Nursing Care Plan

Thyroid cancer is a disease in which malignant (cancer) cells form in the tissues of the thyroid gland.

The thyroid is a gland at the base of the throat near the trachea (windpipe). It is shaped like a butterfly, with a right lobe and a left lobe. The isthmus, a thin piece of tissue, connects the two lobes. A healthy thyroid is a little larger than a quarter. It usually cannot be felt through the skin. The thyroid uses iodine, a mineral found in some foods and in iodized salt, to help make several hormones. Thyroid hormones do the following:

• Control heart rate, body temperature, and how quickly food is changed into energy (metabolism).
• Control the amount of calcium in the blood.

There are four main types of thyroid cancer:

• Papillary thyroid cancer: The most common type of thyroid cancer.
• Follicular thyroid cancer. Hürthle cell carcinoma is a form of follicular thyroid cancer and is treated the same way.
• Medullary thyroid cancer.
• Anaplastic thyroid cancer.

Possible signs of thyroid cancer include a swelling or lump in the neck.

Thyroid cancer may not cause early symptoms. It is sometimes found during a routine physical exam. Symptoms may occur as the tumor gets bigger. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• A lump in the neck.
• Trouble breathing.
• Trouble swallowing.
• Hoarseness.

More :

Nursing Management for Thyroid Cancer: Preoperative, Intraoperative and Postoperative

Cataract


A cataract is a clouding of the lens in your eye. It affects your vision. Cataracts are very common in older people. By age 80, more than half of all people in the United States either have a cataract or have had cataract surgery.

Common symptoms are

• Blurry vision
• Colors that seem faded
• Glare
• Not being able to see well at night
• Double vision
• Frequent prescription changes in your eye wear

Cataracts usually develop slowly. New glasses, brighter lighting, anti-glare sunglasses or magnifying lenses can help at first. Surgery is also an option. It involves removing the cloudy lens and replacing it with an artificial lens. Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataracts.

NIH: National Eye Institute


Having cataracts is often compared to looking through a foggy windshield of a car or through the dirty lens of a camera. Cataracts may cause a variety of complaints and visual changes, including blurred vision, difficulty with glare (often with bright sun or automobile headlights while driving at night), dulled color vision, increased nearsightedness accompanied by frequent changes in eyeglass prescription, and occasionally double vision in one eye. Some people notice a phenomenon called "second sight" in which one's reading vision improves as a result of their increased nearsightedness from swelling of the cataract. A change in glasses may help initially once vision begins to change from cataracts; however, as cataracts continue to progress and opacify, vision becomes cloudy and stronger glasses or contact lenses will no longer improve sight.

Cataracts are usually gradual and usually not painful or associated with any eye redness or other symptoms unless they become extremely advanced. Rapid and/or painful changes in vision are suspicious for other eye diseases and should be evaluated by an eye-care professional.

To detect a cataract, the eye-care provider examines your lens. A comprehensive eye examination usually includes the following:

• Visual acuity test: An eye chart test is used to measure your reading and distance vision.
• Refraction: Your eye doctor should determine if glasses would improve your vision.
• Glare testing: Vision may be significantly altered in certain lighting conditions and normal in others; in these circumstances, your doctor may check your glare symptoms with a variety of different potential lighting sources.
• Potential acuity testing: This helps the ophthalmologist get an idea of what your vision would be like after removal of the cataract. Think of this as the eye's vision potential if the cataract was not present.
• Contrast sensitivity testing: This checks for your ability to differentiate different shades of gray, which is often this limited by cataracts.
• Tonometry: a standard test to measure fluid pressure inside the eye (Increased pressure may be a sign of glaucoma.)
• Pupil dilation: The pupil is enlarged with eye drops so that the ophthalmologist can further examine the lens and retina. This is important to determine if there are other conditions which may ultimately limit your vision besides cataracts.

Source : http://www.emedicinehealth.com/cataracts/page6_em.htm#Exams and Tests

1. Objective data: patient's eye's lens appears cloudy. Both pupils appear to look gray.

Subjective data: patients complaining blurred vision / dim and decreased visual acuity and glare, the patient is difficult to see at night.

Nausea

Nausea is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, preceded vomiting. A person can suffer nausea without vomiting. Some common causes of nausea are motion sickness, gastroenteritis (stomach infection) or food poisoning, side effects of many medications including cancer chemotherapy, or morning sickness in early pregnancy. Medications taken to prevent nausea are called antiemetics and include diphenhydramine, metoclopramide and ondansetron. Nausea may also be caused by stress and depression.


Vomiting

Symptomatic treatment may occur while the underlying illness is being investigated because ideally, nausea and vomiting should resolve when the cause of the symptoms resolves.

Nausea and vomiting are often made worse when the patient is dehydrated, resulting in a vicious cycle. The nausea makes it difficult to drink fluid, making the dehydration worse, which then increases the nausea. Intravenous fluids may be provided to correct this issue.

There are a variety of anti-nausea medications (antiemetics) that may be prescribed. They can be administered in different ways depending upon the patient's ability to take them. Medications are available by pill, liquid, or tablets that dissolve on or under the tongue, by intravenous or intramuscular injection, or by rectal suppository.

Common medications used to control nausea and vomiting include promethazine (Phenergan), prochlorperazine (Compazine), droperidol (Inapsine) metoclopramide (Reglan), and ondansetron (Zofran). The decision as to which medication to use will depend on the specific situation.
www.medicinenet.com

Purpose: devisit fluid and electrolyte resolved

Expected outcomes: The signs of dehydration do not exist, the mucosa of the mouth and lips moist, fluid balance.

Nursing Intervention:

• Observation of vital signs.
• Observation for signs of dehydration.
• Measure infut and output of fluid (fluid balance).
• Provide and encourage families to provide drinking a lot of approximately 2000 - 2500 cc per day.
• Collaboration with physicians in the provision of therafi fluid, electrolyte laboratory tests.
• Collaboration with a team of nutrition in low-sodium fluids.

Nursing Diagnosis: Risk for Fluid Volume Deficit related to a sense of nausea and vomiting

Purpose: Maintaining the balance of fluid volume.

Expected outcomes: The client does not nausea and vomiting.

Nursing Intervention:

• Monitor vital signs.
• Rational: This is an early indicator of hypovolemia.
• Monitor intake and urine output and concentration.
• Rationale: Decreased urine output and concentration will improve the sensitivity / sediment as one suggestive of dehydration and require increased fluids.
• Give fluid little by little but often.
• Rationale: To minimize loss of fluid.
• The risk of infection associated with an inadequate defense of the body, characterized by: body temperature above normal. Respiratory frequency increased.