Capitol Medical Center Colleges

#4 Sto. Domingo Ave., Quezon City

In partial fulfillment of the requirement for NCM 104 RLE-

East Avenue:3 East presents:

Case Analysis of

Molar Pregnancy

Presented by:
Goya, Darlene L.
BSN level III

Presented to:
Mrs. Lenie Agpalasin RN
Clinical Instructor

April 9, 2019
 TABLE OF CONTENTS

I. INTRODUCTION ……………………………………….
i. Introduction ………………………………………..
ii. Acknowledgement ………………………………..
iii. Objectives………………….................................
iv. Significance of the study…………………………
v. Theoretical Framework………………………….
II.NURSING HISTORY
i. Demographic Profile………………………………..
ii. History of Present Illness…………………………..
iii. Past Medical History………………………………..
iv. Family History……………………………………….
III. GORDON’S 11 FUNCTIONAL HEALTH
PATTERNS……….. ………………………................
IV. PHYSICAL ASSESSMENT……………………………
i. General Assessment ………………………………
ii. General Survey………………………………………
iii. Physical Assessment…………………………
V. LABORATORY AND TEST RESULTS ………………
VI. CLINICAL DISCUSSION………………………………….
i. Anatomy and Physiology………………………….
ii. Management of the disease ……………………..
iii. Pathophysiology……………………………………
VII. PHARMARCOLOGY …………………………………
VIII. NURSING MANAGEMENT…………………………
i. Nursing Care Prioritization……………………….
ii. Nursing Care Plans…………………………………
iii. Discharge Planning……………………………
BIBLIOGRAPHY………………………………………
 CHAPTER ONE

Introduction

Molar pregnancies are fairly rare, happening with roughly 1 case for every 600
pregnancies. When a molar pregnancy arises a problem occurs at the time of
conception, when the egg and sperm join together, that results in the formation of
cells that grow very rapidly but are unable to form the placenta and fetus of a normal
pregnancy.

Molar pregnancies take two different forms, complete and partial molar
pregnancies that differ in their genetic make-up, their development and in particularly
in the risk of needing additional treatment.

In a complete molar pregnancy the genetic material is just from the father as
the original nucleus containing the mother's genetic material is lost at the time of
conception or whilst the egg is developing in the ovary. Complete molar pregnancies
form a mass of rapidly growing cells but do not contain a foetus and can not develop
into a baby. After diagnosis and evacuation there is about a 10-15% chance of
needing further treatment after a complete molar pregnancy.

In a partial molar pregnancy there is genetic material from both the father and
the mother but an imbalance as there two sets from the father. In a partial molar
pregnancy there can be a fetus visible on an early ultrasound, but it is always
abnormal and can not develop into a baby as it does not survive beyond the first 3
months of the pregnancy.

After the evacuation, most partial molar pregnancies do not require any
additional treatment as in more than 99% any of the residual cells just fade away
over the next month or two.

In the first few weeks of a molar pregnancy there is often a tendency for
morning sickness, bleeding and some abdominal pain. However these symptoms do
not always occur and on their own are not particularly abnormal for a normal
pregnancy. Most molar pregnancies are diagnosed at the first ultrasound scan that in
a complete molar pregnancy shows a mass of cells without the presence of a fetus
or in a partial mole an abnormal non-viable fetus and placenta.
 "Acknowledgement”

This Case Presentation could not have been possible without the participation
and assistance of so many people whose names may not all be enumerated. Their
contributions are sincerely appreciated and gratefully acknowledged. However, I
would like to express their deep appreciation and indebtedness particularly to the
following:

Mrs. Lenie Agpalasin RN for sincere, valuable guidance and encouragement

extended to me.

To all relatives, friends and others who in one way or another shared their
support, financially, and physically, Thank you.

Above all, to the Great Almighty, the author if knowledge and wisdom, for his
countless love.

I, Thank you.
Specific and General Objectives:
General Objective:

This Case Study aims to identify & determine the needs of the patient. This
is also intends to help patient promote healthy lifestyle and understand such
condition through application of the nursing skills and for the students to gain
knowledge, skill & attitude.

Specific Objectives:

In order to meet the general objective, I aims to:

 To establish rapport with the patient, the patient’s family and significant other.
 To gather relevant data from the patient and their significant other, and
interpret them.
 To elaborate the patient’s past and present health history.
 To discuss the Anatomy and Physiology of the organ involved in the patient’s
disease.
 To present the Pathophysiology of the patient’s disease.
 To interpret the laboratory test results of the patient.
 To discuss the nature of the drugs given to the patient.
 To present a specific, measurable, attainable, and realistic and time bounded
nursing care plans for the patient.

Significance of the study:

The significance of this study is to allow me to gain further information about

the chosen case which is Colloid Goiter , and gather in-depth information and
proper management. It will also widen my knowledge relating to awareness of the
possible risk factors and how to prevent them.

Theoretical Framework

Caring Science and Human Caring Theory

The Caring Science and Human Caring theory by Jean Watson, a renowned
nurse theorist, is the balance between science and caring that forms the basis of the
nursing profession. It approaches the human care relationship as a moral concept.
Further, it seeks to explain the human care process in nursing, preserve humanity
and integrity of the patients, and reintroduce true caring and healing into education
and clinical practices.

Jean Watson’s Metaparadigm of Nursing

1. The Person (Patient)

 Is subjective and unique, not objective, predictable and calculating.
 Have distinct human needs, which are biophysical, psychophysical,
psychosocial and interpersonal.
 Is to be valued, cared for, respected, nurtured, understood and assisted.
  Is a functioning whole, there is no division among the mind, body and spirit.
 Is directly influenced by their external environment.

2. . The Environment
 Is crucial to the holistic healing (mental, physical, social, emotional, spiritual,
developmental, protective, supportive environments), which is conductive to a
patient’s health and well-being.

3. Health
 Is viewed holistically, as the unity between the physical, social, mental and
spiritual self, with all the parts working together in harmony and functioning to
their full capacity.
4. Nursing
 Is a caring, meaningful and harmonic connective bond that is shared between
the nurse, and the patient.

Rationale:
I chose this theory because it mainly concerns on how nurses care for their
patients and how that caring progresses into better plans, promote health and
wellness, prevent illness, and restore health. And since caring for a Post-operative
patient, not only promoting the treatment needed physically but also the emotional
and mental wellness of the patient.
 CHAPTER TWO
DEMOGRAPHIC DATA

Biography Data:
This is the case of Mrs. N,E. 54 years of age, born on April 18, 1964, Married,
and a Roman Catholic who is currently residing at 170 Bayanihan St., Baesa,
Caloocan City. She was admitted at Capitol Medical Center on January 24, 2019,
6:21pm in the evening. Her Chief complain was Anterior Neck Mass

History of Present Illness:

3 years prior to admission, patient had Anterior Neck Mass.

1 year prior to admission, patient sought consultation to a physician. She was

adviced to undergo the operation but she refuse because they were not yet
prepared.
1 day prior to admission, Mrs. N,E due to enlarged neck mass they again sought for
consultation.

PAST HEALTH HISTORY

Mrs. N,E was hospitalized when she as 28 years old due to Post CS with
hypertension. No other past record and Allergy.

LIFE STYLE

Mrs. N,E is livingin Urban Area with his husband and their 3 children She spends her
day doing household chores daily (laba, luto, linis bahay). The patient is not taking
any vitamins. She is taking 8 glasses of water a day. Non- smoker and non- alcoholic
drinker. Do not like to eat repolyo, sitaw, and sayote.

FAMILY HISTORY
 CHAPTER THREE
Gordon’s 11 Functional Health Patterns
January 28, 2019

Before Hospitalization During Hospitalization Analysis &

Interpretation
Health Perception Patient has a good Because of the Patient’s health
and Health perception regarding removed nodules the perception and
her life. She rated her patient rated her health management pattern
Management Pattern health with a score of with the score of 7/10. increased, but is able to
5/10. Patient does not perform a few health
seek consult to quack management process
doctors and does not to maintain and
use any herbal improve health.
medicine. She
sometimes self-
medicates especially
when experiencing a
common illness
specifically fever, head
ache, cold and flu.
Whenever she seeks
help from a medical
 health care provider
and is given
prescriptions, she
follows them
accordingly.
Nutrition and Patient eats 3 to 5 Patient was NPO, then Fluid intake is on the
Metabolism Pattern times a day. Breakfast diet was changed to average of 8-10
at 8 am, lunch at 12 soft diet. She eats glasses per day.
noon and dinner at 8 accordingly. She eats In terms of her food
pm. Patient used to eat in the appropriate time intake patient should
fatty, unhealthy foods because of medication shift to eating healthy
such as liempo. In that needs to be taken. foods such as fish,
terms of fluid intake, fruits and vegetables..
client stated that she
consumes at an
average of 5-6glasses
of water per day. She
also drinks caffeine, but
reverted to eating
healthy snacks such as
wheat bread, and
drinking plenty of water
instead of drinking
caffeine.
Patient’s defecates 2- She has difficulty in There is no changes in
Elimination and 3x a day with brownish defecating. He voids 2- her voids but with
Urinary Pattern stool. She does not use 4 times a day. difficulty in defecating.
laxatives. She voids 3-
5 times a day.
Patient wakes up early Patient physical activity Patient performs less
Activity and Exercise to do the household decreased due to physical activity
Pattern chores and she operation but ambulate because of rest
considered walking as every morning requirement, but is able
 her exercise to perform a few tasks
such as walking and
turning in bed.
Patient mostly sleeps Patient stated that she Fundamentals of
Sleep and Rest 4-5 hours. She states still had insomnia and nursing, 8-10hours of
Pattern that she experiences disturbed sleeping sleep is needed to have
insomnia, and finds it because of taking an adequate rest and
difficult to sleep at night medications and vital an environment that is
unless extremely tired. signs. conductive to health is
Using cellphone is her necessary to provide
way of dealing with her comfort to an individual.
insomnia. – The client has an
abnormal state of sleep
and rest.
She is able to Patient currently feels Patient decreased the
Cognition and remember events from more healthy due to worrying about her
Perception Pattern a long time ago. She removed nodules. health and she feel
does not have any Financial decisions are more comfortable.
hearing problems. She on both of her and her
is oriented to time, husband.
place and can recall
past events. Decision
making is mostly on
her.
Roles and Relation Patient describes Patient is currently Patient expresses good
Pattern herself as a loyal wife confiding in her family relationship with her
to her husband as well for emotional support. family.
as a responsible They are her source of
mother to their children. strength.
The most important
thing in her life is her
family. She also states
that their neighbors are
 good people.
Patient describes Patient still confides to Patient is being a
Self-Perception and herself as a her family and her positive thinker despite
Self-Concepts hardworking, friendly beliefs as her source of of what happened to
Pattern and God fearing strength. her health.
person.. Patient is
contented to have
provided his family with
good life.
Coping and Stress Patient states that the Patient states that the Patient expresses good
Tolerance Pattern most stressful thing in hospitalization is coping and stress
her life is when the currently the most tolerance pattern.
doctor said that she stressful thing she has
needed to undergo experienced. She's
surgery or her condition aware that being
may lead to be worst. hospitalized is a
Patient copes up with stressful situation, but
stress by bringing the attempts to reinforce a
whole family to the mall positive mindset.
for shopping and
watching movies.
Patient's religion is There is no change Patient displays good
Values and Belief Roman Catholic and with his religious life. values and belief
Pattern goes to church once in He believes God will pattern.
the weekend with his help him recover faster.
whole family. They are
very religious and
donate a lot to their
church. Family is very
important to her. She
wished to give their
children better future.
 CHAPTER FOUR
PHYSICAL ASSESSMENT
 General Assessment

January 28, 2019

Actual findings Normal findings Analysis and

interpretations

Weight 120lbs 132lbs Weight is appropriate

to client’s height.

Height 5’2 Within normal range

Temperature 36oC 36oC – 37.5*C Within normal range

Pulse Rate 85 beats/min 60-100 beats/min Within normal range

Respiratory 20 breaths/min 12-20 breaths/min Within normal range

Blood Pressure 120/80mmHg 90/60 – 120/80mmHg BP reading is ideal

and healthy

 General Survey

She is 5’2 in height and 120lbs in weight. Patient has relaxed posture.
Overall hygiene appears clean and is neatly dressed. No body odor, emotions
 are appropriate to situation, and patient appears jolly oftentimes. She also had
clear and understandable speech, and has sense of reality.

 Physical Assessment

Body part Technique Normal Findings Actual Findings Analysis &

examined used Interpretation

Skin Inspection, Light to deep brown, Skin is medium Patient's skin

generally uniformed light brown slightly dry and
Palpation
skin color, no uniform in color, has presence of
edema, no abrasions No presence of incision on
or lesions, any foul body anterior neck
temperature is within odor, Good Skin other than that,
the normal range, turgor, with there are no
good skin turgor, no slightly dry skin, deviations from
edema Presence of normal.
incision at
Anterior neck.
Body is in normal
temperature.
Hair Inspection Evenly distributed, Hair is evenly No deviations
thick resilient , no distributed with from normal
infection, has gray hairs. No
variable amount of signs of infections
body hair or infestation.
Nails Inspection Convex curvature. Client has a pink, No deviation
Nails are smooth clean and smooth from normal
highly vascular and nail which returns
 pink, clean, with to its normal state
intact epidermis in 3 seconds.
which returns to its
normal state
generally less than 4
seconds during
blanch test of
capillary refill.
Skull & Face Inspection Rounded, Head is round No deviations
Palpation symmetrical, and facial from normal
absence of nodules, features are
symmetric facial symmetrical.
movements, Face There are no
has a smooth and presence of
uniform consistency. nodules, masses
No presence of and depressions
edema or mass during palpation.
Face has a
smooth and
uniform
consistency. No
presence of
edema or mass
Eyes & Vision Inspection Eyebrows and Eyebrows and No deviations
eyelashes are eyelashes are from normal
evenly distributed evenly distributed
and symmetrical no and symmetrical
infections noted. no infections
eyelids has no noted. Eyelids
discharges, no has no
discoloration and lids discharges, no
close symmetrically. discoloration and
Bulbar conjunctiva lids close
appeared to be symmetrically.
transparent with few Bulbar
capillaries evident. conjunctiva
Sclera appeared appeared to be
white. Palpebral transparent with
conjunctiva few capillaries
appeared shiny, evident. Sclera
smooth and pink . no appeared white.
edema or tearing of Palpebral
the lacrimal gland. conjunctiva
Cornea is appeared shiny,
transparent, smooth smooth and pink .
and shiny and the no edema or
details of the iris are tearing of the
visible. Client also lacrimal gland.
blinks when cornea Cornea is
was touched. Pupils transparent,
are black and equal smooth and shiny
in size, constrict and the details of
when looking at near the iris are visible.
object and dilates at Client also blinks
far objects and when cornea was
converges when touched. Pupils
object is moved are black and
towards the nose. equal in size,
Iris is flat and round. constrict when
PERRLA (pupils looking at near
equally round object and dilate
respond to light at far objects and
accommodation) converges when
illuminated and non- object is moved
illuminated pupils. towards the nose.
When tested for the Iris is flat and
extra ocular muscle, round . Patient
both eyes of the wears an
client coordinately eyeglasses and is
moved in unison with near sighted.
parallel alignment. Pupil responds o
Client was able to light.
 read the newsprint
held at a distance of
14 inches.
Ears & Hearing Inspection Symmetrically Auricles are Everything is
aligned auricles. symmetrically normal no
Color same as the aligned with the discharges.
face. Pinna recoils outer canthus of
when folded. Able to the eye with no
hear equally on both deformities or
sides abnormalities.
Color same as
the face. Pinna
recoils after it is
folded. Was able
to hear equally on
both sides.

Nose & Sinuses Inspection Nose is Symmetric, Nose appeared No deviations

No discharges or symmetric and from normal
flaring. Not Tender, straight no
no lesions, air discharges or
moves freely when flaring. Not
breathing. Nasal tender, no
cavity mucosa is lesions, air moves
pink freely as the
client breathes
through the
nares. Nasal
cavity mucosa is
pink
Mouth and Inspection Symmetrical, able to Symmetrical and No deviations
Oropharynx purse slightly from normal
lips,moist,have a discolorated dry except for her
smooth texture. No lips . Symmetric dry lips
discoloration on the and have a
enamels, no smooth texture.
 retraction of gums, The client was
pinkish color of able to purse his
gums. Buccal lips when asked
mucosa uniformly to whistle. No
pink, moist, slightly discoloration on
rough. Smooth the enamels, no
palates light pink retraction of
and smooth. Hard gums, Pinkish
Palate has irregular color of gums.
texture. Uvula Buccal mucosa of
Positioned in the the client
midline of the soft appeared
palate uniformly pink,
moist and slightly
rough, presence
of thin white
coating. Smooth
palates are light
pink and smooth
while hard palate
has a more
irregular texture.
Uvula is
positioned in the
midline of the soft
palate.

Neck Inspection Equal size of neck Head centered The patient

Palpation muscles, smooth with dry and undergone
intact dressing total Thyroid
head movements gland is not Lobectomy
with no discomfort. visible even in Right with
swallowing Isthmusectom
Not palpable lymph
y, frozen
nodes. Trachea section (Jan
placed in the midline 26,2019)
of the neck.
-other findings
are normal
Thorax and Inspection Intact Chest wall, No The chest wall is No deviations
Lungs Palpation tenderness and intact with no from normal
Percussion masses. Full tenderness and
Auscultation symmetric masses. There is
expansion, 2-3 cm full and
separation of thumbs symmetric
during deep expansion and
inspiration.quiet, the thumbs
rhythmic and separate 2-3 cm
effortless during deep
respirations. Spine inspiration when
vertically aligned. assessing for the
Right, left shoulders respiratory
and hips are of the excursion. The
same height client manifested
quiet, rhythmic
and effortless
respirations. The
spine is vertically
aligned. The right
and left shoulders
and hips are of
the same height.

Heart Inspection No pulsation except No pulsation No deviations

Palpation for apical area. except for apical from normal
Auscultation S1(lub) is heard at area.
all sites, louder at S1(lub) is heard
apical area at all sites, louder
S2(dub) is heard at at apical area
all sites, louder at S2(dub) is heard
the base of the at all sites, louder
heart. at the base of the
heart.

Breast/Axillae Inspection Breast even with the Breast even with No deviations
 Palpation chest wall. Skin the chest wall. from normal
uniform in color Skin uniform in
smooth, intact no color smooth,
retractions. intact no
Round/oval in retractions. Dark
shape, bilaterally the brown in color,
same color from light round,equal in
pink to dark brown. size, pointed in
Round, everted and same direction
equal in size, similar with no
in color, soft and discharges,
smooth, point in the tenderness and
same direction,no nodules.
discharges, no
tenderness, masses
or nodules.
Muscles Inspection Equal muscle on Patients muscle No deviations
Palpation both sides of the is equal in size on from normal
body, no both sides of the
contractures, no body. Firm
tremors. Firm muscle with
muscles, smooth coordinated
coordinated movement. Equal
movement, equal strength on each
strength on each body side. No
body side. No deformities and
deformities, tenderness. Was
tenderness or able to move
swelling. Able to selected body
move selected body parts.
parts.
Neurological Inspection Can count Client was can Client cannot
Observation backwards, can speak clearly and read letters from
distinguish sharp was able to count far distance.
and dull, hot and backwards, can
cold. Can distinguish distinguish sharp
 items in hand. Can and dull, hot and
walk back and forth cold. Can
in a limited range of distinguish items
motion. Can read in hand. Can walk
from near and afar back and forth in
a limited range of
motion. Can read
from near
distance.

CHAPTER FIVE
LABORATORIES AND DIAGNOSIS RESULTS
Laboratory and Diagnosis Study

ULTRASOUND RESULT
Date & Time Printed: 01/08/2019 12:09:08 PM

CHEST PA VIEW

Apparent opacities are noted in the right apical region obscured by osseous
structures.

Heart is top normal in size.

Diaphragm and costophrenic sulci are intact.

IMPRESSION:

TOP NORMAL CARDIAC SIZE.

SUSPICIOUS RIGHT APICAL OPACITIES. SUGGEST APICOLORDOTIC VIEW.

ULTRASOUND RESULT
ULTRASOUND OF THE NECK

The right lobe of the thyroid gland is enlarged while the left lobe is normal in size.
The right lobe measures 4.6 x 1.9 x 2.2 cm while the left lobe measures 3.6 x 1.5 x
1.0 cm.
 A lobulated heterogeneous solid nodule (or aggregate solid nodules) is seen in the
right mid to lower pole measuring 3.6 x 1.9 x 2.5cm. A small cystic nodule measuring
0.4 x 0.4 cm is seen in the right upper pole.
The left lobe is unremarkable.
The isthmus is normal in thickness and echogenicity. It measures 0.14cm.
Both submandibular glands are unremarkable.
No enlarged lymph nodes are seen in both sides of the neck.

IMPRESSION:
- ENLARGED RIGHT LOBE OF THE THYROID GLAND WITH
HETEROGENEOUS SOLID NODULE AND SMALL CYST.
- UNREMARKABLE ULTRASOUND OF THE LEFT LOBE AND ISTHMUS
OF THE GALND.
- UNREMARKABLE ULTRASOUND OF THE SUBMANDIBULAR GLANDS.
- NO EVIDENCE OF CERVICAL LYMPHADENOPATHY.

CHEMISTRY

Date Reported: 24-JAN-20 9:08:09 PM

SI UNITS CONVENTIONAL UNITS
Test Name Result Reference Result Reference Range
Range
Capillary Blood Glucose
DATE 01-24-2019
@08:00 PM 130.0 mg/dL 130.0 mg/dL

CLINICAL CHEMISTRY
Date & Time Printed: 01/16/2019 08:32:57 PM
SI UNITS CONVENTIONAL UNITS
TEST RESULTS REFERENCE VALUES RESULTS REFERENCE VALUES
FBS H 6.91 4.11 – 5.89 mmol/L 124.52 74.06 - 106.14 mg/dL
Sodium 139 136.00 – 145.00 mmol/L 139 136.00 – 145.00 mEq/L
Potassium 4.26 3.50 – 5.10 mmol/L 4.26 3.50 – 5.10 mEq/L
Total Calcium 2.22 2.15 – 2.55 mmol/L 8.90 8.62 – 10.23 mg/dL
Ionized Calcium 1.27 1.16 – 1.32 mmol/L 1.27 1.16 – 1.32 mmol/L

HEMATOLOGY
Date & Time Printed: 01/09/2019 12:02:35 PM
TEST RESULT REFERENCE VALUE
Hemoglobin 119 110.00 – 160.00 g/L
 Hematocrit 0.36 0.37 – 0.47
RBC count 5.48 4.20 – 5.40x10 12/L
WBC count 6.86 5.00 – 10.00x10 9/L
Platelets INCREASED* 150.00 – 400.00x10 9/L
MCV 66 26.00 – 32.00 pg
MCHC 328 310.00 – 360.00 g/L
Segmenters 0.48 0.36 – 0.66
Lymphocyte 0.40 0.22 – 0.40
Monocyte 0.07 0.04 – 0.08
Eosinophil 0.05 0.01 – 0.04

IMMUNOLOGY
Date & Time Printed: 01/08/2019 06:00:55
TEST NAME RESULT REFERENCE RANGE
Thyrotropin 2.220 0.27 – 4.20µIU/mL

CLINICAL MICROSCOPY
Date & Time Printed: 01/08/2019 11:50:12
ROUTINE:
Color DARK YELLOW Blood NEGATIVE
Transparency SLIGHTLY HAZY Protein NEGATIVE
Specific Gravity 1.010 Glucose NEGATIVE
PH 8.0 Ketone NEGATIVE

MICROSCOPIC:
WBC 0-3/HPF
RBC 0-2/HPF
Casts NONE
Epithelial Cells FEW
Mucus Threads RARE
Amorphous
Phosphates FEW
Bacteria RARE
Crystals NONE
 Anatomy and Physiology

Thyroid gland is made up of two lobes connected by a narrow band called

isthmus which one located at each side of the trachea. It is also the largest
endocrine glands. Secreting Thyroid hormone is the main function of the Thyroid
gland. The hormones secreted by the thyroid gland are the Thyroxine,
Triiodothyronine and the Calcitonin which plays a major role in the metabolism,
growth and development of the human body. It also regulates many body functions
by constantly releasing a steady amount of thyroid hormones into the bloodstream.

Thyroxine (T4)

Also known as “tetraiodothyronine”. Is the main hormone secreted into the

bloodstream by the thyroid gland. This hormone plays vital roles in digestion, heart,
muscle function, brain development and maintenance of bones. High level of T4 will
make pituitary gland release less TSH which will lead to hypothyroidism and low
level of T4 will make pituitary gland release more TSH which will lead to
hyperthyroidism. The production and release of thyroxine is controlled by feedback
loop system that involves the hypothalamus, pituitary and thyroid gland. When the
levels of thyroid hormones (T4 and T3) increase, it prevents the release of both
thyrotroponin-releasing hormone and thyroid stimulating hormone, the body maintain
a constant level of thyroid hormones in the body.
Triiodothyronine (T3)

This hormone from the Thyroid gland is responsible for basal metabolic rate
which regulates the amount of oxygen and energy needed by the body to perform
such actions. It also potentiates the effects of the beta-adrenergic receptors on the
metabolism of glucose. This hormone also increases the heart rate and force of
contraction which is responsible also with our systolic and diastolic blood pressure.

Calcitonin

This hormone is also known as thyrocalcitonin which is involved in helping

regulate the levels of calcium and phosphate in the blood. It inhibits the activity of
osteoclasts which are responsible for breaking down of the bone. When bone is
broken, the calcium contained in the bone is released in the bloodstream. Therefore,
the inhibition of the osteoclasts by calcitonin directly reduces the amount of calcium
released into the bloodstream.
Pathophysiology
Types of Goiter, Common Cause, Signs and Symptoms.
Type of Goiter Cause Typical Symptoms and Signs

Iodine deficiency Lack of sufficient Thyroid gland enlargement (goiter)

(endemic goiter) dietary iodine Normal or underactive thyroid
intake (hypothyroidism)

Graves disease Autoimmune Goiter

(diffuse toxic stimulation of the Hyperthyroidism
goiter) thyroid gland

Autoimmune Persistent Goiter

thyroiditis immune system Hypothyroidism
(Hashimoto, inflammation
chronic of person's own
lymphocytic) thyroid

Subacute Viral infection Painful, tender and swollen gland

thyroiditis Malaise, fever, chills, and night sweats
(painful, de Thyrotoxicosis, often followed by
Quervain) hypothyroidism

Toxic adenoma Benign thyroid Nodular goiter

and toxic tumor(s) Hyperthyroidism
multinodular
goiter

Goiter and Malignant thyroid No symptoms

thyroid nodules tumors Local neck symptoms
suspicious for Symptoms of tumor spread
malignancy

What Causes Them?

It’s not always clear why a person gets thyroid nodules. Several medical conditions can
cause them to form. They include:

 Thyroiditis: This is chronic inflammation of the thyroid. One type of thyroiditis is

called Hashimoto’s disease. It’s associated with low thyroidactivity
(hypothyroidism).
 Iodine deficiency: A diet that lacks iodine can result in thyroid nodules. This is
uncommon in the U.S., since iodine is added to many foods.
 Thyroid adenoma: This is an unexplained overgrowth of thyroid tissue. Most
adenomas are harmless, but some produce thyroid hormone. This leads to
an overactive thyroid (hyperthyroidism).
 Thyroid cyst: This is usually caused by a thyroid adenoma that’s breaking down
(“degenerating”).
 Thyroid cancer: Most thyroid nodules aren’t cancer, but some can be.

Who’s At Risk?

By the age of 60, half of all people have them. They’re often very small. You might only
learn you have a Goiter when your doctor feels for one during an examination or if you
have an ultrasound of your thyroid.

Still, several things can increase your chances of developing a Goiter. They include:

 Living in a part of the world where the diet doesn’t include iodine
 Having a family history
 Being Female
 Age 40 and above

How is goiter treated?

Treatment for goiter depends on how large the thyroid has grown, symptoms, and
what caused it. Treatments include:
 No treatment/"watchful waiting." If the goiter is small and is not bothering
you, your doctor may decide that it doesn’t need to be treated. However, the
goiter will be closely watched for any changes.
 Medications.
o Levothyroxine
o Methimazole
o Propylthiouracil
 Radioactive iodine treatment. This treatment, used in cases of an
overactive thyroid gland, involves taking radioactive iodine orally.
 Biopsy. A biopsy is the removal of a sample of tissue or cells to be studied in
a laboratory. A biopsy may be needed if there are large nodules in the thyroid
gland. A biopsy is taken to rule out cancer.
 Surgery. Surgery is performed to remove all or part of the thyroid gland.
Surgery may be needed if the goiter is large and causes problems with
breathing and swallowing. Surgery is also sometimes used to remove
nodules. Surgery must be done if cancer is present. Depending on the
amount of thyroid gland removed, the patient may need to take thyroid
hormone replacement therapy for the rest of his or her life.
Pharmacology
 Assessment Nursing Planning Nursing Interventions Rationale Expected
Diagnosis Outcome
S–Ø Risk for Infection Short Term: 1. Therapeutic 1. To gain trust and Short Term:
related to After 3-4 hours of, the communication. cooperation of the After 3-4 hours of
surgical wound nursing interventions, 2. Monitor and record patient. nursing
O - The patient may the patient will vital signs. 2. To obtain baseline interventions, the
manifest: verbalize 3. Stress proper hand data. patient shall have
understanding of washing technique. 3. Poor nutritional verbalized
-With dry and intact individual causative 4. Instruct on proper status may cause understanding of
dressing on the factors might wound care. inability to muster a individual causative
excised area contribute infection. 5. Encourage to eat cellular immune factors might
vitamin C rich foods. response to contribute infection.
-Undergone Long Term: 6. Emphasized pathogens and are
surgery(total After 2-3 days of necessity of taking therefore more Long Term:
Thyroid nursing interventions, antibiotics as susceptible to After 4 days of
the patient will directed. infection. nursing
Lobectomy Right achieve timely wound 7. Closely observe and 4. To maintain optimal interventions, the
with healing. instruct to report nutritional status. patient shall have
Isthmusectomy, signs and symptoms 5. To promote wound achieved timely
frozen section) of infection such as healing. wound healing.
fever, sore throat, 6. To boost the
swelling, pain and immune system.
-With incision at drainage. 7. To prevent and
Anterior neck 8. Inspect the wound detect as early as
for swelling, unusual possible the
drainage, odor presence of any
redness, or progressing
separation of the infection.
suture lines. 8. Wound infection is
accompanied by
signs of
inflammation and a
delay in healing.
 Assessment Nursing Diagnosis Objectives Nursing Interventions Rationale Expected
Outcome
S-Ø Acute Pain related Short Term: 1. Therapeutic 1. To gain trust of Short Term:
Patient may to surgical incision After 4-5 hours of, communication. the patient. After4-5 hours of
verbalize with a the nursing 2. Monitor vital signs. 2. For baseline nursing
pain scale of 8/10 interventions, the 3. Assess verbal/non- data. interventions, the
patient will verbal reports of 3. Useful in patient shall have
O - patient may demonstrate use of pain, noting location, evaluating pain, demonstrated use
manifest: relaxation skills and intensity (0-10 choice of of relaxation skills
diversional scale), and duration. interventions, and diversional
>Facial Grimaces activities, as 4. Accept the effectiveness of activities, as
indicated, for description of pain. therapy. indicated, for
>Restlessness individual situation. Experienced and 4. Pain is a individual situation.
convey acceptance subjective
>Irritability Long Term: of client’s response experience and
After 3-4 days of to pain. cannot be felt by
>Sleep nursing 5. Determine client’s others. Long Term:
Disturbances interventions, the acceptable level of 5. Varies with After 3-4 days of
patient will report pain and pain individual and nursing
>Moaning, crying relieve and control goals. situation. interventions, the
Change in blood controlled pain. 6. Provide comfort 6. To promote non- patient shall have
pressure, heart rate measures (heat or pharmacological reported relieve and
and respiratory rate cold packs, quiet pain controlled pain.
environment and management.
calm activities). 7. They are usually
7. Monitor skin color altered in acute
and temperature pain.
and vital signs.
 -Instruct the patient to take the prescribe medications.
-Teach the patient on how to take the medicine in the right time, right
M dose and right route as prescribed by the physician.
-Educate the client about the effect of her medication.

-Promote a calm and clean environment.

-Encourage the relative to promote good ventilation and free from
E pollution environment.
-Promote an infection-free environment by cleaning the surroundings.

-Advise the patient and as well as the relatives to have a healthy

lifestyle.
-Advise the patient to avoid smoking area and avoid alcohol beverages
T intake.
-Instruct the patient to use povidone solution in cleaning her wound
incision site.

-Encourage the patient to have a daily wound care.

-Encourage the patient to have a proper hygiene by taking a bath and
H hand washing using water and mild soap.
-Encourage the patient to have a clean and aseptic dressing technique
to her wounds to prevent contamination.

-Advise the patient to have a monthly check-up to a physician.

-Encourage the patient for the compliance of her take home
O medications.
-Encourage the patient to maintain her healthy condition.

-Advise the patient to eat foods rich in iodine, like sea foods &
D nutritious foods that will make her healthy.
-Advise the client to have a proper diet and adequate fluid intake.

-Provide safety by keeping things in the right place specially those

which can injured.
S -Encourage the relatives to be sensitive enough about the things that
can harm the patient.
-Be careful all the time.
 CHAPTER NINE
BIBLIOGRAPHY

Gonzalo, A. G. (2011). Jean Watson-Caring Theory . Retrieved March 12, 2017,

from http://nursingtheories.weebly.com/jean-watson.html

Short, C., & Williams, N. (Eds.). (n.d.). Dr. Jean Watson: Theory of Caring Science.
Retrieved March 12, 2017, from http://jeanwatsoncaringscience.weebly.com/theory-
description.html

https://www.archivesofpathology.org/doi/pdf/10.1043/1543-
2165(2005)129%5B1575%3AFSOTAP%5D2.0.CO%3B2

https://general.surgery.ucsf.edu/conditions--procedures/goiter.aspx

https://my.clevelandclinic.org/health/diseases/12625-goiter/management-and-
treatment