Beruflich Dokumente
Kultur Dokumente
CASE STUDY
ON
Submitted to:
Submitted by:
RICHARD B. TANUCO
Student
BSN Level III Section C
INTRODUCTION
GENERAL DATA
HISTORY OF PRESENT ILLNESS
PAST HEALTH HISTORY
NURSING REVIEW OF SYSTEMS
FAMILY , PERSONAL, SOCIAL AND
ENVIRONMENTAL HISTORY
A. MEMBERS OF IMMEDIATE FAMILY
B. PERSONAL AND SOCIAL HISTORY
C. ENVIRONMENTAL HISTORY
D. HEREDO-FAMILIAL HISTORY
PHYSICAL ASSESMENT
A. ANATOMY AND PHYSIOLOGY
OF THE SYSTEM INVOLVED
B. CONCEPTUAL FRAMEWORK
ON THE PATHOPHYSIOLOGY
C. DISCUSSION ON THE PATHOPHYSIOLOGY &
SYMPTOMATOLOGY
MEDICAL MANGEMENT
A. TREATMENT AND PROCEDURES
B.. MEDICATIONS
C. DIAGNOSTICS PROCEDURES
D. DIET
NURSING MANGEMENT
A. ACTAUL CARE GIVEN
B. PROBLEMS ENCOUNTERED DURING
THE IMPLEMENTATION OF NURSING CARE
C. RESTORATIVE MEASURE USED
D. EVALUATON
E. PATIENT TEACHING
A. CONCLUSION
B. recommendation
IMPLICATIONS OF THE STUD
A. NURSING EDUCATION
B. NURSING PRACTICE
C. NURSING REASEARCH
APPENDICES:
BIBLIOGRAPHY
I. INTRODUCTION
Metabolism is the process of the entire collection of the chemical reactions that occur in a living cell. These
properties are the basis of life, allowing the cells to grow and reproduce, maintain their structure and respond o
their environment Regulation of this balance is a dynamic and is one of the function of the endocrine and
neuroendocrine system.
Endocrine secretions, together with the nervous system coordinate the balance of metabolism, reproduction,
water and electrolyte balance, and nutrient absorption. Metabolism is closely regulated by thyroid hormone
Adenomas of the thyroid are typically discrete, solitary masses. With rare exception, they are derived
from follicular epithelium and so might all be called follicular adenomas. A variety of terms have been
proposed for classifying adenomas on the basis of degree of follicle formation and the colloid content
of the follicles. Simple colloid adenomas (macrofollicular adenomas), a common form, resemble
normal thyroid tissue; others recapitulate stages in the embryogenesis of the normal thyroid (fetal or
microfollicular, embryonal or trabecular). There is limited utility in these classifications because mixed
patterns are common, and most of these benign tumors are nonfunctional. Clinically, follicular
adenomas can be difficult to distinguish from dominant nodules of follicular hyperplasia or from the
less common follicular carcinomas. Numerous studies have made it clear that adenomas are not
forerunners of cancer except in rare instances. Although the vast majority of adenomas are
nonfunctional, a small proportion produce thyroid hormones and cause clinically apparent
TSH stimulation and represents another example of thyroid autonomy, analogous to toxic multinodular
goiters.
GENERAL DATA
SEX: FEMALE
OCCUPATION: MISSIONARY
RELIGION: BAPTIST
CITEZENSHIP: FILIPINO
BIRTHDATE: 07/14/1966
WEIGHT: 49.9 KG
LMP: 12/29/2009
GRAVIDA: 3
FULLTERM:3
LVING:3
III. HISTORY OF PRESENT ILLNESS
Client has anterior neck mass 3 yrs. prior to admission; onset of anterior mass noted approximated one by one
mass, movable, soft. Consulted a physician in Thailand, thyroid part taken, given medications with poor
compliance. 2yrs prior to admission, follow-up is done in Thailand. FNAM done shared cystic mass thyroid. A
month prior to admission, follow-up done, advised FNAB which shared follicular neoplasm, thyroid positive
dysphagia.
Two weeks prior to admission noted dry cough, given amoxicillin for one week.
Client has Endometriosis, Benign Lymphoma, Migraine, Otitis media and hypothyroidism. In 1998, client
undergone laparoscopy. 2000 and 2001 she had a cessarian delivery, at the same time ligation was done. Last
Client uses salt, sugar fat products in daily living and cooking of foods. Non smoker and occasional alcohol
drinker. She always drink enough fluids and leisure activities and active in exercise and a responsible mother of
their family. She had an annual check-up with their family physician. She had undergone many surgical
procedures.
She eats three times a day with seldom afternoon snacks. And every after meals she drunks 1-2 glasses of water
and fluid products. She doesn't have any restriction with food and fluid intake and has no special diets or
supplements taken. Has good appetite but has dysphagia as complainant, no allergies noted.
ELLIMINATION PATTERN
Client has no difficulties in defecations as well as urinations. Urine is clear and no aids attached. Bladder habits
Client actively involved herself on exercise. She can walk freely and without axillary equipments to use.
Together with hi husband they are missionaries of their church and travel on different places.
SLEEP-REST PATTERN
Client sleep 8 hours a day, she go to bed every 9pm and awake around 6am. After she sleep, when she woke up
she feel rested. Ad she doesn't use sleeping pills as the way she feel asleep.
COGNITIVE-PERCETUAL PATTERN
Client is alert, conscious, normal speech and can speak and read English, Bisaya ans Cambodian language and
Client make decision alone and with the help of her husband. She always seek help to her physician when it
comes to the health of her family. She solve all their problems together with her husband and making ways and
option to their problems that they encountered. Her present health goal is to have enough rest and improve her
health by encouraging herself in exercise and eating of healthy foods and food supplements.
ROLE-RELATIONSHIP PATTERN
Client is married with three offspring. She work now as an missionary to their religion. She doesn't
have any problem when I comes to the relationship with her family, neighbors ad friends.
SEXUALITY-REPRODUCTIVE PATTERN
Client's LMP was on December 10,2009. She had three full term, No preterm labor, and three living
children. She had migraine before and after menstrual periods. She also perform self-breast
examination every after menstruation. Client is sexually active and had permanent method of family
planning which is, she undergone tubal ligation after her second cessarian procedure.
VALUE-BELIEF PATTERN
Client is a baptist religion member. She actively participate on their church activity and a missionary of
their church together with her husband. Client belief that god is their strength and their protector of
STATUS FAMILY
LOMER MALE 44 HEALTHY HUSBAND COLLEGE
CRUZ
KENNY MALE 20 HEALTHY ELDEST 3RD YEAR
CRUZ
GERNIN FEMALE 12 HEALTHY 2ND SON GRADE 4
DELACRU YRS.OLD
Z
GAYCUM MALE 9 HEALTHY 3RD SON GRADE 4
DELA YRS.OLD
CRUZ
Client x is a married, 43 yrs.old and married. She was a college graduate and able to have a degree in
college. She was able to continue his usual activities and continue to met her friends and neighbor.
She also send his eldest son to school and get her child from school. She usually get to sleep after she
watched television and prepare their foods. Before she get sleep she make sure that she is clean and
maintain proper hygiene. She knows how to speak Tagalog and speak mostly on Cebuano, English
dialect
C. ENVIROMETAL HISTORY
Client live at 55 Katipunan Labangon, Cebu City. Has three children. They live in a concrete house and
located along the road and fully furnished. They had proper drainage such as septic tank. They don'
have any problem with their neighbor. And they had proper disposal of garbage, since e garage truck in
their community collected their garbage every weekend. Their water is supplied by MCWD but they
D. HEREDO-FAMILIAL HISTORY
According to client their family has incidence of hypertension, asthma and diabetes. She and her
husband are hypertensive and she is asthmatic. She had also a history of cancer (breast) in her mother’s
side.
VII. PHYSICAL ASSESMENT
Received client lying in bed awake, coherent, conscious with an ongoing ivf of #4 of DLR 1L @
120cc/hr, attached at the right hand and infusing well. With a vital signs of:
Temperature: 36.8*c
1. NEUROSENSORY/COGNITIVE/PERCEPTUAL
Client is alert, coherent, and responsive. She is oriented with time, person and place. She has adequate hearing
and adequate visions. Normal speech and can speak English, Bisaya and Cambodian language.
2. RESPIRATORY
Her chest is symmetrical, normal in breathing pattern. Unproductive cough. Bronchial and vestibular sounds
hear.
3. CARDIVASCULAR
She is on a full diet with out fluid and water restrictions. Clients complain of difficulty in swallowing.
5. MUSCOSKELETAL SYSTEM
She experience fatigue and muscle pains. She also claimed to have back pain but relieved by rest and pain
reliever medications. Client has good posture.
6. GENITO-URINARY SYSTEM
Client had her menarche when she was 10 years old. She has menstrual problem and evidence of migraine before
INFANCY Trust vs. Mistrust She had a complete During the first
mother. needs.
Fulfillment of
these needs is
required for
infants to develop
a basic sense of
trust.
( Craven,2003;13
55)
TOODLER Autonomy vs. Shame She tries to assert her Even the smallest
mother. independently,
even when it
or make a mess.
Exploring the
environment
too.
(Craven,2003;13
55)
PRE- Initiative vs. Guilt Language develops During the period
these social
circles enlarge to
family,
preschooler’s
language, play
pattern and
appearance
change rapidly.
( Craven,2003;13
55)
SCHOOL Industry vs. Inferiority She partly engaged A child compares
( Koizer,2002;60
5)
ADOLESCE Identity vs. Role She was conscious with Adolescents are
(Kozier,2002;616
)
YOUNG Intimacy vs. Isolation Se seeks independence During young
with a significant
weather to have
children or not.
IX. A. ANATONY AND PHYSIOLOGY OF THE SYSTEM INVOLVED
The thyroid (which means “shield”) gland is composed of two lobes connected by an isthmus that lies
on the trachea approximately at the level of the second tracheal ring (Fig. 2). The gland is enveloped by
the deep cervical fascia and is attached firmly to the trachea by the ligament of Berry. Each lobe resides
in a bed between the trachea and larynx medially and the carotid sheath and sternocleidomastoid
muscles laterally. The strap muscles are anterior to the thyroid lobes, and the parathyroid glands and
recurrent laryngeal nerves are associated within the posterior surface of each lobe. A pyramidal lobe is
often present. This structure is a long, narrow projection of thyroid tissue extending upward from the
isthmus and lying on the surface of the thyroid cartilage. It represents a vestige of the embryonic
thyroglossal duct, and it often becomes palpable in cases of thyroiditis or Graves’ disease. The normal
thyroid varies in size in different parts of the world, depending on the iodine content in the diet. In the
Figure 2. The normal anatomy of the neck in the region of the thyroid gland. (From Halsted, W.S. The
The thyroid has an abundant blood supply (Fig. 3). The arterial supply to each thyroid lobe is twofold.
The superior thyroid arteries arise from the external carotid artery on each side and descend several
centimeters in the neck to reach the upper poles of each thyroid lobe, where they branch. The inferior
thyroid arteries, each of which arises from the thyrocervical trunk of the subclavian artery, cross
beneath the carotid sheath and enter the lower or midpart of the thyroid lobe. The thyroidea ima is
sometimes present; it arises from the arch of the aorta and enters the thyroid in the midline. A venous
plexus forms under the thyroid capsule. Each lobe is drained by the superior thyroid vein at the upper
pole, which flows into the internal jugular vein; and by the middle thyroid vein at the middle part of the
lobe, which enters either the internal jugular vein or the innominate vein. Arising from each lower pole
is the inferior thyroid vein, which drains directly into the innominate vein.
Figure 3. Anatomy of the thyroid and parathyroid glands. A. Anterior view. B. Lateral view with the thyroid
retracted anteriorly and medially to show the surgical landmarks (the head of the patient is to the left). (From
Kaplan EL: Thyroid and parathyroid. In Schwartz SI (ed): Principles of Surgery, 5th ed., New York, McGraw-
PARATHYROID GLANDS
The parathyroids are small glands that secrete parathyroid hormone, the major hormone that controls
serum calcium homeostasis in humans. Usually four glands are present, two on each side, but three to
six glands have been found. Each gland normally weighs 30 to 40 mg, but they may be heavier if more
fat is present. Because of their small size, their delicate blood supply, and their usual anatomic position
adjacent to the thyroid gland, these structures are at risk of being accidentally removed, traumatized, or
The upper parathyroid glands arise embryologically from the fourth pharyngeal pouch (Figs. 7, 8).
They descend only slightly during embryologic development, and their position in adult life remains
quite constant. This gland is usually found adjacent to the posterior surface of the middle part of the
thyroid lobe, often just anterior to the recurrent laryngeal nerve as it enters the larynx.
HOST
AGENT
HERIDOFAMILIAL
HISTORY OF
CANCER IB PROLIFERATION
BREAST IN HER OF THYROID
MOTHER SIDE. FOLLICLE
INCREASES.
ENLARGEMENT
OF THYROID
ALTERED
CUNCTION OF
HYPER SECRETES
OF T4 AND T3
>WARM HORMONES.
WHEM
TOUCH
>DYSPHAGIA
>PAINLESS THYROIFECTOMY
MASS WAS DONE.
LEGEND:
PATHOPHYSIOLOGY
The TSH receptor signaling pathway plays an important role in the pathogenesis of toxic adenomas.
Activating ("gain of function") somatic mutations in one of two components of this signaling system—
most often the TSH receptor itself or the α-subunit of Gs —cause chronic overproduction of cAMP,
generating cells that acquire a growth advantage (see This results in clonal expansion of follicular
epithelial cells that can autonomously produce thyroid hormone and cause symptoms of thyroid excess.
Overall, mutations leading to constitutive activation of the cAMP pathway appear to be the cause of a
proportion (10% to 75%) of autonomously functioning thyroid adenomas. However, the molecular
The typical thyroid adenoma is a solitary, spherical, encapsulated lesion that is well demarcated from
the surrounding thyroid parenchyma ( Fig. 24-14 ). Follicular adenomas average about 3 cm in
diameter, but some are smaller and others are much larger (up to 10 cm in diameter). In freshly resected
specimens, the adenoma bulges from the cut surface and compresses the adjacent thyroid. The color
ranges from gray-white to red-brown, depending on the cellularity of the adenoma and its colloid
content. The neoplastic cells are demarcated from the adjacent parenchyma by a well-defined, intact
capsule. These features are important in making the distinction from multinodular goiters, which
contain multiple nodules on their cut surface (even though the patient may present clinically with a
solitary dominant nodule), produce less compression of the adjacent thyroid parenchyma, and lack a
well-formed capsule. Areas of hemorrhage, fibrosis, calcification, and cystic change, similar to those
encountered in multinodular goiters, are common in follicular adenomas, particularly within larger
lesions.
Microscopically, the constituent cells often form uniform-appearing follicles that contain colloid ( Fig.
24-15 ). The follicular growth pattern within the adenoma is usually quite distinct from the adjacent
non-neoplastic thyroid. This is another feature distinguishing adenomas from multinodular goiters, in
which nodular and uninvolved thyroid parenchyma may have similar growth patterns.
Figure 24-14 Follicular adenoma of the thyroid. A solitary, well-circumscribed nodule is seen.
Figure 24-15 Follicular adenoma. The photomicrograph shows well-differentiated follicles resembling normal thyroid parenchyma.
X. MEDICAL MANAGEMENT
DOCTORS ORDERS
typing.
8 hours.
clearance.
01/05/2010
of P.E reviewed.
neoplasm, benign.
accordingly.
respiratory distress.
aspiration precaution.
at the bedside.
costrel 3x a day.
cavity TID.
Give to sprays before sleeping
tonight.
MEDICATIONS
>Panecovib
>Kalminosen spray
DIAGNOSTIC PROCEDURES
CHEST X-RAY
LUNGS ARE CLEAR. HEART IS NOT ENLARGED. THE TRACHEAL IS AT THE MIDLINE,
T1.
ULTRASOUND
IMMUNOLOGY REPORT
THYROID FUNCTION TEST
CHEMISTRY REPORTS
VALUE REFERENCE
SE
NINE
serum
SEROLOGY REPORT: O+
HEMATOLOGY
CBC:LEVEL REFERENCE
HEMATOCRIT38.4 37.0-47.0 %
MCV88 81-99 fl
MCH29.7 27.0-31.0 pg
RDN11.3 11.6%
PDN13.0 9.0-14.0%
MPV9.2 9.2-11.1 fl
RELATIVE:
NEUTROPHIL50.2 40-74 %
LYMPHOCYTE41.1 19-48%
MONOCYTE4.9 3.4-9.0%
ESONPHILS3.6 0.0-7.0%
BASOPHILS0.2 0.0-1.5%
DIET
intravenous fluid an able to time tape. I also done bedside care and always attending on whatever my
clients needs.
During the care of my client there is no problems Id encountered in the implementation of nursing
care. The client is very cooperative and make importance on what the health care staff told.
Client had undergone thyroidectomy as the surgical treatment of the disease she had. Thyroidectomy is
a surgical procedure in which all or part of the thyroid gland is removed. The thyroid gland is located in
the forward part of the neck (anterior) just under the skin and in front of the Adam's apple. Together
with her medications client status is quite good and recovered fast. Monitoring vital signs also needed.
She was also instructed to perform breathing exercise and coughing exercise.
EVALUATION
Client was appreciative of the extended to her. She was grateful for the time and effort given to her
during her stay in the hospital. She was attentive to the care given to her an follow what the physician
The patient was attuned to her health needs and further encouragement was needed to convince her
some of the necessary things she need to continue the therapeutic regimen in their home.
PATEIENT TEACHING
Client was given home medication to continue her recovery at home. She was encourage to ambulate
her self for faster healing of the surgical site. Frequent wound care is encourage. Take good care of
your drain.
• Use a cotton swab and hydrogen peroxide (or another solution your doctor told you to use) to
clean the wound area 2 times a day until the stitches are out.
• If you have a drainage bulb, empty it 2 times a day. Keep track of the amount of fluid you
empty each time. When it is only about a tablespoon, your surgeon may remove the drain.
• If you have dressings over the wound area, change them the way your doctor or nurse showed
• Wash the area with mild soap and water when the stitches are out. Gently pat it dry.
XII. CONCLUSION
Many individuals to radioactive iodines, chiefly the effects of which on benign thyroid diseases are
largely unknown. The risk was significantly higher in women compared with men, with no clear
modifying effects of age at exposure. In conclusion, persons exposed to radioactive iodines as children
and adolescents have an increased risk of follicular adenoma, though it is smaller than the risk of
thyroid cancer in the same cohort. Compared with results from other studies, this estimate is somewhat
Pertaining to the patients case, Adenoma was a hereditary. In this case to prevent complications you
must be able to know if your race has a greater risk of acquiring such illness. Removal of the affected
area is one surgical intervention one to stop the metastasizes of the cell so that it cannot lead to
malignant neoplasm.
In this study, it really proof that knowledge is a power for it really help individual to make appropriate
actions and interventions that can be applied to each specific objectives with a specific rationale so that
people whom gonna read this work will be able to comprehend and understand what im talking about
especially caring this kind of client so that others will be guided on what to do and what would be the
priority action to be done. May this work of mine can help us health care providers on what is the
proper and exact ways on ealing our clients problem so that it is easy for us to make specific action for
them.
RECOMMENDATION
The care study is a requirement for us nursing student to be able to proceed to the next level. I tell you
this work is not easy to make and need enough time . We must put in our mind that we need to have
this work be the best and give all of us in making it. My recommendation is just, we must give enough
time to make this and must have time management so that we can pass this work with confidence and
NURSING EDUCATION
This study implicates what are the proper ways on treating specific problem concerning to our patient
and to promote good health among our client. Furthermore, this study is the best way to show our
unique ability to solve those problem that are difficult to solve with the help of many resources.
NURSING PRACTICE
As a nurse in the future, this study that we conducted really a great tool for us to build more
NURSING RESEARCH
This study I made , i considered it as a research because it show what are the common experienced
JANUARY 08,2010
In connection to the completion of the requirement of the subject, NCM 501202-A Related Learning
Experience, may I ask permission from your good office to take the case of MRS.DELACRUZ,
GRACE R. female, 43 years old, a resident of KATIPUNAN LABANGON, CEBU CITY, and is
diagnosed of FOLLICULAR ADENOMA AT THE RIGHT THYROID., as a subject of nu MS
Care Study.
Very respectfully,
Noted By:
Approved By: