NURSING CARE PLAN (MULTI NUDULAR GOITER)

Nursing Care Plan 1

NURSING PROBLEM: Risk for Ineffective Airway Clearance related to obstruction of the trachea, swelling, bleeding and laryngeal spasm, characterized by: Subjective data: pain swallowing, painful wound. Objective data: breathing fast and deep, there are secretions / mucus. INTERVENTION AND TREATMENT The first priority is to ensure an adequate airway and breathing. If you suspect that the patients airway is compromised, keep an intubation tray and suction equipment at the bedside at all times. Pay particular attention to any sign of airway obstruction, such as stridor or dyspnea, and check on the patient frequently. Elevate the head of the patients bed to high Fowler position during meals and for 30 minutes afterward to limit the risk of aspiration. If you suspect that the goiter is increasing in size, monitor the patients neck circumference daily.

Nursing Care Plan 2

NURSING PROBLEM: Impaired Verbal Communication related to vocal cord injury / damage to the larynx, tissue edema, pain, discomfort, characterized by: Subjective data: swelling of the throat tissues, pain in the wound, the patient does not feel comfortable, pain swallowing. INTERVENTION AND TREATMENT Check both the incision and behind the neck for postoperative bleeding; notify the physician immediately if significant bleeding occurs. Each time you monitor the vital signs, assess the patients vocal quality and compare it with the patients preoperative speaking. Maintain the neck and head in good alignment, and support them during position changes to prevent traction on the sutures and damage to the operative site.

Nursing Care Plan 3

NURSING PROBLEM: 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. INTERVENTION AND TREATMENT .1. Study the presence of pain symptoms, both verbal or nonverbal, note the location, intensity (scale of 0-10), and duration. Rationale: useful in evaluating pain, determine the choice of interventions to determine effectiveness of therapy. 2. Give patients in semi-fowlers position and support the head / neck with a small pillow. Rationale: prevent hyper-extension neck and protect the integrity of the suture line. 3. Suggest patients use relaxation techniques, such as imagination, soft music, progressive relaxation. Rationale: help to refocus attention and help patients to cope with pain / discomfort more effectively. 4. Give & evaluation prescribed analgesic effectiveness. Rationale: Analgesics should be at great pains to block pain.

Nursing Care Plan 4

NURSING PROBLEM: Anxiety And Knowledge Deficits INTERVENTION AND TREATMENT Whatever the cause of the goiter, the patient may be highly anxious about the medical diagnosis itself or the resulting symptoms. Make sure that patients have the information they need to understand the disease. If the goiter is unsightly, recommend that the patient choose clothing that neither restricts activity nor draws attention to the neck. If the patients appearance is extremely distressing, refer the patient for appropriate counseling.

Nursing Care Plan 5

NURSING PROBLEM: Discharge And Home Health Care Guidelines INTERVENTION AND TREATMENT 1. Teach the patient to avoid medications and foods that lead to endemic or sporadic goiter. Patients with endemic goiter should use iodized salt to supply at least 300 g of iodine daily to prevent goiter. Be sure that the patient understands all medications, including the dosage, route, action, adverse effects,

and the need for any laboratory monitoring of thyroid medications. Encourage the patient to take thyroid hormone supplements at the same time each day to maintain constant thyroid levels in the blood.

2. Have the patient immediately report to the physician any signs and symptons of thyrotoxic crisis; these include rapid heart rate and palpitations, perspiration, shakiness and tremors, difficulty breathing, and nausea and vomiting. Teach the patient to report any increased neck swelling, difficulty in swallowing, or weight loss. If the patient had surgery, teach him or her to change any dressings, to inspect the incision for redness, swelling, and discharge, and notify the physician about changes that indicate infection.