A nurse is caring for a client who is postoperative following a partial thyroidectomy. Which of the following findings is the priority for the nurse to report to the provider?

Gastroesophageal reflux disease (GERD) occurs when gastric contents flow backward into the esophagus due to relaxation or weakness of the lower esophageal sphincter. This causes symptoms such as heartburn, regurgitation, and chest discomfort, especially after meals or when lying flat. Management includes lifestyle modifications aimed at reducing reflux episodes and protecting the esophageal lining. Patient teaching is essential to prevent symptom worsening and long-term complications.

A. Eating a light meal 1 hour before bedtime is not recommended because lying down soon after eating increases the risk of reflux. Clients with GERD should avoid eating for at least 2 to 3 hours before bedtime to reduce nighttime symptoms. Even a light meal can stimulate acid production and worsen reflux when taken too close to sleep.

B. Increasing caloric intake by 250 calories per day is not a standard recommendation for GERD management. In fact, weight reduction is often encouraged in overweight clients because excess abdominal pressure worsens reflux. The goal is symptom control through dietary timing and food choices rather than increasing caloric intake.

C. Sleeping with the head of the bed elevated 6 inches is an effective nonpharmacological intervention for GERD. Elevation uses gravity to help prevent gastric contents from refluxing into the esophagus during sleep. This reduces nighttime heartburn, regurgitation, and irritation of the esophageal mucosa.

D. Lying down for 30 minutes after each meal is contraindicated because it promotes reflux by allowing stomach contents to move more easily into the esophagus. Clients should remain upright after meals and avoid bending over or reclining. Upright positioning improves gastric emptying and reduces symptom severity.

Following extubation, close respiratory assessment is essential because airway compromise can develop rapidly. Nurses must monitor for signs of upper airway obstruction, impaired oxygenation, and respiratory distress. Some findings such as mild sore throat are expected, while others indicate a potentially life-threatening emergency requiring immediate intervention. Early recognition of airway obstruction is critical to prevent respiratory failure and the need for reintubation.

A. Stridor is a high-pitched inspiratory sound that indicates upper airway obstruction, often caused by laryngeal edema or swelling after extubation. This finding suggests narrowing of the airway and can rapidly progress to complete obstruction if untreated. Immediate intervention is required to maintain airway patency and prevent respiratory arrest.

B. Sore throat is a common and expected finding after extubation due to irritation of the pharynx and larynx from the endotracheal tube. It is usually mild and resolves with supportive care such as hydration and throat comfort measures. It does not require urgent intervention unless accompanied by airway compromise.

C. Rhonchi are low-pitched breath sounds caused by secretions in the larger airways and may occur after extubation if mucus remains present. They often improve with coughing, suctioning, or repositioning. Although they require assessment, they are less immediately dangerous than signs of upper airway obstruction such as stridor.

D. An SaO2 of 92% may be slightly lower than ideal but can be acceptable depending on the client’s baseline condition and overall respiratory status. It requires monitoring and possibly supplemental oxygen, but it is not as urgent as evidence of airway obstruction. Stridor takes priority because airway patency must always be addressed before oxygenation concerns.