Nursing care plan thyroidectomy

I. Indications: thyroid cancer, hyperthyroidism, large goiters
constricting tissues or structures in the neck

II. Procedures
a. May be done as an open, minimally invasive, or endoscopic
procedure
b. Video-assisted, minimally invasive surgical technique that
markedly shortens incision length to typically around 1 in.
versus 3 in. with traditional surgical procedure
c. Totally endoscopic procedure that involves the creation of
an invisible incision—using special instrumentation and
technique—with part or all of the thyroid gland removed
through small puncture sites in the underarm area and
avoiding a neck incision.
d. Total thyroidectomy: Entire gland and surrounding lymph
nodes are removed.
i. Performed in cases of malignancy or when there is a
high risk of developing multiple sites of thyroid cancer
ii. Presence of numerous separate nodules
iii. Enlarged thyroid makes breathing and swallowing
difficult
e. Lobectomy: Lobe is removed with or without the isthmus
between the lobes.
i. Done to remove single nodule or multiple nodules in a
single lobe
f. Subtotal thyroidectomy: Up to five-sixths of the gland is
removed.
i. Performed when antithyroid drugs do not correct
hyperthyroidism or RAI therapy is contraindicated
ii. Procedure of choice for hyperthyroidism, with 95% cure
rate

III. Statistics (Fallon, 2003)
a. Frequency of procedure: In 2001, approximately
34,500 cases performed in United States.
b. Morbidity: 12% to 50% of individuals develop hypothyroidism
within first year.
c. Mortality: Essentially zero for procedure, or about the level
associated with general surgery (Kaplan & Angelos, 2006);
in thyroid storm (rare complication) 20% to 30%.

Care Setting
Care is given in an inpatient acute surgical unit.

Related Concerns
Cancer,
Hyperthyroidism (Graves’ disease, thyrotoxicosis),
Psychosocial aspects of care,
Surgical intervention,

Nursing Priorities
1. Reverse and manage hyperthyroid state preoperatively.
2. Prevent complications.
3. Relieve pain.
4. Provide information about surgical procedure, prognosis,
and treatment needs.

Discharge Goals
1. Complications prevented and minimized.
2. Pain alleviated.
3. Surgical procedure and prognosis and therapeutic regimen
understood.
4. Plan in place to meet needs after discharge.

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