Assessment

Subjective:
> 2 years PTA, the client
noticed an enlargement on
the right anterior portion of
her neck about 2cm in dm.
and did not go for
consultation nor take any
medication as reported.
> Expressed the need for
further information.
> Admits that her illness
was unexpected and
sudden.
> She believes it was
brought by lack of seafoods
in her diet.
> Describes herself as
healthy woman despite her
illness, with no major
changes in her physical
capacity/strength.
> Sedentary lifestyle as
reported.
Objectives:
> 37 year old, F/M
> high school graduate
> Lack of questions
> Obese
> increase BMI 30.0
> wt - 90 kg, ht - 1.50 m.
> waistline 45 inches
> s/p thyroidectomy, day 7
> speaks softly
> with pressure dressing on

Diagnosis
Knowledge
deficit (learning
need) regarding
disease process,
condition,
prognosis,
treatment, selfcare and
discharge needs.

Planning
Short Term Goal:
1. Patient and caregiver
verbalized
understanding of postoperative treatment and
care for postthyroidectomy.
2. Participate in
treatment regimen.
3. Participate in
learning process.
4. Exhibit increased
interest and assume
responsibility for own
learning by beginning
to look for information
and ask questions.
5. Verbalize
understanding of
condition and disease
process and treatment.
6. Identify relationship
of signs and symptoms
with causative factors.
Long Term Goal:
1. Self-esteem
enhancement.
2. Initiate necessary
lifestyle changes.
3. Identify
interferences to learning
and specific actions to
deal with them.
4. Perform necessary

Interventions / Rationale
Universal Self-care Requisites:
1. Activity and exercise therapy on strength
training, balance and muscle control with
promotion of body mechanics (Johnson et al.,
2007). Post-operative exercises to be instituted
after incision heals like flexion, extension,
rotation and lateral movement of head and neck.
Regular ROM exercises strengthen neck
muscles, enhance circulation and healing
process. Encourage progressive general exercise
program. Exercise can stimulate the thyroid
gland and production of hormones, facilitating
recovery of general well-being (Myers &
Gulanick, 2007; Doenges et al., 1997).
2. Instruct in incisional care like cleansing and
dressing application which enables patient to
provide competent self-care (Doenges et al.,
1997)
Developmental Self-care Requisites:
1. Discuss the possibility of change in voice.
Alteration in vocal cord function may cause
changes in pitch and quality of voice which may
be temporary or permanent (Doenges et al.,
1997).
2. Instruct the patient to avoid temperature
extremes. Exposure to hot and cold temperatures
promotes thyroid hyperplasia and increases the
thyroid levels, Avoid high environmental
temperatures (Myers & Gulanick, 2007).
Health-deviation Self-care Requisites:
1. Behavioral modification technique wherein
the patient will be guided to have a positive
outlook by undergoing the process of self-

Evaluation
> Discuss
understanding about
the disease, condition,
treatment, self-care
and needs.
> Participate in the
activities and nursing
interventions.
> Verbalize interest
and adherence to
regimen.
> Follow instructions
and interventions for a
particular condition or
s/sx.
> Positive outlook on
immediate recovery.
> Life-style and
behavioral changes.

anterior neck
> neck rigidity not noted
> with limited ROM of
neck
> NVE at 30o angle right
and left

procedures correctly
and explain reasons for
the actions.

discovery (Johnson et al., 2007; Laurente et al.,

1997).
2. Weight management program and Dietary
modification. Nutritional counseling and
management (Johnson et al., 2007). Discuss the
need for well-balanced, nutritious diet because it
promotes healing and helps patient to
regain/maintain appropriate weight. Use of
iodized salt is often sufficient to meet iodine
needs unless salt is restricted. Identify foods
high in calcium and vitamin D which maximizes
supply and absorption of calcium if parathyroid
function is impaired (Doenges et al., 1997).
Maintain a low-calorie diet. During the
hypothyroid period, the patient should reduce
caloric intake to prevent weight gain (Myers &
Gulanick, 2007). Recommend avoidance of
goitrogenic foods (thyroid-inhibiting substances)
which are contraindicated because these foods
inhibit thyroid activity (Myers & Gulanick,
2007, Doenges et al., 1997).