Nodular Thyroid Goiter

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This was presented last Feb. 21, 2008. Has some errors due to lack of sources especially with regards to the patient's data. This is sort of hypothetical and I made this powerpoint! I just want to share it! I hope this idea works for your future presentations.. Want an editable version?

Text of Nodular Thyroid Goiter

PHYSICAL ASSESSMENT VITAL SIGNS: RESPIRATORY BP 120/70 -(-) Cough PR 58 -(-) Difficulty of RR 21 breathing Temp. 370C -Symmetrical chest expansion CARDIOVASCULAR-Clear breath sounds -(-) Chest pain -(-) Hypertension MUSCULOSKELETAL - (-) Tremors - (-) Trousseaus sign

NEUROLOGICAL -PERRLA -LOC: Alert -Strong reflexes INTEGUMENTARY -Skin color: Pale touch -Good skin turgor -Warm to -Dry skin

NUTRITIONAL/METABOLIC positive Dysphagia (-) N&V

GASTROINTESTINAL TRACT -Present BM GENITOURINARY TRACT -Clear urine color OVER ALL APPEARANCE -With wound dressing on neck

Thyroid Gland

Increase energetic exchange of the calorie gene Increase need of TSH

Compensated increase hormonal production Hyperplasia into local follicles Enlarged thyroid / nodular goiter Compression of trachea and esophagus Difficulty of Difficulty breathing in swallowing

Subtotal Thyroidectomy

Date2/8/200 8 2:00 PM

Doctors Order

Rationale

Please admit to -for further management of surgery. Secure consent for management. patient -to protect client from having any surgical procedure they do not want/do not understand and protects also the hospital -for health personnel and monitoring and recording v/s avoid aspiration and as a -to every shift preparation for surgery.

TPR every shift NPO

Date

Doctors Order

Rationale

IVF on OR day For elective Subtotal Notify thyroidectomy COC/ROD/OR Refer ROD for scheduling

-to replace body fluids lost either before or during -to remove the part surgery affected by the nodule -to inform the physician -for management of operation

Date

Doctors Order

Rationale

2/9/200 8

O2 inhalation at 3 LPM via nasal cannula while Monitor is asleep patient patient every 15 minutes till stable, q 1x1, q 2x1, q 4 &

-to increase oxygen supply

-to determine sudden changes in patients condition

Date

Doctors Order

Rationale

IVF: Decrease to KVO while on BT. D5 LR gtts/min. D5 NR hours.1L 1L

-adequate nutrition that provide tissue repair -for adequate hydration and nutrition that promotes healing

x 30 x8

D ate

Doctors Order

Rationale

Left arm, BT of FWB

-to replace blood loss post-

500 ml x 25 gtts/min op Post-BT, line) (save BT Hgb and Hct -to monitor blood chemistry 6 hours after Meds: Tramadol 50 mg hours x dose ANST -to relieve pain of patient,

slow IV push every 6 post-op

D ate

Doctors Order

Rationale

Ketorolac 30 mg, IV, -to relieve pain of patient, every 6 hours x 6 ,every 8 hours by 2 Cefazolin 1 gm, IV, doses. every 8 hours post-op hyperacidity due to NPO -to reduce the incidence of status certain post-op infections Ranitidine 50 mg, IV -to reduce the risk of doses ANST ( ).

Date

Doctors Order

Rationale

Moderate high back -to facilitate lung Monitor intake and rest output every 2 hours and record02/10/20 08

-to check for expansion fluid balance - for gradual orientation of diet post-op

Clear pleaseliquid to general liquid diet.

Date

Doctors Order

Rationale

IVF PNSS hours.

1L

x 16

- for adequate hydration and nutrition that -for continuous promotes healing pharmacologic

Continue meds.

CWD( change wound management - to prevent infection and dressing ) to protect from bacterial contamination.

Date

Doctors Order

Rationale

Increase Cefazolin - to reduce the incidence to 1 gm, IV, every Caltrate 8 hours 1 tab BID of certain post-op infection - to prevent and treat calcium deficiency due to thyroid d/o

Date

Doctors Order

Rationale - for gradual orientation of - for continuous diet post-op pharmacologic - for adequate management hydration and nutrition that - to prevent infection and promotes healing to protect from bacterial contamination

2/11/0 General to Soft 8 Continue present diet meds. IVF D5 NM1L

x 16

hours. CWD (Clean Wound Dressing)

Date

Doctors Order

Rationale

Give Cotalbex 1 ampoule, IV OD. Give Ponser 5002/12/0 8

- treatment and prevention of vitamin B deficiency -to relieve diseases pain of the - adequate nutrition that patient provide needed tissue repair

DAT mg, TID.

Date

Doctors Order

Rationale

For serum Ionized calcium test. IVF D5 NM hours. CWD1L

- to monitor calcium concentration in the blood - for adequate hydration and nutrition that - to prevent infection and promotes healing to protect from bacterial contamination

x 16

Date

Doctors Order

Rationale

02/13/ 08

Continue present meds. IVF D5 NM hours. CWD1L

- for continuous pharmacologic - for adequate management hydration and nutrition that - to prevent infection and promotes healing to protect from bacterial contamination

x 16

Date

Doctors Order

Rationale

02/14/08

Nevramin 1 Thyrax 500 tablet, BID gm 1 tablet, BID

-for neural disturbances -to increase level of TSH

Caltrate 1 tab BID - to treat calcium deficiency

Date

Doctors Order

Rationale

2/15/0 Insert IVF PNSS1L x 8 KVO. Calcium gluconate drip 2 ampoules in Increase Caltrate 250 cc D5W x 8 1 tab BID

- for adequate hydration and nutrition that -to reverse promotes healing hypermagnesemia due - to treat calcium to overcorrection deficiency

Date

Doctors Order

Rationale

2/16/0 Continue present 8 meds. Continue gluconate drip 2 ampoule, IV, in 250 cc D5W x 8 hours.

- for continuous pharmacologic - to reverse management hypermagnesemia due to overcorrection

Date

Doctors Order

Rationale

2/17/08

Continue present meds. Follow up serum Ionized calcium Continue present test. meds.

- for continuous pharmacologic - to monitor calcium management concentration in the blood - for continuous pharmacologic management

02/18/0 8

11.20.07 Macroscopic & Microscopic Examination Cytology reveals islands of dishesive cells w/ moderate anisonucleosis. The individual cells have round nuclei surrounded by scant cytoplasm. Some cells have rounded intranuclear inclusions. The cluster of cells shows anatomic borders of palisading cuboidal cells. The background shows moderate lymphocytes, hemosiderophages & red blood cells.

11.20.07 NORMAL T3 T4 TSH VALUES 0.6 1.8 ug/ml 4.8 -12.0 0.4 6.0 ug/dl uIu/ml RESULTS 1.23 11.04 0.56 JUSTIFICA Normal TION Normal Normal

CLINICAL CHEMISTRY 02.01.08 COMPONENTS & SI Hemoglo 12-16 g/dl VALUES Hematoc .40-0.54 bin rit g/dl WBC 5.0-10.0 x 109/L JUSTIFICATION Within normal Within normal value Decreased value 4.3 x 109/L level:Hematopoiet ic disease, Viral infections, agranulocytosis, Anti-thyroid drugs. RESULTS 13.3 g/dl 0.40 g/dl

CBC COMPONENTS & SI BT VALUES minutes 1-7 BUN 10-18 mg/dl RESULTS 1 30 8 mg/dl JUSTIFICATI Normal ON Cirrhosis, malnutrition, nephrosis Chronic glomerulonep hritis, nephritis, CHF, muscle

Creatinine

0.6-1.2 mg/dl

1.3 mg/dl

01.08.08 ECG interpretation: Norma Sinus rhythm at 98/min RR interval: 0.16 seconds QRS: 0.06 seconds QT interval: interval 0.32 seconds Chest X- Ray: Normal PA View

01.08.08 COMPONENTS & SI Hemoglob 12-16 g/dl VALUES Hematocri in .40-0.54 RBC t 4-5.5 x g/dl 1012/L WBC 5.0-10.0 x 109/L RESULTS JUSTIFICATION 13.3 g/dl Within normal 0.40 g/dl Within normal value 4.4 x 1012/L Within normal value value Decreased 4.3 x 109/L level:Hematopo ietic disease, Viral infections, agranulocytosis, 223 x 109/L Anti-thyroid Within normal drugs. value.

Platelets

150-400 x 109/L

01.08.08 Differential Count Neutrophil 50-70% Eosinophil s 1-3% Lymphocy 25-35% s tes Monocytes 4-6% RESULT 61% S 1% 31% 7% JUSTIFICATION Normal Normal Normal Normal

02.09.08 NORMAL T3 T4 TSH VALUES 0,6 1.8 4.8 -12.0 ug/ml ug/dl 0.4 6.0 uIu/ml RESULT S 1.03 9.54 0.49 JUSTIFICATION Normal Normal Normal

02.17.08 NORMAL VALUES Calcium JUSTIFICATION Decreased level: diarrhea, mal 8.5 10.4 6.0 mg/dl absorption of mg/dl calcium from GIT, hypoparathyroidism , alcoholism RESULT S

Generic Name: Cefalozin Sodium Brand Name: Cefradine Dosage: 1gm IV q8Classification Antibiotic Cephalosporin (1st Generation)

Indication Susceptible infections and prophylaxis of infections during surgical operations Mechanism of Action Bactericidal: inhibits synthesis of bacterial cell wall and causes cell death. Contraindication Hypersensitivity to Cephalosporin and penicillin Use cautiously with renal failure, lactation, and pregnancy.

Side Effects/ Adverse Effects Nausea, diarrhea, vomiting, abdominal pain, headache, restlessness, rash. GU: Nephrotoxic Nursing Consideration >History of penicillin and cephalosporin allergy. >Have vit. K available in case hypoprothrombinemia occur. >Do not use alcohol while taking this drug for 3 days because severe reactions occur. >Report severe diarrhea, DOB , unusual tiredness,

Generic Name: Calcium Salts Brand Name: Caltrate Dosage: 1 tab BID Classification Antacid Electrolyte Indication Hypocalcemic tetany or hyperkalemia and parathyroid tetany. Necessary for proper nerves and muscle function, blood clot, normal cardiac function.

Mechanism of Action Essential element of the body, helps maintain the functional integrity of the nervous and muscular system, an enzyme co-factor and affects the secretory activity of the endocrine and exocrine glands. Contraindication Hypersensitivity to salmon calcitonin or fish products, lactation. Use cautiou