VII.

DISCHARGE PLANNING

Patient may go home as ordered dated June 27, 2013 and was ordered to have OPD
follow-up a week after discharge. The clients IVF was consumed and discontinued, change of
dressing done and kept dry and intact. The client was ambulatory and was ordered regular
diet.

Medications
Instruct the patient to take the ordered medications at the right time, dosage, and
frequency.
Since the patient is taking several medications, advice her to organize medications in a
container so that it would be easier to access the medications on time.
Inform the patient not to skip medication, and if skipped, do not double the next dose.
Patient is for discharge, with the following take home medicines:
1. Co-Amoxiclav (Augmentin) 375mg 1 tablet PO twice a day (8am-6pm) for 7 days
(discontinue on July 3, 2013). This is indicated for the treatment of infections in
adults and children. It can be taken before or after meals, bur preferable with meals
to avoid gastrointestinal upset. Possible side effects are diarrhea, nausea and
vomiting.
2. Dolcet 1 tablet PO as needed for pain. This is indicated for the management of
moderate or severe pain on the operative site. Commonly reported side effects of
this medication are nausea and dizziness, therefore driving or operating machineries
are not advised after taking this medication. Other side effects are constipation,
flatulence, dry mouth, pruritus, increased sweating and tinnitus.
3. Calcium carbonate 500mg I tab twice a day (8am-6pm). This is indicated for the
patient as a dietary supplement since the most common complication after total or
near-total thyroidectomy is hypocalcemia secondary to hypoparathyroidism. It is
best taken after meals to avoid GI irritation like upset stomach, vomiting, stomach
pain, belching and constipation.
Exercise
Surgical manipulation of the thyroid requires time to recover. It is advised to have 4 to 6
weeks duration time for recovery. Avoid straining at the affected area. Strenuous exercise
and lifting should also be avoided. Light exercise such as walking, deep breathing and
coughing exercise are recommended. Normal activities, including returning to work, can
usually be resumed after about a week. The patient is encouraged to do stretching in the
morning and at night as this would help in the circulation of the blood in the body. Range of
motion exercise also helps to prevent dizziness and weakness

Treatment

Multinodular Non-toxic Goiter disease usually is treated by removing the thyroid gland.
It is important to rest and let the body recover after surgery. Consequently, to prevent
other complications, the patient must have her lifestyle and diet modified. Inform the
patient to take prescribed medications on time and with the right dosage. If any signs and
symptoms of recurrence of illness, immediately report to the doctor so that it can be
intervened on. Do not use any herbal medications to cure sickness and immediately seek
medical advice.

Health Teaching

Encourage the patient to have adequate rest and sleep to promote faster tissue repair
and wound healing. Advise the patient to observe proper hygiene to avoid wound
contamination. Relaxation techniques can be done to help alleviate pain and reduce blood
pressure. Lifestyle modification should be done because they are effective in preventing
further illnesses. The patient is advised to eat low fat, low protein diet and low sodium
intake as well. Some pain or discomfort at the operative site may be experienced. This is
generally aggravated by movement, coughing and sneezing. Gently support the wound area
when you need to cough. Analgesias may be taken as discussed with the healthcare
provider. The redness, slight swelling and bruising around the wound normal and the skin
closures (steristrips) applied will fall off naturally.



OPD Follow-up

Remind patients that regular check-ups are important to ensure that the patient
condition is constantly monitored by the doctor. If any of the following symptoms are
noted, the patient should contact the healthcare provider:
Bleeding at the operative site;
Wound become more painful, red, inflamed or swollen;
Pain is not relieved by the prescribed painkillers;
A fever develops.
As these could be signs of an infection that may need to be treated with antibiotics.


Diet

In time, patients who have undergone thyroid removal are exposed to a high risk of
developing osteoporosis, and other bone diseases due to lack of calcium in the bone as well
as in the blood. In order to prevent the occurrence of serious post-thyroidectomy
complications, operated patients need to make drastic lifestyle and dietary changes. The
patient was ordered to take high protein foods for faster tissue repair and instructed on diet
as tolerated. People who had thyroid removal surgery are advised to eat smaller meals.
Considering the fact that the metabolism is affected due to absence of thyroid gland and its
hormone that helps our body to regulate metabolism. Operated patients also need to take
vitamin and mineral supplements and artificial hormones.