PAPILLARY CA, THYROID

Nursing Management of a Patient with Papillary CA,Thyroid Ethelbert M. Calub Christine Deserie B. Cunanan Our Lady of Fatima University

Nursing Management of Patient with Papillary CA,Thyroid I.L., a 59 years old male with Papillary CA, thyroid, complains of noisy breathing 1 year PTA (+) hoarseness, no consult. 8months PTA (+) corn-sized anterior neck mass non-hyperemic, non-tender, firm mass w/ dignitition (-) consult, (-) medication, change in voice character(+). Advised biopsy out patient refuse, medications was prescribed but patient didnt comply. Some dyspnea still w/ hoarseness.

Pathophysiology Papillary cancer is the most common, and most treatable, type of thyroid cancer. Most people with papillary thyroid cancer can be completely cured with surgery. There are more than 10,000 new cases of papillary thyroid cancer diagnosed in the United States every year. In fact, papillary cancer comprises at least 70% of all diagnosed thyroid cancers. Most people develop papillary thyroid cancer before age 40, and it is much more common in women than in men, although the reason for this is not understood.

The majority of people with papillary thyroid cancers do not even know they have the disease until a doctor notices a painless thyroid lump. Occasionally, a thyroid lump may be too small to feel, but instead, you or your doctor may notice an enlarged lymph node or gland in your neck which does not shrink. There are lymph nodes all over your body that help to fight infection and the nodes near an infected area tend to become enlarged until the infection is gone. You may notice that the lymph nodes in your neck right under your jaw bones tend to become enlarged when you have a sore throat and shrink when you are feeling better. However, if the glands do not become smaller in a few weeks, that could be a signal that the lymph glands are abnormal. The pathophysiology of thyroid cancer is not completely defined. Alterations of several molecular factors have been associated with thyroid malignancy. These include proliferative factors such as growth hormones and oncogenes, and apoptotic and cell-cycle inhibitory factors such as tumor suppressors. Physiological behaviour depends on tumor type. Thyroid cancer is thought to reflect a continuum from well differentiated to anaplastic, characterized by early and late genetic events. Up to one third of patients with differentiated thyroid cancer experience tumor dedifferentiation, accompanied by increased tumor grade and loss of thyroid-specific functions such as iodine accumulation.

Papillary carcinoma tends to spread to local lymph nodes, whereas follicular and Hurthle cells more often spread haematogenously. Anaplastic thyroid cancer is a rare, aggressive, undifferentiated carcinoma with a high propensity for local invasion and metastatic spread. Nodal spread is common with thyroid lymphomas. History I.L., a 59 years old male with Papillary CA, thyroid, complains of noisy breathing 1 year PTA (+) hoarseness, no consult. 8months PTA (+) corn-sized anterior neck mass non-hyperemic, non-tender, firm mass w/ dignitition (-) consult, (-) medication, change in voice character(+). Advised biopsy out patient refuse, medications was prescribed but patient didnt comply. Some dyspnea still w/ hoarseness.

Nursing Physical Assessment I.L. was alert and oriented to person, place and time. The patients temperature was 36.9c, pulse rate 75bpm, respiratory rate was 24cpm, blood pressure of 100/70 with upper airway obstruction to thyroid malignancy. The patients blood pressure has been monitored to avoid hypotension, no IV fluids administered, patients skin was warm and dry. The patients surgical incision was total thyroidectomy

w/ neck dissection, total laryngectomy. The urine output from 07001200 was 500 ml. I.L appeared frail and thin with paresis. The patients height was 56 (1.68m) and her weight was 53kg. (116.6 lbs). The patient was ambulatory and was able to perform independent activities of daily living. The patient has endotracheal tube intact.

Related Treatments The patient has undergone electrocardiogram and the result was normal, ultrasound of whole abdomen the liver was in normal size, gallbladder is normal in size, pancreas and spleen are in normal size, both kidneys are in normal size but with increased parenchymal echogenecity and loss of corticomedullary differentiation, with mild diffuse hepatic parenchymal disease, moderate renal parenchymal disease with simple cysts, bilateral. Chest PA, lung fields are clear and normo aerated. Sulci are intact, heart is normal size and configuration. Pulmonary vascularity is within normal limits bony thoracic cage and soft tissue envelope are unremarkable. CT scan, multiple contrast-enhanced axial images reveal an ill defined large contrast enhancing solid mass along the right anterior neck extending from the omo-hyoid down to the pre-thyroid area, measuring

about 5x4x8cm. The adjacent muscles and thyroid lamina are infiltrated with partial lysis of the lower thyroid cartilage. There is tumor extension to the para-laryngeal space. An ill defined solid mass is seen in the right supraglottic region involving the aryepiglottic fold; pre-epiglottic space; anterior commissure with diffuse swelling of the vocal cords. The mass measures 2.5 x 1.5 cm. with severe luminal stenosis. The larynx is also displaced to the left. The right thyroid gland is displaced posteriorly by the mass with intrinsic small ill defined nodular lesion. The left thyroid is not enlarged. There are few slightly enlarged lymph nodes in the jugulo-digastric, submandibular and sublingual regions.