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Thyroidectomy Nursing Care Plan -Risk for Ineffective Airway Clearance

Hyperthyroidism is a metabolic imbalance that results from overproduction of thyroid hormone. The most common form of this condition is Grave’s disease, which common manifestations are increase of thyroxine (T4) production and enlargement of the thyroid gland known as goiter.

The incidence of Grave’s disease affects women eight times more frequently than men especially on ages 30-60. (Tierney, et al., 2005) A family history of thyroid abnormalities is also one contributing factor to this condition.

Signs and Symptoms

  • Palpitations
  • Dysrhythmias: atrial fibrillation
  • Systolic hypertension, tachycardia, full bounding pulse, wide pulse pressure
  • Urinating in large amounts
  • Diarrhea or frequent bowel movements
  • Sudden weight loss
  • Anxiety
  • Increased appetite and thirst
  • Enlarged thyroid (goiter)
  • Exophthalmos
  • Rapid and hoarse speech
  • Heat intolerance and excessive sweating
  • Difficulty of breathing
  • Weakness, fatigues, and muscle atrophy
  • Elevated temperature, excessive sweating
  • Nervousness
  • Fine tremors: purposeless, quick, and jerky movements of body parts
  • Hyperactive Deep Tendon reflex
  • Oligomenorrhea or amenorrhea

Medical Management

There are several treatments used for managing hyperthyroidism. The treatment mainly depends on the underlying cause, severity of the condition, the age, and the parity.Hyperthyroidism management is composed with different therapies. The main goal for these therapies is to decrease the hyperactivity of the thyroid gland in secreting thyroid hormones.

Antithyroid therapy

Propylthiouracil (PTU) and methimazole (Tapazole) are antithyroid agents that inhibit the synthesis of thyroid hormones.

Propranolol (Inderal), or beta-adrenergic blocking agents, are used as an adjunct therapy for symptomatic relief of tachycardia and other peripheral effects until antithyroid hormones reach their full effect.

Radioactive Iodine therapy

The goal of this therapy is to destroy the overactive thyroid cells. Radioactive isotope of iodine is concentrated in the thyroid gland, where it destroys thyroid cells without jeopardizing other radiosenstive tissues. (Smeltzer, Bare, Hinkle, & Cheever, 2010)

Surgical Management

Thyroidectomy is a surgical removal of the thyroid gland. It is performed to patients with hyperthyroidism who doesn’t respond to antithyroid medications and iodine therapy. There are two kinds of thyroidectomy. Total thyroidectomy is a surgical procedure where all the thyroid gland is removed. On the other hand, subtotal thyroidectomy is a surgical procedure in which only a portion of the thyroid gland is removed to prevent the need for lifelong thyroid hormone medication.

Thyroidectomy Nursing Care Plan

References: 

  • Doenges, M., Moorhouse, M., Murr, A. (2006) Nursing Care Plans: Guidelines for individualizing client care across the lifespan. F. A Davis Company, Philadelphia. 7th edition.
  • Mosby. 2006. Mosby’s Pocket Dictionary of Medicine, Nursing, and Health Professions. Elsevier Singapore. 5th edition.
  • Sharma, P. & Meyers, A. (2013). Complications of Thyroid Surgery. Retrieved at http://emedicine.medscape.com/article/852184-overview
  • Smeltzer, S., Bare, B., Hinkle, J., Cheever, K. 2010. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins. 12th edition
  •  Tierney, L. M., McPhee, S. J. & Papadakis. M. A. (2005). Current medical diagnosis and treatment. New York: Lange Medical Books/McGraw Hill.