Professional Documents
Culture Documents
College of Nursing
S.Y. 2016 2017
Submitted to:
Maam Jesusa Gabule, RN MAN
Clinical Instructor
Submitted by:
BSN 3 NB
September 16, 2016
A. DISEASE CONDITION
The thyroid gland is an important organ of the endocrine system. It is located at the
front of the neck just above where your collarbones meet. The gland makes the
hormones that control the way every cell in the body uses energy. This process is
called metabolism.
(Brunner & Suddarths) Some thyroid glands are nodular because of areas of
hyperplasia (overgrowth). no symptoms may arise as a result of this condition, but
not uncommonly these nodules slowly increase in size with some descending into
the thorax, where they cause local pressure symptoms. Some nodules become
malignant, and some are associated with a hyperthyroid state. Therefore, the patient
with many thyroid nodules may eventually require surgery.
Nodular goiter can refer to:
B. PREDISPOSING/PRECIPITATING FACTORS
PREDISPOSING FACTORS
Sex
The female-to-male ratio is 4:1. In the Wickham study, 26% of women had a goiter,
compared to 7% of men. Thyroid nodules are less frequent in men than in women,
but when found, they are more likely to be malignant.
Age
The frequency of goiters decreases with advancing age. The decrease in frequency
differs from the incidence of thyroid nodules, which increases with advancing age.
Familial Goiter
Genetic marker (TG, MNG-I)
Geographic Areas
PRECIPITATING FACTORS
Iodine deficiency is the most common cause of goiter. The body needs iodine to
produce thyroid hormone. If you do not have enough iodine in your diet, the
thyroid gets larger to try and capture all the iodine it can, so it can make the right
amount of thyroid hormone. So, a goiter can be a sign the thyroid is not able to
make enough thyroid hormone. The use of iodized salt in the United States
prevents a lack of iodine in the diet.
Overgrowth of normal thyroid tissue. Why this occurs isn't clear, but such a
growth which is sometimes referred to as a thyroid adenoma is
noncancerous and isn't considered serious unless it causes bothersome
symptoms
from
its
size.
Some
thyroid
adenomas
(autonomous
or
C. CLINICAL MANIFESTATIONS
Thyrotoxic symptoms - Most patients with toxic nodular goiter (TNG) present with
symptoms typical of hyperthyroidism, including heat intolerance, palpitations,tremor,
weight loss, hunger, and frequent bowel movements. Anorexia and constipation may
occur, in contrast to frequent bowel movements often reported by younger patients.
Dyspnea
or
palpitations
may
be
common
occurrence.
Cardiovascular
heat intolerance
muscle weakness/wasting
hyperactivity
fatigue
tremor
Palpitations
Insomnia
Anxiety
Increased bowel movement
irritability
weight loss
osteoporosis
increased appetite
non-painful goitre (swelling of the thyroid gland)
tachycardia (high heart rate - above 100 beats per minute at rest in adults)
SURGICAL MANAGEMENT
Thyroid nodules that are found to be suspicious for malignancy must be removed
along with the remainder of the thyroid gland to prevent the spread of thyroid cancer.
BENEFITS AND RISKS OF SURGERY
Thyroid surgery can remove one-half (thyroid lobectomy or hemi-thyroidectomy)
or all of the thyroid gland (total thyroidectomy) to establish with certainty whether a
goiter or nodule is cancer or not. Surgery to remove an enlarged thyroid can relieve
compression of nearby structures and improve symptoms in patients with related
difficulty swallowing, cough, or shortness of breath. Thyroid surgery can also cure
certain forms of thyroid gland overactivity associated with goiter or nodules.
Thyroid surgery almost always requires hospitalization and anesthesia. The incision
causes pain for a day or two after surgery, and it leaves a scar, which is usually
relatively inapparent after a year. As with any operation, bleeding and infection can
complicate thyroid surgery.
Behind the thyroid gland, there are two sets of important structures that can be
accidentally injured during the course of a thyroid operation. The recurrent laryngeal
nerves run along side the windpipe on their way to the voicebox (larynx), where they
control the muscles that move the vocal cords.
smashed, or has its blood supply cut off, then a person will suffer some degree of
voice loss.
This vocal cord paralysis can lead to a range of voice changes, ranging from losing a
high octave or two while singing to the inability to shout to a severely disabling
whisper of a voice. If both recurrent laryngeal nerves are injured, then a person may
have difficulty breathing and require that a hole be created connecting the windpipe
with the front of the neck (tracheostomy).
Four parathyroid glands are also located behind the thyroid: two on each side. If the
parathyroids are accidentally removed or injured, then the patient's blood calcium
levels drops-resulting in tingling, numbness, and muscle cramps. Rarely, a severely
low calcium level can lead to throat spasm or a seizure.
Fortunately, these
4. Acute Pain related to the surgery of the tissue / muscle and postoperative edema,
characterized by:
Subjective data: ask, ask for information, statements misconceptions.
Objective data: do not follow the instructions / complications that can be prevented.
Nursing Priorities
1. Reduce metabolic demands and support cardiovascular function.
2. Provide psychological support.
3. Prevent complications.
4. Provide information about disease process/prognosis and therapy needs.
Discharge Goals
1. Homeostasis achieved.
2. Patient effectively dealing with current situation.
3. Complications prevented/minimized.
4. Disease process/prognosis and therapeutic regimen understood.
5. Plan in place to meet needs after discharge.
G. BIBLIOGRAPHY:
Holzheimer R. G., M.D., Ph.D. (2014) Benign nodular thyroid disease. Retrieved on
September 19, 2016 at http://www.ncbi.nlm.nih.gov/books/NBK6893/reneholzheimer.de/ Medical Faculty, Martin Luther University, Halle-Wittenberg, Germany
Davis, A.B., MD (2013) Toxic Nodular Goiter Clinical Presentation retrieved on
September 19, 2016 at http://emedicine.medscape.com/article/120497-clinical#b4
http://emedicine.medscape.com/article/120034-overview#a6
https://medlineplus.gov/ency/article/000317.htm
http://www.nanda-books.com/2012/10/nursing-care-plan-for-goiter-assessment.html
http://endocrine.surgery.ucsf.edu/conditions--procedures/goiter.aspx