VBUNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE

COLLEGE OF NURSING

TOPIC: Thyroid Carcinoma (Papillary Carcinoma)

General Objective: After 2 hours of lecture-discussion, the group 4 students will be able to enhance basic knowledge, apply basic procedures and appreciate
interventions rendered to patient with Thyroid Carcinoma (Papillary carcinoma).
 SPECIFIC CONTENTS METHODOLOGY TIME RESOURCES
ALLOTMENT EVALUATION
OBJECTIVES

Specifically, the
group 4 students
will be able to:

1. discuss the I. INTRODUCTION/OVERVIEW

overview about Lecture- 5 minutes A. Materials Question and
Thyroid Papillary carcinoma is a relatively common well-differentiated thyroid discussion - Answer
Carcinoma; cancer. Papillary/follicular carcinoma must be considered a variant of B. Human
papillary thyroid carcinoma (mixed form). Despite its well-differentiated resources
characteristics, papillary carcinoma may be overtly or minimally invasive. -students
In fact, these tumors may spread easily to other organs. Papillary tumors -clinical
have a propensity to invade lymphatics but are less likely to invade blood instructors
vessels. Papillary carcinoma appears as an irregular solid or cystic mass in
a normal thyroid parenchyma. C. Books
-Nursing care
Thyroid cancers are more often found in patients with a history of low- plans
or high-dose external irradiation. Papillary tumors of the thyroid are the - Student
most common form of thyroid cancer to result from exposure to radiation. Drug guide
The life expectancy of patients with this cancer is related to their age. Of handbook
patients with papillary cancers, about 11% present with metastases outside -Mims
the neck and mediastinum. handbook
-Maternal and
Thyroid cancer can occur in any age group, although it is most Child Health
common after age 30, and its aggressiveness increases significantly in Nursing
older patients. The majority of patients present with a nodule on their
thyroid that typically does not cause symptoms. D. Electronics
In the Philippines, thyroid cancer ranks 7th overall, 4th in females and
17th in males. An estimated 2,584 new cases, 2,068 in females and 516 in
males (1998). The incidence is three times more in females than that in
males. Thyroid cancer is the most common cancer of women at age 15-24.

In the USA, there are about 37,000 new cases of thyroid cancer each
year according to the National Cancer Institute. Females are more likely to
have thyroid cancer at a ratio of three to one.

2.define the Lecture- 5 minutes Bantam , The Question and

related terms; Ronchi- is lowpitched sonorous sound and may have gurgling discussion Bantam Answer
quality.They originate in larger airways when there is excessive Medical
secretions,abnormal airway collapsibility due to repetitive rupture of Dictionary, 5th
 APPENDIX A
(SCHEMATIC DIAGRAM OF PATHOPHYSIOLOGY)
APPENDIX B
(HEREDOFAMILIAL HISTORY)
 APPENDIX C (NCP)

Name: L.A.Q. Date of Admission: November 30, 2010

Age: 71 years old Room Number: M13
Diagnosis: Hospital Number: 100022621935
Attending Physician: Dr. Edguardo Go Yu
CLINICAL PORTRAIT PERTINENT DATA

ASSESSMENT Chief complaints:

 Received patient lying on bed conscious, awake, coherent, dyspnea
afebrile with an ongoing IVF bottle no.6 of PNSS 1L @20
gtts/min well-hooked on left hand. Patient has NGT and ETT. HISTORY OF PRESENT IILNESS:
She also has O2 and a suction machine at bedside. Patient’s
lips were pale, dry and cracked. Abnormal breath sounds
auscultated.
PAST HEALTH HISTORY:

Significant Findings:
- a huge mass encasing the trachea with the involvement of
thyroid gland on both sides Vital signs upon admission:
BP= 120/80 mmHg
P= 78 bpm
Vital Signs during first contact with the patient: R=21 cpm
BP= 120/90 mmHg T= 36.
P= 74 bpm
R=14 cpm
T= 36.5 0C

DATA NURSING SCIENTIFIC GOAL AND NURSING RATIONALE EVALUATION

DIAGNOSIS BASIS OUTCOME INTERVENTIONS
CRITERIA

Subjective: Ineffective After 8 hours of Independent: After 8 hours of

airway appropriate nursing appropriate
“no verbal cues” clearance interventions the 1. Monitor respiratory 1. Respirations may nursing
Objective: related patient will be able to rate, depth, and work remain somewhat rapid interventions the
excessive maintain patent of breathing. because of hyperthyroid patient was not
− O2 at 11 mucous airway, and free from state, but development able to maintain
L/min secretion aspiration. of respiratory distress is patent airway.
indicative of tracheal
− Presence Specifically, the compression from
of ETT patient will be able edema or hemorrhage.
and NGT to:
2. Rhonchi may indicate
− Excessive − acquire basic 2. Auscultate breath airway obstruction/
mucous knowledge of sounds, noting accumulation of copious
secretions disease presence of rhonchi. thick secretions.
condition
− Frequent 3. Indicators of tracheal
coughing − effectively obstruction/laryngeal
noted cough up 3. Assess for dyspnea, spasm, requiring prompt
secretions stridor, “crowing” evaluation and
and cyanosis. intervention.
− mobilize
secretions 4. Keep head of bed 4. Enhances breathing.
elevated 30-45
− demonstrate degrees. Caution
proper deep client to avoid
breathing bending neck;
exercises support head with
pillows in the
immediate
postoperative period.

5. Assist with 5. Maintains clear airway

repositioning, deep and ventilation.
breathing exercises
 and or coughing as
indicated.

6. Suction as indicated,
noting color and 6. to maintain the airway
characteristics of patency.
sputum.

Collaborative:
1. Reduces discomfort of
1. Provide steam sore throat and promotes
inhalation. expectoration of
secretions.
 DATA NURSING SCIENTIFIC BASIS GOAL AND NURSING RATIONALE EVALUATION
DIAGNOSIS OUTCOME CRITERIA INTERVENTIONS
Adequate nutrition is
Imbalanced necessary to meet the After 8 hours of Independent: After 8 hours of
Nutrition: less body’s demands. appropriate nursing appropriate nursing
Subjective: than body Nutritional status can be interventions the patient 1. Determine interventions the
requirements affected by disease or will be able to etiological 1. Proper assessment patient was still on
“no verbal related to injury states; physical demonstrate stable factors for guides intervention. NGT feeding.
cues” inadequate factors (e.g., muscle weight or progressive reduced
intake in weakness, poor dentition, weight gain toward goal nutritional
relation to activity intolerance, pain, with normalization of intake.
metabolic substance abuse); social laboratory values and no
Objective: 2. Establish 2. Depending on the
needs factors ( e.g., lack of signs of malnutrition.
financial resources to appropriate etiological factors of
-NGT short- and
obtain nutritious foods); the problem,
feeding long-range
or psychological factors improvement in
(e.g, depression, boredom, Specifically, the patient goals. nutritional status may
-weakness
dementia). During times will be able to: take a long period of
noted
of illness, adequate time. Without realistic
- Have nutritional short term goals to
nutrition plays an
intake adequate provide tangible
important role in healing
for individual rewards, patients may
and recovery. Cultural and
needs lose interest in
religious factors strongly
affect the food habits of addressing this
- Have a good problem.
the patients. Patients who muscle tone
are older experience 3. Assess GI 3. Because protein
problems in nutrition function and turnover of the GI
- Follow dietary mucosa occurs
related to lack of financial restrictions tolerance to
resources , cognitive enteral approximately every 3
impairments causing them feedings- days, thy GI tract is at
to forget to eat, physical knowing great risk for early
limitations that interfering what type of dysfunction and
with preparing food, tube atrophy from disease
deterioration of their used(NGT): and malnutrition.
senses of smell and taste, note bowel Intolerance of formula/
reduction of gastric sounds, presence of dumping
secretions that reports of syndrome may require
accompanies aging and in nausea, alteration of rate of
eating. abdominal administration/concentr
Gulanick/Myers(2007). discomfort; ation or type of
Nursing Care Plans, presence of formula, or possibly
Nursing Interventions and diarrhea/cons change to parenteral
Nursing Diagnosis. 6th tipation, administration.
Edition: Mosby, Inc. development
 CUES/ NURSING SCIENTIFIC OUTCOME NURSING RATIONALE EVALUATION
EVIDENCES DIAGNOSIS BASIS CRITERIA INTERVENTIONS
Subjective: Any procedure, no After 8 hours of Independent: Goal met
no verbal cues Risk for infection matter how simple nursing intervention
related to presence of just like placing an the patient will be 1. note risk factors - this will determine After 8 hours of nursing
Objective: susceptible condition, Endotracheal Tube free from any signs for occurrence of the probable intervention the patient was
presence of and Nasogastric Tube of infection as infection such as contributing factors free from any signs of
-with endotracheal Endotracheal Tube carries the risk for evidenced by: environmental that could cause infection as evidenced by:
and nasogastric tube and Nasogastric Tube Infection because the exposure and skin infection on the -a temperature of 36.8C at
presence of the tube -temperature of integrity incision site and the end of the shift
-stressful appearance is a favorable portal 36.5C-37.5 C. these will serve as a -and displayed positive
noted of entry for any guide for preventive attitude to prevent infection
microorganisms - the patient and the measures. such as handwashing and
-excessive mucous especially when S.O will display disinfection after every
secretions handwashing is not positive attitudes to 2. observe for -for early activities, together with his
properly stressed prevent infection localized signs of identification of S.O.
-increased WBC with before and after such as handwashing infection at insertion onset of infection for
a result of 14.4 handling the patient. and disinfection after site prompt intervention.
1O^3/uL Any person who has every activities.
weak immune 3. assess and -informs the nurse
system is susceptible document skin for the occurrence of
to infection conditions noting infection and the
especially those inflammation, appropriate
persons who has an secretions and interventions to
illness or is suffering drainage. manage the infected
from certain disease. site.

4. note signs and -identifies for the

symptoms like fever, proper treatment.
chills and excessive
sweating.

5. stress proper -lessens possibility of

handwashing contracting
techniques by all nosocomial
caregivers between infections towards
therapies. the client.

6. monitor laboratory -for early and/ or

tests like WBC accurate
count. determination for
Porth, C. 2005. possible occurrence
 NURSING GOALS AND OUTCOME NURSING
CUES SCIENTIFIC BASIS RATIONALE EVALUATION
DIAGNOSIS CRITERIA INTERVENTIONS
Subjective: Activity Most activity intolerance After 8 hours of nursing Independent:
intolerance related is related to generalized interventions the patient will
No verbal cues to generalized weakness and debilitation be able to reduce the effects 1.Assess the patient’s 1.The stated After 8 hours of
weakness; secondary to acute or of inactivity, promote response to activity, parameters are nursing
Objective: imbalance between chronic illness and optimal physical activity. chest pain or helpful in assessing interventions
oxygen supply and disease. This is especially dyspnea; excessive physiological patient was able
- stressful demand. apparent in older patients Specifically the patient will fatigue and responses to stress to reduce the
appearance noted with a respiratory related be able to: weakness; of activity and, if effects of
problems. Since there is diaphoresis; present, are inactivity as
-patient was placed insufficient supply of -maintain activity level dizziness or syncope. indicators of over evidence by
on complete bed oxygen to the body, within capabilities as exertion moving herself
rest without toilet generalized weakness is evidenced by the absence of up to bed without
privilege. noted which can alter the weakness and fatigue 2.Provide calm, 2. Helps patient to assistance..
ADLs of the patient. comfortable attain adequate rest
-presence of -recognize and appreciate surroundings; periods thus
endotracheal tube the importance of the minimize relieving patients
was noted. interventions environmental weakness.
activity or noise.
Limit the number of
visitors and length of
stay.

Gulanick/Myers(2007). 3.Schedule periods 3.Helps reduce

Nursing Care Plans, of uninterrupted rest; sympathetic
Nursing Interventions assist patient with stimulation;
and Nursing Diagnosis. self care activities as promotes relaxation
6th Edition: Mosby, Inc needed

4.Instruct patient in 4.Reduces physical

relaxation stress and tension
techniques, guided that affect blood
imagery, distractions. pressure and the
course of
hypertension.

Dependent:
1.Provide 1.To help increase
supplemental oxygen the tissue perfusion
to keep oxygen in the muscles and
saturation 90% or cells.
above as prescribed
with activity.
 CUES/ NURSING SCIENTIFIC OUTCOME NURSING RATIONALE EVALUATION
EVIDENCES DIAGNOSIS BASIS CRITERIA INTERVENTIONS
APPENDIX D
(DRUG STUDY)
 APPENDIX E (IVF STUDY)

Type of IVF Content Classification Indication Contraindication How Supplied Nursing

Interventions
0.9% Sodium Each 100ml contains Isotonic For replacement or Renal/Circulatory 1000ml in plastic Before
Chloride 900mg of Sodium maintenance of fluid impairment, older bottle Administration:
Chloride and electrolytes adults, sodium 1.Do handwashing
Electrolytes in retention. 2.Check the IVF
1000ml: sheet
3.Check the Doctor’s
Soduim…..154mmol order
Chloride….154mmol 4.Read the label of
the bottle. Ensure
solution is the one
ordered.
5.Inspect the
container for leaks.
During
Administration:
1.Close the clamp
2.Administer the IV
solution.
3.Hang the IVf bottle
slowly.
4.Regulate the drops
per minute as
prescribed.
After Administration:
1.Do after care
2.Document the
name of the Iv bottle,
hooked, date and
time started.
3.Assess for any
redness or any
allergic reactions.
Monitor IVF and IV
site.
4.Refer to health care
provider if allergic
reactions occur.
IV Bottle IV Bottle IV Bottle IV Bottle IV Bottle
APPENDIX F
(IDP)
 APPENDIX G
(LABORATORY RESULTS)

BIBLIOGRAPHY

BOOKS:

ELECTRONICS: