.