Case Study (Goiter)

DAVAO MEDICAL SCHOOL FOUNDATION, INC.
MEDICAL SCHOOL DRIVE, BAJADA, DAVAO CITY

COLLEGE OF NURSING
IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS
IN NCM 103 RLE
CASE STUDY
GOITER
SUBMITTED TO:
GREMMA W. BARATAS, RN, MN

CLINICAL INSTRUCTOR
SUBMITTED BY:
YASIERAH K. AGALIN, ST. N

CHRISTINE JOY R. ALONDAY, ST. N
SIVAN WILFRED G. BARBARONA, ST. N
CHEENE S. BELACSI, ST. N
ISRAEL G. DELMINDO, ST. N
EARL GARCIA, ST. N
VENICE ATHENA PAJARO, ST. N
ABBEGAILE ANNE R. SIENES, ST. N
DATE SUBMITTED:
NOVEMBER 12, 2016

TABLE OF CONTENTS
I. INTRODUCTION....................................................................................................1-2
A. Background of the study.........................................................................................1

B. Significance of the study.........................................................................................2
C. Relevance of the study...........................................................................................2
II. OBJECTIVES(General and Specific objectives) .................................................3-4

III. HEALTH HISTORY.................................................................................................5
IV. PATIENT PROFILE.................................................................................................5
V. DEVELOPMENTAL TASK....................................................................................6-7
VI. GENERAL ASSESSMENT..................................................................................8-9
VII. ANATOMY AND PHYSIOLOGY....................................................................10-12
VIII. DEFINITION OF TERMS...............................................................................13-14
IX. ETIOLOGY............................................................................................................15
X. PATHOPHYSIOLOGY......................................................................................16-18
XI. PROGNOSIS........................................................................................................19
XII. SYMPTOMATOLOGY....................................................................................20-22
XIII. LABORATORY (DIAGNOSTIC) TESTS.......................................................23-26
XIV. MEDICAL AND SURGICAL TREATMENT).................................................26-32
XV. NCP................................................................................................................33-35
XVI. DISCHARGE PLANNING (METHOD)..........................................................36-37
A. Medication............................................................................................................36
B. Exercise................................................................................................................37
C. Treatment..............................................................................................................37
D. Health Teaching....................................................................................................37
E. Out-patient order...................................................................................................37
F. Diet........................................................................................................................37
XVII. RECOMMENDATIONS.....................................................................................38
XVIII. BIBLIOGRAPHY/REFERENCES....................................................................39
INTRODUCTION
A. BACKGROUND OF THE STUDY
Goiter is a swelling of the neck or larynx resulting from enlargement of the thyroid
gland (thyromegaly), associated with a thyroid gland that is not functioning properly.
The degree of swelling, and the severity of symptoms produced by the goiter depend on
the individual. Some cases involve a small amount of swelling, and others can involve
considerable swelling that actually constricts the trachea and causes breathing
problems.
Worldwide, the most common cause for goiter is deficiency, The prevalence of goiter in
areas of severe iodine deficiency can be as high as 80%. Populations at particular risk
tend to be remote and live in mountainous areas in South-East Asia, Latin America and
Central Africa. Iodization programs are of proven value in reducing goiter size and in
preventing goiter development and cretinism in children. Autonomy can develop in
nodular goiters leading occasionally to thyrotoxicosis and iodization programs can also
induce thyrotoxicosis, especially in those aged >40 years with nodular goiters
1
SIGNIFICANCE OF THE STUDY
This study will be a significant endeavor in understanding this condition, it will
help the students and clinical instructors in gaining more knowledge that will help them
deal with future similar cases. By being able to encounter this case and study it,
students will become more competent and expectedly will be more confident with
themselves. Furthermore this research will provide recommendations on how to plan
and proper nursing interventions for the said case.
RELEVANCE OF THE STUDY
We had found this case to be interesting and challenging on our part as student
nurses since its our first time to encounter it. And we were able to relate to it since its
one of the most common diseases that affect the thyroid gland In the Philippines, Based
on the studies of urinary iodine levels conducted by the Department of Health, most
goiter cases are found in the mountainous provinces and other remote areas of the
country. The Food and Nutrition Research Institute performed a nutritional survey in
1998 to assess the extent of iodine deficiency among 10,616 school children aged six to
12 years. It was discovered that the country as a whole had mild iodine deficiency.
2
OBJECTIVES
GENERAL OBJECTIVE:
At the end of our two-week exposure in the Davao Medical School Foundation
Hospital, medical- surgical ward, we will be able to acquire knowledge and reliable
information about goiter in order for us students to become knowledgeable; be able to
demonstrate competent nursing care that will address our patients condition; and to
demonstrate right attitude and provide quality nursing care.
SPECIFIC OBJECTIVES:
This case study is made to achieve the following reasons:
1. Establish rapport with our patient as well as her significant others to gain trust
and cooperation.
2. Collect significant information regarding our patients conditions as well as the

family history, past and present health history.
3. Evaluate clients data according to the nursing and developmental theory.
4. Describe the structures and normal function of the body organs involved.
5. Trace the Pathophysiology of the disease process and its enduring

symptomatology
6. Review and interpret medical order and results of possible laboratory

examination that the client has undergone.
3
7. Identify the different signs and symptoms, as well as the presentation of its
etiology and contributing factors in the development of this condition
8. Make effective nursing care plans that address the present and possible needs.
9. Enumerate clients medications which include both therapeutic andthe adverse

effects
10. Present discharge plan for clients condition.
4
HEALTH HISTORY
PATIENT PROFILE
Name:
Sex:
Age:
Status:
Address:
Nationality:
Religion:
Occupation:
Birthdate:
Mother:
Father:
Spouse:
Birth Place:
Chief Complaint:
5
GENOGRAM
Fathers side
Mothers Side
Grandmother
Grandmother Grandfath 60, alive
Grandfath 50, alive er
er 70, dead
64, alive
Patient Son Daughter

Youngest 35 Second Eldest
22, alive eldest (husband 28, alive
eclampsia 38, alive of the
36, alive
patient)
35, alive
Youngest 2nd youngest 2nd eldest Eldest

2 weeks 10 years 11 years 14 years
Male
Female
Patient
6
DEVELOPMENTAL TASK
Developmental Task: Erik Erickson
Psychosocial Stage:
Developmental Task: Sigmund Freud
Psychosexual Theory:
Developmental Task: John Piagets Cognitive theory
Developmental Task: Lawrence Kohlberg
Moral Development Theory
GENERAL ASSESSMENT
7
Family History:
Patient family
(-) Hypertension (-) Hypertension
(-) Diabetes Mellitus (-) Diabetes Mellitus
(-) bronchial asthma (-) bronchial asthma
(-) food and drug allergies (-) cancer
Past history:
(+) smoking
(-) alcoholic and beverage drinks
No noted hospitalizations in the past.
Health Care Provider:
DOCTOR
Final Diagnosis:
Complete H.Mole G8P7
General Appearance:
conscious
coherent
Level of sensorium:
cooperative
EENT:
- Anicteric Sclerae, (+) pale palpebral conjunctiva
Breast:
-Non tender
Lungs:
-CBS, equal chest expansion
Final Diagnosis:
GOITER
8
9
ANATOMY AND PHYSIOLOGY
10
DEFINITION OF TERMS
11
ETIOLOGY
Iodine deficiency is the major cause of goiter worldwide, but this is rarely a cause in
more economically developed countries that add iodine to salt. As iodine is
inconsistently present in plant foods, vegan diets may lack sufficient iodine; this is less
of a problem for vegans who live in countries such as the US that add iodine to salt).
Rates of goiter are higher in areas where there is a deficiency of the trace mineral,
which is found in seafood, plant food grown in iodine-rich soil, and cow's milk.
In some parts of the world, the prevalence of the condition can be as high as 80 per
cent - such populations tend to be in remotely mountainous areas of southeast Asia,
Latin America and central Africa, where daily intake of iodine can fall below 25
micrograms a day and children are often born with hypothyroidism.4
The thyroid gland needs iodine in order to manufacture thyroid hormones, which
regulate the body's rate of metabolism.
The main cause of goiter in developed countries is autoimmune disease. Women over
the age of 40 are at greater risk of goiter, as are people with a family history of the
condition.2
Hypothyroidism is the result of an underactive thyroid gland, and this causes goiter.
Because the gland produces too little thyroid hormone, it is stimulated to produce more,
leading to the swelling.3 This usually results from Hashimoto's thyroiditis/disease, a
condition in which the body's immune system turns on itself and causes inflammation
within the thyroid gland.2,3
12
Hyperthyroidism is also a cause of goiter - from an overactive thyroid gland, which
produces too much thyroid hormone. This usually happens as a result of Graves'
disease, also an autoimmune disorder in which the body's immunity turns on itself and
attacks the thyroid gland, causing it to swell.
Less common causes of goiter include the following:
Nodules - benign lumps, single or multiple
Smoking - thiocyanate in tobacco smoke interferes with iodine absorption
Hormonal changes - pregnancy, puberty and the menopause can affect thyroid
function
Thyroiditis - inflammation caused by infection, for example
Lithium - the psychiatric drug can interfere with thyroid function
Overconsumption of iodine - too much iodine can cause goiter, just as too little
does
Radiation therapy - particularly if to the neck.
13
PATHOPHYSIOLOGY
Predisposing Precipitating
Sex: female (4:1) History of radiation
Age: over 40 years old therapy to haed or neck
Family history of goiter Excessive amounts of
iodine
Iodine deficiency
Etiology: may be caused by one

or several factors stated
Presence of uniform
follicular epithelial
hyperplasia
Development of areas of
involution and fibrosis
interspersed with areas of focal
hyperplasia
Thyroid architecture loses

uniformity
Development of nodules
14
Reduced TSH levels
Thyroid gland slowly increases Development of
in size functional automony
May lead to
thyrotoxicosis
Pressure on anterior
Visible anterior neck neck structures
mass
Pressure on Pressure on
Venous outflow Pressure on the trachea the recurrent
obstruction of the the esophagus laryngeal nerve
head and the neck
dysphagia
hoarseness
Facial plethora Engorgement of

the neck veins dyspnea coughing wheezing
If treated If not treated
May complicate
Good prognosis into thypoid
cancer
death Poor prognosis

PROGNOSIS
15
A simple goiter may disappear on its own, or may become larger. Over time, the thyroid
gland may stop making enough thyroid hormone. This condition is
called hypothyroidism.
In some cases, a goiter becomes toxic and produces thyroid hormone on its own. This
can cause high levels of thyroid hormone, a condition called hyperthyroidism.
Results vary depending on the underlying condition. The early stages of goiter often
respond well to medication (hormone therapy); a marked reduction in size or complete
resolution can occur within 3 to 6 months. When nodules are present, only about one-
third of individuals see a reduction in gland size after hormone therapy. Surgery
(thyroidectomy) is generally effective. Even in cases in which the goiter regresses with
treatment, it may recur in months or years. Undiagnosed progressive thyroid cancer can
be fatal.
16
SYMPTOMATOLOGY
SIGNS AND RATIONALE

SYMPTOMS
Uterine enlargement Uterine enlargement is cause excessive trophoblastic growth and
retained blood.
Vaginal Bleeding Most common sign of H. mole. May occur in abdominal cavity
causing pain. Molar tissue seperates from the decidua causing
bleeding. The uterus may become distended by large amount of
blood and dark fluid may leak into vagina.
Absence of fetal H.mole is a fake pregnancy and therefore there is no fetus or fetal
heart tone heart rate
Severe Nausea and Nausea is very common during pregnancy. This is due to extremely
vomiting high levels of human chorionic gonadotropin (hCG).
Hyperthyroidism Can be present due to stimulation of the thyroid gland by the high
levels of circulating HCG or by a thyroid stimulating substance
produced by the trophobasts.
Vaginal discharge parts of the mole deteriorate, small amounts of tissue, which
resemble a bunch of grapes, may pass through the vagina
anemia In cases of serious or prolonged bleeding, a woman's body is not
able to replace red blood cells as fast as they are lost. This can lead
to anemia (low red blood cell counts). Symptoms can include fatigue
and shortness of breath, especially with physical activity.
Ovarian cysts hCG may cause fluid-filled cysts to form in the ovaries. These cysts
can be large enough to cause abdominal swelling. They only occur
with very high levels of HCG. Even though they can become quite
large, they usually go away on their own about 8 weeks after the
molar pregnancy is removed.
17
infection In larger tumors, some of the tumor cells may die, creating an area
where bacteria can grow. Infection may develop, which can cause
vaginal discharge, pelvic cramps, and fever.
Lung symptoms The lung is a common site for distant spread of GTD. Spread to the
lungs may cause coughing up of blood, a dry cough, chest pain, or
trouble breathing.
18
DIAGNOSTIC TEST
HEMATOLOGY Result Range Interpretation

Hemoglobin L 63.0 115.0 155.0 g/L A low hemoglobin count is a
commonly seen blood test result.
Hemoglobin (Hb or Hgb) is a
protein in red blood cells that
carries oxygen throughout the
body.
In many cases, a low

hemoglobin count is only slightly
lower than normal and doesn't
affect how you feel. If it gets
more severe and causes
symptoms, your low hemoglobin
count may indicate you have
anemia.
Hematocrit L 0.23 0.36 0.48 Causes of low hematocrit, or
anemia, include: Bleeding
(ulcers, trauma, colon cancer,
internal bleeding) Destruction of
red blood cells (sickle cell
anemia, enlarged spleen)
Decreased production of red
blood cells (bone marrow
supression, cancer, drugs)
RBC L 3.86 4.20 6.10 x10^6/uL When the hemoglobin count is
low, the body is not able to get
as much oxygen to go
throughout the body.
WBC H 10.42 5.0 10.0 x10^3/uL An increased production of white
blood cells to fight an infection
MCV L 58.80 79.40 94.80 fl Mean corpuscular volume (MCV)
is the average volume of red
cells in a specimen. MCV is
elevated or decreased in
accordance with average red cell
size; ie, low MCV indicates
microcytic (small average RBC
size), normal MCV indicates
normocytic (normal average
RBC size), and high MCV
indicates macrocytic (large
average RBC size).
19
MCHC L 27.8 32.20 35.50 g/dL The mean corpuscular
hemoglobin concentration, a
measure of the concentration of
hemoglobin in a given volume of
packed red blood cells. It is
reported as part of a standard
complete blood count.
Differential The blood differential test
count measures the percentage of
each type of white blood cell
(WBC) that you have in your
blood. It also reveals if there are
any abnormal or immature cells.
Neutrophil H 79 55.00 75.00 % It is important to realize that an
abnormal increase in one type of
white blood cell can cause a
decrease in the percentage of
other types of white blood cells.
An increased percentage of
neutrophils may be due to: Acute
infection. Acute stress.
Lymphocyte L 16 20 35% Lymphocytopenia is an
abnormally low number of
lymphocytes (a type of white
blood cell) in the blood. Many
disorders can decrease the
number of lymphocytes in the
blood, but viral infections
(including AIDS) and
undernutrition are the most
common.
Monocyte 4 2 10 % A blood differential test, also
called a white blood cell count
differential, measures the
number of each of the five types
of white blood cells present in
your blood: neutrophils.
lymphocytes. monocytes.
Eosinophil 1.000 18% Eosinophils have two distinct
functions in your immune
system. They destroy invading
germs like viruses, bacteria, or
parasites such as Giardia and
pinworm. Eosinophils also create
an inflammatory response,
especially if an allergy is
20
involved.
Basophil Basophils are produced in your
bone marrow, circulate in the
blood and are the least abundant
of all leukocytes. They are
classified as immune cells and
categorized a granulocytes.
Therefore, the basic function of
this white blood cell is release of
its substances in response to a
foreign invasion.
Platelet Count 319 150 400 x10^3/uL A platelet count is a lab test to
measure how many platelets you
have in your blood. Platelets are
parts of the blood that help the
blood clot. They are smaller than
red or white blood cells.
Urinalysis Result Range Interpretation

Chemical Analysis
pH 6.5 A urine pH test can tell
your doctor how acidic
or basic (alkaline) your
urine is using a simple,
painless urine test.
Many diseases, your
diet, and the medicines
you take can affect
how acidic or basic
your urine is. For
instance, results that
are either too high or
low can indicate the
likelihood that your
body will form kidney
stones. If your urine is
at an extreme on either
the low or high end of
pH levels, you can
adjust your diet to
reduce the likelihood
painful kidney stones
will form. In short, your
urine pH is an indicator
21
of your overall health
and gives your doctor
important clues as to
what is going on in
your body.
Glucose Negative The glucose urine test
measures the amount
of sugar (glucose) in a
urine sample. The
presence of glucose in
the urine is called
glycosuria or
glucosuria.
Protein Negative Urine protein testing is
used to detect protein
in the urine, to help
evaluate and monitor
kidney function, and to
help detect and
diagnose early kidney
damage and disease.
Urine
Flowcytometry
WBC 8.0 0 27 /uL Leukocyte esterase is
an enzyme present in
most white blood cells
(WBCs). Normally, a
few white blood cells
(see microscopic
examination) are
present in urine and
this test is negative.
When the number of
WBCs in urine
increases significantly,
this screening test will
become positive.
When the WBC count

in urine is high, it
means that there is
inflammation in the
urinary tract or kidneys.
The most common
cause for WBCs in
urine (leukocyturia) is a
22
bacterial urinary tract
infection (UTI), such as
a bladder or kidney
infection.
RBC H 40 0 28 /uL This test is used to
detect hemoglobin in
the urine
(hemoglobinuria).
Hemoglobin is an
oxygen-transporting
protein found inside
red blood cells (RBCs).
Its presence in the
urine indicates blood in
the urine (known as
hematuria). The small
number of RBCs
normally present in
urine usually result in a
"negative" test.
However, when the
number of RBCs
increases, they are
detected as a "positive"
test result.
Epithelial Cells H 14 0 7/uL Epithelial cells in urine
may be a cause for
concern if the numbers
are higher than normal.
The sloughing of
epithelia is quite a
normal process of the
body sheddingdead
cells and creating new
ones. If epithelial cells
are high in your urine it
could signal a problem
with your kidneys or an
infection in your urinary
system. This article will
examine some
possible causes of
epithelial cells in urine
and what urinalysis
means.
Cast Urinary casts are
23
formed only in the
distal convoluted
tubule (DCT) or the
collecting duct (distal
nephron). The proximal
convoluted tubule
(PCT) and loop of
Henle are not locations
for cast formation.
Hyaline casts are
composed primarily of
a mucoprotein (Tamm-
Horsfall protein)
secreted by tubule
cells.
Bacteria 4 Urine is normally
sterile, which means
that it contains no
bacteria. A small
number of bacteria
may be found in the
urine of many healthy
people. This is usually
considered to be
harmless. However, a
certain level of bacteria
can mean that the
bladder, urethra, or
kidneys are infected.
NCP
Assessment Diagnosis Planning Intervention evaluation
24
Objective: Risk for infection After 8 hours Establish rapport Goal met as
VS Taken r/t surgical of nursing Rationale: To gain evidenced by
and incision intervention, patients trust and normal vital signs
recorded secondary to total the patient will cooperation and patient
Temp: 36.2 abdominal be able to: showed no signs
C hysterectomy Identify Monitor V.S. and symptoms of
Pulse: 71 and Rationale: To obtain infection
RR: 19 demonstrat baseline data
BP: 110/80 e
interventio Observe and report
n to signs of infection
prevent such as redness,
infection warmth, discharge,
Patient will and increased body
show no temperature.
signs and Rationale: With the
symptoms onset of infection the
of infection immune system is
activated and signs
of infection appear.
Note and report

laboratory values
(e.g., white blood
cell count) rationale:
Laboratory values
provide a global view
of the client's immune
function
Use proper hand

washing techniques
before and after
giving care to client.
Rationale: Hand
washing significantly
decreases the
number of
microorganisms
Provide wound
healing such as
cleaning of wound
Rationale: To reduce
risk for infection
25
Provide care, change
dressing as needed
To promote healing to
the incision
26
BP: 110/80 e
activated and signs
Note and report

laboratory values
(e.g., white blood
Laboratory values
function
Use proper hand

washing techniques
before and after
Rationale: Hand
decreases the
number of
microorganisms
Provide wound
healing such as
cleaning of wound
27
risk for infection

dressing as needed
the incision
28
BP: 110/80 e
activated and signs
Note and report

laboratory values
(e.g., white blood
Laboratory values
function
Use proper hand

washing techniques
before and after
Rationale: Hand
decreases the
number of
microorganisms
Provide wound
healing such as
cleaning of wound
29
risk for infection

dressing as needed
the incision
30
BP: 110/80 e
activated and signs
Note and report

laboratory values
(e.g., white blood
Laboratory values
function
Use proper hand

washing techniques
before and after
Rationale: Hand
decreases the
number of
microorganisms
Provide wound
healing such as
cleaning of wound
31
risk for infection

dressing as needed
the incision
32
BP: 110/80 e
activated and signs
Note and report

laboratory values
(e.g., white blood
Laboratory values
function
Use proper hand

washing techniques
before and after
Rationale: Hand
decreases the
number of
microorganisms
Provide wound
healing such as
cleaning of wound
33
risk for infection

dressing as needed
the incision
34
DISCHARGE PLANNING
Medication Instruct the patient to comply with the treatment regimen

faithfully.
Rationale: this would promote faster recovery and prevention

of relapse.
Intruct to take medication with exact dosge as ordered
Rationale: correct dosage hinders from possible adverse

effects due to overdosing of a certain drug
Explain the side effects of medication
Rationale: to orient or to have knowledge of what possible

side effects to expectg upon taking the drugs. Refer for further
reassessment.
Intruct patient to avoid taking medication that are not

prescribed by the physicians.
Rationale:over the counter drugs might cause side effects or

even adverse effects that may worsen status.
Remind the patients significant others for the scheduled

consultsation with the physician
Rationale: in order to determine the effectiveness of the drug.
Take full course of medication
Rationale: to kill microorganisms resistance.
Instruct significant others to refere immediately if there is an

adverse reaction of the drug
Rationale: to discontinue theraphy and to lessen

complications.
Exercise Discuss to the client importance or help client develop a

program of exercise and relaxation techniques as tolerated.
Health Teaching Moreover, a teaching plan that affect clients holistic wellness
should be done in order to maintain an environment that is
35
conducive for health promotion.
Out-patient Proper referral is best for the health care provider to evaluate
Order condition of the client, whether it is improving or not. Also, for
early diagnosis of any other underlying conditions
Diet Proper execution of clients diet is very important so informing
and instructing client or clients watcher about proper meals to
be given to the client and increasing oral fluid intake is
important. ( Dietary Salt: moderate intake, and high in
cholesterol foods)
Encouraged to increase fluid intake to at least 8-10glasses per
day as tolerated to maintain hydration.
Advised to eat as fruits and green leafy vegetables.
36
RECOMMENDATIONS
As nurses, our vital role is to provide health care and deliver services in the
hospital to improve the health status of each individual. This nursing care study is
important for us because it in enables to give the proper health teaching to our chosen
client.
We recommended this case to the following persons and institution for the further
improvement of the study.
TO THE FAMILY:
This study for the family of our patient to follow the treatment prescribed such as
to take the medications as on time and right dosage and other recommended measures
by the physicians, encourage having adequate rest to hasten the recovery of the
patient. Through the adherence of fulfillment of the suitable medical management, for
the fast recovery of the patient.
TO THE STUDENT:
We recommended this study for the students as a reference for the future cases,
in order to have some based line datas to refer.
TO THE COLLEGE OF NURSING

We recommended this study to our department for giving us a precise details and
an access of further study of this case. We advocate also for giving us an abundance
time to research in order to prevent typographical and grammatical errors.
TO THE DAVAOMEDICAL SCHOOL FOUNDATION HOSPITAL

We recommended this study to Southern Philippines Medical Center for them to
able to evaluate and appreciate the said case and share this as a reference and
information having those patients who has certain condition.
37
BIBLIOGRAPHY/REFERENCES
1. Blackwells Nursing Dictionary Second Edition (2011), Blackwells Publishing Ltd.

2. Fundamentals of Nursing Eight Edition, Kozier&Erbs, Pearson, Prentice Hall
3. Nurses Pocket Guide, Diagnoses Prioritized Interventions, and
rationales,MarilynnE.Doenges,Mary Frances Moorhoouse,Alice C. Murr, 13 th
edition.
4. Lippincotts Nursing Drug Handbook, Lippincott, 2014
5. Day, R. A., Paul, P., Williams, B., Smeltzer, S. C., & Bare, B. G. (2016). Brunner
& Suddarths Canadian textbook of medical-surgical nursing (3rd Canadian ed.).
Philadelphia: Lippincott Williams & Wilkins
6. gnatavicius, D. D., Workman, M. L., & Henderson, L. (2015). Medical-surgical
nursing: Critical thinking for collaborative care (7th ed.). Toronto: Elsevier
Saunders. (ISBN 978-1-4377-2801-9)
7. Jarvis, C. (2014). Physical examination & health assessment (2nd Canadian ed.).
St. Louis, MO: Saunders. (ISBN 978-1-9266-4872-9)
38

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Case Study (Goiter)

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DAVAO MEDICAL SCHOOL FOUNDATION, INC.

MEDICAL SCHOOL DRIVE, BAJADA, DAVAO CITY

GREMMA W. BARATAS, RN, MN

YASIERAH K. AGALIN, ST. N

NOVEMBER 12, 2016

A. Background of the study.........................................................................................1

II. OBJECTIVES(General and Specific objectives) .................................................3-4

A. BACKGROUND OF THE STUDY

preventing goiter development and cretinism in children. Autonomy can develop in

This study will be a significant endeavor in understanding this condition, it will

themselves. Furthermore this research will provide recommendations on how to plan

and proper nursing interventions for the said case.

RELEVANCE OF THE STUDY

information about goiter in order for us students to become knowledgeable; be able to

demonstrate right attitude and provide quality nursing care.

This case study is made to achieve the following reasons:

2. Collect significant information regarding our patients conditions as well as the

3. Evaluate clients data according to the nursing and developmental theory.

5. Trace the Pathophysiology of the disease process and its enduring

6. Review and interpret medical order and results of possible laboratory

9. Enumerate clients medications which include both therapeutic andthe adverse

10. Present discharge plan for clients condition.

Patient Son Daughter

Youngest 2nd youngest 2nd eldest Eldest

Developmental Task: Erik Erickson

Developmental Task: Sigmund Freud

Developmental Task: John Piagets Cognitive theory

Developmental Task: Lawrence Kohlberg

Moral Development Theory

more economically developed countries that add iodine to salt. As iodine is

cent - such populations tend to be in remotely mountainous areas of southeast Asia,

micrograms a day and children are often born with hypothyroidism.4

regulate the body's rate of metabolism.

leading to the swelling.3 This usually results from Hashimoto's thyroiditis/disease, a

within the thyroid gland.2,3

attacks the thyroid gland, causing it to swell.

Less common causes of goiter include the following:

Nodules - benign lumps, single or multiple

Smoking - thiocyanate in tobacco smoke interferes with iodine absorption

Lithium - the psychiatric drug can interfere with thyroid function

Radiation therapy - particularly if to the neck.

Etiology: may be caused by one

Thyroid architecture loses

Facial plethora Engorgement of

If treated If not treated

death Poor prognosis

gland may stop making enough thyroid hormone. This condition is

can cause high levels of thyroid hormone, a condition called hyperthyroidism.

respond well to medication (hormone therapy); a marked reduction in size or complete

SIGNS AND RATIONALE

HEMATOLOGY Result Range Interpretation

In many cases, a low

Urinalysis Result Range Interpretation

When the WBC count

Assessment Diagnosis Planning Intervention evaluation

Note and report

Use proper hand

Note and report

Use proper hand

Provide care, change

Note and report

Use proper hand

Provide care, change