A

CASE STUDY

ON

FOLLICULAR NEOPLASM OF THE THYROID

Submitted to:

MS. LOUIE GRACE MIRAFLOR, RN.

BSN Level III Clinical Instructor
CHH 7B

Submitted by:

RICHARD B. TANUCO
Student
BSN Level III Section C

February 13, 2010

 TABLE OF CONTENTS

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:

APPENDIX A: PERMIT LETTER

APPENDIX B. NCP
APPENDX. C. DP
APPENDIX D. DRUG STUDY
APPENDIX E. IVF STUDY

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

with some influence of the cortisol and epeniphrine.

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

thyrotoxicosis. Hormone production in functional adenomas ("toxic adenomas") occurs independent of

TSH stimulation and represents another example of thyroid autonomy, analogous to toxic multinodular

goiters.
 GENERAL DATA

HOSPITAL: CHONG HUA HOSPITAL

PATIENTS NAME: DELA CRUZ, GRACE RONQUILLO

ADDRESS: 53 KATIPUNAN LABANGON, CEBU CITY

AGE: 43 YEARS OLD

SEX: FEMALE

OCCUPATION: MISSIONARY

HUSBAND NAME: LOMER DELA CRUZ

CIVIL STATUS: MARRIED

RELIGION: BAPTIST

CITEZENSHIP: FILIPINO

BIRTHDATE: 07/14/1966

HEIGHT: 146 CM.

WEIGHT: 49.9 KG

LMP: 12/29/2009

MENARCHE: 10 YRS. OLD

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.

IV. PAST HEALTH HISTORY

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

2002, she had a removal of lymphoma

V NURSING REVIEW OF SYSTEMS

GORDONS HEALTH PATTERN

 HEALTH MAINAINANCE – PERCEPTION PATTERN

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.

 NUTRITIONAL- METABOLIC PATTERN

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

within normal limits.

 ACTIVITY AND EXCERSICE PATTERN

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

articles. Hearing within normal limits and ca see 20:20 vision.

 COPING- STRESS TOLERANCESELF PERCEPTION/SELF-CONCEPT PATTERN

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

their family. There is no restriction of foods, blood transfusion in their religion.

VI. FAMILY, PERSONAL, SOCIAL AND ENVIRONMENTAL HISTORY

A. MEMBERS OF IMEDIATE FAMILY

NAME SEX AGE GEN. POSITION EDUCATIONAL

HEALTH IN THE BACKGROUND

STATUS FAMILY
LOMER MALE 44 HEALTHY HUSBAND COLLEGE

DELA YRS. OLD GRADUATE

CRUZ
KENNY MALE 20 HEALTHY ELDEST 3RD YEAR

DELA YRS.OLD SON COLLEGE

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

B. PERSONAL AND SOCIAL HISTORY

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

buy mineral water for their drinking purposes.

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

Pulse Rate: 64 bpm

Respiratory Rate: 15 cpm

Blood Pressure: 90/60 mmHg

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

Regular apical pulse. Normal nail bed.

4. GASTROINTESTINAL METABOLLIC PATTERN

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

and after menstrual periods. Urine is clear. No adaptive aids attached.

VIII. DEVELOPMENTAL DATA

STAGES & DEVELOPMENTAL SICNIFICANT SCIENTIFIC

AGE TASK CHARACTERISTCS BASIS

INFANCY Trust vs. Mistrust She had a complete During the first

(BIRTH TO immunization. She year of life,

8 MONTHS) gradually weaned to a infants depend on

cup as her desire for parents for all

sucking decreases. their

Preferred to be with her physiological

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

HOOD (18 and Doubt own independence and child wants to

MONTHS curios about the world feel in control ad

TO 3 and a time of fear from needs to learn to

YEARS) separation from her perform tasks

mother. independently,

even when it

takes a long time

or make a mess.

Exploring the

environment

begins and learns

about her body

too.

(Craven,2003;13

55)
PRE- Initiative vs. Guilt Language develops During the period

SCHOOL rapidly and involves the preschool are

( 1-5 herself in active fascinating

YEARS) assertive play. creatures. As

these social

circles enlarge to

include peers and

 adults outside the

family,

preschooler’s

language, play

pattern and

appearance

change rapidly.

( Craven,2003;13

55)
SCHOOL Industry vs. Inferiority She partly engaged A child compares

AGE ( 6-12 herself to peers but more their skills to

YEARS ) time on her best friend. those of their

Her physical, social and peers in a number

cognitive development of areas including

increased. motor skills.

( Koizer,2002;60

5)
ADOLESCE Identity vs. Role She was conscious with Adolescents are

NCE (12-18 confusion her physical appearance. usually

YEARS) She had stated engaging concerned about

herself to a relationship their bodies, their

to opposite sex. appearance and

Menarche started at the their physical

age of 13. abilities.

(Kozier,2002;616
 )
YOUNG Intimacy vs. Isolation Se seeks independence During young

ADULT and decided to be with adulthood

( 18-40 the man he dreams for. People become

YEARS) At the age of 29 she independence

finally made her own and establish

family. close relationship

with a significant

others and decide

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

United States it weighs approximately 15 grams.

Figure 2. The normal anatomy of the neck in the region of the thyroid gland. (From Halsted, W.S. The

operative story of goiter. Johns Hopkins Hospital Rep 19:71, 1920.)

VASCULAR SUPPLY

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-

Hill, 1989, pp 1613-1685.)

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

devascularized during thyroidectomy (10).

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.

B. CONCEPTUAL FRAMEWORK ON THE PATHOPHYSIOLOGY AND SYMPATOLOGY

OF THE DISEASE CONDITION

 FOLLICULAR NEOPLASM
BENIGN

HOST
AGENT

43 YEARS OLD EXPOSURE TO

CARCINOGENIC
SUBSTANCE.S AND
GENETIC
PREDISPOSITION

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 MANIFESTATIONS SURGICAL MANAGEMENT

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

pathogenesis of a significant proportion of thyroid tumors remains to be defined, especially the

pathogenesis of nonfunctioning adenomas.

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

DATE AND TIME DOCTORS ORDER

1/4/2010  Pls. admit direct to room under the

primary service of DR. Dangoy.

 Labs: c/o DR. Dangoy include

bleeding time, protime, blood

typing.

 Schedule for thyroid surgery on

1/5/2010 @ 7:30 pm.

 Dr. Emily Strades for anesthesia.

 Restart cefuroxime 750 mg ivtt for

8 hours.

 Star d5lr 1L @ 120cc/hr.

 Labs: CBC, U/A, Na AND

 K,CREATININE, ECG -12L.

 Dr. Elizabeth Aguilar for CP

clearance.

01/05/2010

 NPO Post midnight

 Patient seen and examined, history

of P.E reviewed.

 Problem: Thyroid follicular

neoplasm, benign.

 I&O q shift, TPR q 4 refer

accordingly.

 Apply ice pack on post-op site.

 Refer for bleeding and signs of

respiratory distress.

 Fluid to follow D5LR 1L@ 120

01/06/2010
cc/hr.
  Diet as tolerated with strict

aspiration precaution.

 Kindly prepare assessing materials

at the bedside.

 Steam inhalation for 30 minutes

every 6 hours for 2 days.

 E. tosicoxib 120 mg, tab once a day.

 Suggest O2 inhalation @ 1-2 L/min.

 Bactidol Oral gargle TID.

 For digital mammogram.

01/07/2010
 KSS

 May reinsert ivf tomorrow.

 Kalminosen spray 2 spray for

costrel 3x a day.

 May not insert IV.

 Change dressing done.

 Penrose drain removed.

 Sterile strips applied.

 Pls. give tramadol +paracetamol

(Dollet) 1tab every 8 hours.

 Reverse kalminosen spray to bucal

cavity TID.
  Give to sprays before sleeping

tonight.

MEDICATIONS

> Cefuroxime (zinacef)

> Tramadol (tramal)

>Panecovib

>Kalminosen spray

DIAGNOSTIC PROCEDURES
CHEST X-RAY

LUNGS ARE CLEAR. HEART IS NOT ENLARGED. THE TRACHEAL IS AT THE MIDLINE,

THERE IS AN NODULE NOTED AT THE RIGHT PARATRACHEAL WALL AT THE LEVEL OF

T1.

ULTRASOUND

RIGHT LOBE: 5.0 X 1.0 cm. 4-6 cm.

LEFT LOBE: 4.2 cm. 2-3 cm.

ISTHMUS: 0.2 cm thick 1-2 cm

 MINIMALLY ENLARGED MANDIBULAR LYMPH NODES.

IMMUNOLOGY REPORT
THYROID FUNCTION TEST

TSH = 1.42 REFERENCE: 0.30-0.50 micro international units per milliliter

CHEMISTRY REPORTS

VALUE REFERENCE

GLUCO 109 70-100 MG/DL

SE

CREATI 0.6 0.6-1.5 MG/DL

NINE

Na 140 134.0-143 MMOL/L

serum

K 3.8 3.3-5.3 MMOL/L

SEROLOGY REPORT: O+
HEMATOLOGY

CBC:LEVEL REFERENCE

WBC6.80 4.8-10.8 10^3/ML

RBC4.39 4.2-5.4 10^6/ML

HEMOGLOBIN13.0 120-160 O2/DL

HEMATOCRIT38.4 37.0-47.0 %

PLATELET322 120-400 10^3/ML

MCV88 81-99 fl

MCH29.7 27.0-31.0 pg

MCH C33.9 33.0-37.0 g/dl

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

Client diet was “diet as tolereated with strict aspiration precautions.

XI. NURSING MANAGEMENT

ACTUAL CARE GIVEN

I was able to render nursing care which include vital signs taking every 4hours. I also follow-up her

intravenous fluid an able to time tape. I also done bedside care and always attending on whatever my

clients needs.

PROBLEMS ENCOUNTERED DURING IMPLEMENTATION OF NURSING CARE

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.

RESTORATIVE MEASURE USED

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

told so in recovering from her illness she experience.

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

you. Keep the area dry.

• 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

smaller, but confidence intervals overlap, suggesting compatibility.

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

to get high grades.

XIII. IMPLICATION OF THE STUDY TO:

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

knowledge, skills and positive attitude towards our work.

NURSING RESEARCH

This study I made , i considered it as a research because it show what are the common experienced

pregnant mother had.

 A
P
E
N
D
I
C
E
S
PERMIT LETTER

JANUARY 08,2010

MRS. MERCY MILAGROS B. APUHIN

Chairman, BSN level 3
University of Cebu- Banilad
College of Nursing
Banilad, Cebu City

Dear Mrs. Apuhin,

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.

I am hoping for your kind consideration.

Thank you very much.

Very respectfully,

Mr. Richard B. Tanuco

BSN 3C- A STUDENT

Noted By:

Ms. Louie Grace A. Miraflor, RN

Clinical instructor
CHH, 7B Station

Ms. Sharme Noelle Adormio, R.N

Adviser

Approved By:

Mrs. Mercy Milagros B. Apuhin

Chairman, BSN Level 3
UC-Banilad, College of nursing