AGUSTIN, AIZEL

ALVAREZ, KHEENEY BAE

AMILHAMJA, FAUZI
SAHALI, JORGEE
SANAANI, NUR-HATHI
USMAN, YUSRHINA

RLE-IV

Biographic Data:

Name of the Patient Mrs H.F. Ward/ Room: Ward 4

Religion: Roman Catholic Attending Physician: Dr. J.G.

Age: 54 Admitting Papillary Thyroid Ca stage II (S/P

Diagnosis: FNAB)

Address: Lamitan City, Basilan Final Diagnosis: Not specified yet

Admission 2/12/22 @ 6:30 am Past Medical +laryngitis

Date/Time History:

History of Present Illness

SIDE NOTES DOCTOR’S ORDER SHEET C A R E D Time/Sign

Date/Time ORDERS

12/02/2021 Admit Patient to ward 4 for Initial Assessment / 6:30 AM Y.U

6:30 AM
 DIAGNOSTIC TESTS: / / 6:30 AM Y.U
- Chest X-ray
- Refer to IM for CP clearance

Monitor Vital signs q 1 hr / 6:30 AM Y.U

Instill D5LR 1L regulated at 20gtts/min; Left Metacarpal vein / / 6:35 AM Y.U

Diet as Tolerated /

For Total Thyroidectomy on 2/14/2022 / 6:40 AM A.A

Secure 2 units of PRBC, type and crossed match for OR use / / 6:40 AM A.A

Pre-op Orders:

14/2/2022 Cefazolin 2 gms IV 1 hr prior to OR / 6:00 AM A.A

6:00 AM

6:30 AM Initiate Initial dose of Tramal, 50 mg IVT 30 mins prior to OR

Metoclopramide 10 mg IV 30 mins prior to OR / 6:30 AM A.A

Monitor Vital signs q 1 hour

 Post Op Orders

14/2/2022 Blood transfusion 1 unit of PRBC type “O” at 25 gtt/min / 1:00 PM A.A
1:00 PM

IVF D5LR 1L regulated at 30gtts/min; Left Metacarpal vein / 1:00 PM A.A

Follow IVF with Plain NSS 1L regulated at 30 gtt/min / 1:00 PM A.A

NPO 1:00 PM A.A

Turn to side: high fowler's position / 1:00 AM C.R

Metoclopramide 10 mg IV every 8 hours for vomiting, / 1: 05 PM Y.U

Cefazolin 1 gm IV q 8 hours / 1: 05 PM Y.U

Nubain 10 mg IV q 4 hours x 5 doses / 1: 05 PM Y.U

Tranexamic Acid 500 mg IV q 8 hours / 1: 05 PM Y.U

Transfuse 2nd unit of blood to consume in 6 hours / 1:05 PM Y.U

For CBC, Ca, & Mg determination in AM / 1:10 PM Y.U

 Refer for Bleeding & any unusual S/Sx / 1:20 PM Y.U

OPERATING ROOM NOTIFICATION SLIP

Name of patient:Mrs H.F. Age:54 Sex:F Ward/Room No:Ward 4

Type of operation: Total Thyroidectomy________ DATE OF SURGERY :2/14/2022

__________________________ TIME OF SURGERY: 7:00 AM

Surgeon: Dr. Agustin Assistant Surgeon:( ) Dr. Usman

Resident( )Dr. Alvarez Resident:( ) Dr. Amilhamja
Anethesiologist:( )Dr. Sanaani Type of Anesthesia:General Anesthesia
Preoperative Diagnosis: Papillary Thyroid Ca stage II (S/P FNAB)
Infection Control Precaution: Standard Precaution______________________________________
(/ ) Clearance: _____________________ ( /) Consent ( /) OR Deposit:_______________________

( /) Cardiology: __________ SPECIAL REQUEST/S:

( ) Endocrine: __________
( ) Hematology: __________
( ) Nephrology: __________
( ) Pulmonary: __________
( ) Pediatric: ___________
( ) Neurology: ____________
Clinical Area: Operating Room:

________________________________ ________________________________
Name and Signature of Nurse Name and Signature of Nurse
________________________________ ________________________________
Name and Signature of HN/AHN/CN Name and Signature of HN/AHN/CN
 KARDEX

DOCTOR’S ORDER FOR PRE-OP IMPLEMENTATION: DOCTOR’S ORDER FOR POST-OP IMPLEMENTATION:

Please admit to ward 4 for initial assessment under the care of ● Transfer client to the surgical unit from PACU
Dr. Dr. J.G. ● Blood transfusion 1 unit of PRBC type “O” at 25 gtt/min
● Diagnostics: ● Start IVF D5LR 1L regulated at 30gtts/min; Left
○ Chest X-ray Metacarpal vein
○ Blood Typing and Cross Matching ● Follow IVF with Plain NSS 1L regulated at 30 gtt/min
○ Refer to IM for CP clearance ● Turn to side: high fowler's position
● Monitor Vital signs q 1 hr ● Continuation Meds:
● Instill D5LR 1L regulated at 20gtts/min; Left Metacarpal ○ Metoclopramide 10 mg IV every 8 hours for
vein vomiting
● Diet as Tolerated ○ Cefazolin 1 gm IV q 8 hours
● Secure OR slip for Total Thyroidectomy on 2/14/2022 ○ Nubain 10 mg IV q 4 hours x 5 doses
● Secure 2 units of PRBC, type and crossed match for OR ○ Tranexamic Acid 500 mg IV q 8 hours
use ● Transfuse 2nd unit of blood to consume in 6 hours
● Informed client to take nothing per orem 8 hours prior to ● For CBC, Ca, & Mg determination in AM
the procedure ● Refer for Bleeding & any unusual S/Sx
● Due medications:
○ Cefazolin 2 gms IV 1 hr prior to OR
○ Initiate Initial dose of Tramal, 50 mg IVT 30 mins
prior to OR
○ Metoclopramide 10 mg IV 30 mins prior to OR
 PATIENT KARDEX

NAME:Mrs H.F. AGE:54 SEX: Female CIVIL STATUS: Married

ADDRESS:Lamitan. RELIGION: Roman Catholic AP: Dr. J.G.
CHIEF COMPLAINT:Chronic pain and difficulty of breathing DIET: As tolerated
CLINICAL IMPRESSION:Papillary Thyroid Ca stage II (S/P FNAB) HOSPITAL NO.:15526
DATE OF ADMISSION: 2/12/22 @ 6:30 am DATE OF DISCHARGE:_____________

MEDICATION SPECIAL PROCEDURE/ENDORSEMENT:

Cefazolin 2 gms IV 1 hr prior to OR 13/02/2022

For Total Thyroidectomy on 2/14/2022 @ 7 AM
Initiate Initial dose of Tramal, 50 mg IVT 30 mins prior to OR
● Secured informed consent
Metoclopramide 10 mg IV 30 mins prior to OR
● Inform OR
Post-Operative Medication:
● Metoclopramide 10 mg IV every 8 hours for vomiting ● Inform Surgeon, Asst. Surgeon, Anesthesiologist
● Cefazolin 1 gm IV q 8 hours
● Nubain 10 mg IV q 4 hours x 5 doses ● Advise NPO
● Tranexamic Acid 500 mg IV q 8 hours
Chest X-ray - referred

Blood Typing and Cross Matching - referred

IV FLUIDS &/or SIDE DRIP/ SLD TRANS
Refer to IM for CP clearance - referred
D5LR 1L x 20 gtts/min; Left Metacarpal vein - complete 12/2/22

Blood transfusion 1 unit of PRBC type “O” at 25 gtt/min-ongoing

IVF D5LR 1L regulated at 30gtts/min; Left Metacarpal vein - 14/2/2022- Post-op Orders
ongoing
● V/S hourly
Follow IVF with Plain NSS 1L regulated at 30 gtt/min- start @
9:05 PM 14/2/22
Blood transfusion 1 unit of PRBC type “O” at 25 gtt/min
● Turn to sides; high fowler's q2
● Transfuse 2nd unit of PRBC type “o” to be consumed
within 6 hours
● Nothing per Orem
● Refer for any bleeding and any unusual s/sx
● CBC, Ca, and Mg determination in AM-with request
 MEDICATION SHEET
Name: Mrs. HF Age: 54
Attending Physician:Dr. J.G. Room no:______

Date Hours
Medication, Frequency, Route Date & Initial

14 15 16

02/12 Cefazolin 2 gms IV 1 hr prior to OR 6: 00 AM YU

ANST (-)

Tramal 50mg IV 30 min prior to OR 6: 30 AM YU

Metoclopramide 10mg 6: 30 AM YU

IV 30 min prior to OR

Post-Operative Medication:

02/14 Cefazolin 1 gm IV q 8 hrs ANST (-) 4

12 YU

Nubain 10 mg IV q 4 hours x 5 doses 12 – 4 YU

4 – 5 YU

8 –

12 1 AA Completed
15/02/2020

4 2 AA

8 3 YU

Metoclopramide 10mg IV q 8 hrs 4 - YU

 12 YU

8 AA

Tranexamic Acid 500 mg IV q 8 hrs 4 - YU

12 YU

8 AA

RN (PRINT NAME) SIGNATURE RN (PRINT NAME) SIGNATURE

YUSRHINA USMAN YU

AIZEL AGUSTIN AA
 Ward 4
MEDICATION CARD

Mrs. HF
Last name, First Name

Cefazolin 2 gms
Name of Drug & Dosage

IV 1 hr prior to OR
Route & Frequency

KA
February 12, 2022 Kheeney Alvarez
Date Signature Over Printed Name

Ward 4
MEDICATION CARD

Mrs. HF
Last name, First Name

Tramal 50mg
Name of Drug & Dosage

IV 30 min prior to OR
Route & Frequency

KA
February 12, 2022 Kheeney Alvarez
Date Signature Over Printed Name

Ward 4
MEDICATION CARD
 Mrs. HF
Last name, First Name

Metoclopramide 10mg
Name of Drug & Dosage

IV 30 min prior to OR
Route & Frequency

KA
February 12, 2022 Kheeney Alvarez
Date Signature Over Printed Name

Ward 4
MEDICATION CARD

Mrs. HF
Last name, First Name

Cefazolin 1 gm
Name of Drug & Dosage

IV q 8 hrs
Route & Frequency

KA
February 14, 2022 Kheeney Alvarez
Date Signature Over Printed Name
 Ward 4
MEDICATION CARD

Mrs. HF
1 Last name, First Name

2 Nubain 10 mg
Name of Drug & Dosage
3

4 IV q 4 hours x 5 doses
Route & Frequency
5

KA
February 14, 2022 Kheeney Alvarez
Date Signature Over Printed Name

Ward 4
MEDICATION CARD

Mrs. HF
Last name, First Name

Metoclopramide 10mg
Name of Drug & Dosage

IV q 8 hrs
Route & Frequency

KA
February 14, 2022 Kheeney Alvarez
Date Signature Over Printed Name
 Ward 4
MEDICATION CARD

Mrs. HF
Last name, First Name

Tranexamic Acid 500 mg

Name of Drug & Dosage

IV q 8 hrs
Route & Frequency

KA
February 14, 2022 Kheeney Alvarez
Date Signature Over Printed Name
 INTRAVENOUS FLUID SHEET
Name: Mrs. H.F. Age: 54
Attending Physician: Dr.J.G Room no155

Bottl Type of Volume Date & Time Signature Rate of Date & Time Signature
e Solution,Drug in CC Started/Initi Flow Ended/
No. Incorporated al Initial
and others

1 Dextrose 5% in 1000 cc February 12, YU 20 February 12, AA

Lactated 2022 @ gtts/min 2022 @
Ringer’s 6:00 am 6:00 pm

Post Operative fluids

2 Dextrose 5% in 1000 cc February 14, YU 30 February 14, AA

Lactated 2022 @ gtts/min 2022 @
Ringer’s 1:05 pm 9:05 pm

PRBC type “O 500 cc From OR- 25 February 14, AA

(-)” serial no. February 14 gtts/min 2022 @
2312454 2022 6:05 pm

3 0.9% Sodium 1000 cc February 14, AA 30 February 15, YU

Chloride 2022 @ gtts/min 2022 @
9:05 pm 5:05 am

PRBC type “O 500 cc February 14, AA 25 February 14, YU

(-)” serial no. 2022 @ gtts/min 2022 @
78989 6:05 pm 12:05 amm

RN (PRINT NAME) SIGNATURE RN (PRINT NAME) SIGNATURE

YUSRHINA USMAN YU

AIZEL AGUSTIN AA

IV TAG

DATE: 02/12/2022______
NAME: H. F.
WARD:ER___________________________
NAME OF FLUID:Dextrose 5% in Lactated Ringer’s 1000 cc @ 20 gtt/min___
DATE/TIME STARTED:____6: 00 am_______ AM/PM
DATE/TIME CONSUME:_ 6:00 pm_____ AM/PM
REMARKS:_@LMCV________________________________________________________YU
Signature:Yusrhina Usman

IV TAG

DATE: 02/14/2022______
NAME: H. F.
WARD:Surgical___________________________
NAME OF FLUID:Dextrose 5% in Lactated Ringer’s 1000 cc @ 30 gtt/min___
DATE/TIME STARTED:____1: 05 pm_______ AM/PM
DATE/TIME CONSUME:_ 9:05 pm_____ AM/PM
REMARKS:_@LMCV________________________________________________________YU
Signature:Yusrhina Usman

IV TAG
 DATE: 02/14/2022_______
NAME: H.F.
WARD:Surgical_________________________
NAME OF FLUID:Plain Normal Saline 1000 cc @ 30 gtt/min___
DATE/TIME STARTED:_____9:05 pm_______ AM/PM
DATE/TIME CONSUME:__ 5:05 am____ AM/PM
REMARKS:@LMCV____________________________________________________________YU
Signature:Yusrhina Usman
 PRE-OPERATIVE

● Usman, Augustin, Alvarez

Doctor’s Order Sheet

SIDE NOTES DOCTOR’S ORDER SHEET C A R E D Time/Sign

Date/Time ORDERS

Admit Patient to ward 4 for Initial Assessment / 8:35 AM A.A

DIAGNOSTIC TESTS: / / 8:40 AM Y.U

- Chest X-ray
- Blood Typing and Cross Matching
- Refer to IM for CP clearance

Monitor Vital signs q 1 hr / 8:55 AM Y.U

Instill D5LR 1L regulated at 20gtts/min; Left / / 9:00 AM Y.U

Metacarpal vein

Diet as Tolerated /

13/2/2022 Secure OR slip for Total Thyroidectomy on / / 9:40 AM A.A

9:40 PM 2/14/2022

Secure 2 units of PRBC, type and crossed match / /

for OR use
 Informed client to take nothing per orem 8 hours /
prior to the procedure

Cefazolin 2 grams IV 1 hr prior to OR / 9:45 AM A.A

14/2/2022 Initiate Initial dose of Tramal, 50 mg IVT 30 mins

6:00 AM prior to OR

Metoclopramide 10 mg IV 30 mins prior to OR / 9:55 AM A.A

14/2/2022 Transfer client to the ward to OR / 12:00 PM A.A

1:00 PM

24 HOUR INTAKE & OUTPUT RECORD

Name: Mrs H.F. Age: 54 Hospital No. :
Attending Physician: Dr. J.G. Ward: 4 Bed No.:

INTAKE OUTPUT
Date: 12/02/2021
SHIFT ORAL NGT OTHERS 8 HRS SHIFT URINE OTHERS 8 HRS SIGN
TOTAL TOTAL

7-3 750 mL N/A 640mL 1390 mL 7-3 780 mL 640 mL 1420 mL KA

(IVF) (CTT)

3-11 3-11

11-7 11-7
 24 HRS 24 HRS
TOTAL TOTAL

Date:13/2/2022
SHIFT ORAL NGT OTHERS 8 HRS SHIFT URINE OTHERS 8 HRS SIGN
TOTAL TOTAL

7-3 7-3

3-11 3-11

11-7 11-7

24 HRS 24 HRS
TOTAL TOTAL

Date:14/2/2022
SHIFT ORAL NGT OTHERS 8 HRS SHIFT URINE OTHERS 8 HRS SIGN
TOTAL TOTAL

7-3 7-3

3-11 3-11

11-7 11-7

24 HRS 24 HRS
TOTAL TOTAL

Date:
SHIFT ORAL NGT OTHERS 8 HRS SHIFT URINE OTHERS 8 HRS SIGN
TOTAL TOTAL
 7-3 7-3

3-11 3-11

11-7 11-7

24 HRS 24 HRS
TOTAL TOTAL

VITAL SIGNS MONITORING CHART

Name: Mrs. H.F Age: 54 Sex: Female

Hospital record No: 0 Ward: 4

Date & Time BP PR RR Temp O2 sat Remarks

12/2/2022 SIGNED
12:00 PM 100/80mmHg 110bpm 25bpm 36.9 96% WARD NOD

2:30pm 120/80mmHg 100bpm 23bpm 36.5 96% SIGNED

WARD NOD
DATE/TIME FOCUS DATA, ACTION, RESPONSE

02/12/2022 Received patient awake, conscious, lying on bed, side rails up and
11 PM- 7 AM shift locked, with IV fluid of D5LR 1L regulated at 20gtts/min @ Left
MCV.

6:15 AM Admission to ward 4 D: With written order for admission to ward 4 under the care of
Dr.J.G—------------------------------------------------------------------------AA
6:25 AM A: Assessed patient’s condition, vital signs taken and recorded.
Examined if informed consent has been given.----------------------AA
6:30 AM R: Patient is admitted to the ward. Referred chest X-ray, blood
typing, cross matching to Dr. J.G. Referred to IM for CP.
clearance—--------------------------------------------------------------------AA

Endorsed to next NOD.

Aizel Agustin, SN Eleanor Manuel, RN Staff:

DATE/TIME FOCUS DATA, ACTION, RESPONSE

02/13/2022 Received patient awake, restless, lying on her bed, side rails up
7 AM - 3PM shift and locked, complaining of pain on her neck.

9:00 AM Pain D: “Sobrang sakit ng lalamunan ko (My throat really hurts),” as

verbalized.---------------------------------------------------------------------YU
9:15 AM A: Provided non pharmacological comfort measures such as
massage and repositioning. Placed in semi-fowler’s position and
9:30 AM supported head and neck in neutral position with small pillows.-YU
A:Provided cutaneous stimulation, such as heat and cold packs to
decrease inflammation. Encouraged use of stress management
skills and relaxation techniques. —-------------------------------------YU
11:30 AM R: Reports maximal pain relief.-------------------------------------------YU

Endorsed to next NOD.

Yusrhina Usman, SN Eleanor Manuel, RN Staff:
DATE/TIME FOCUS DATA, ACTION, RESPONSE

3 PM - 11 PM shift Received patient awake, restless, pacing back and forth beside
her bed.

D: With written order of total thyroidectomy by Dr. Agustin.------AA.

3: 00 PM For Total Thyroidectomy
3:30 PM A: Secured OR slip for Total Thyroidectomy on 2/14/2022.
Informed OR. Informed surgeon and Assistant Surgeon. Explained
her need to be on NPO status 8 hours prior to procedure
—-------------------------------------------------------------------AA
4:00 PM R: OR ready for total thyroidectomy. -----------------------------------AA

4:30 PM For PRBC, type and crossed D: With written order of pre work up laboratory test by Dr.
match Agustin.-------------------------------------------------------------------------AA
4:45 PM A: Assess patients blood type. Referred to the blood bank and
5:30 PM
request form.--------------------------------------------AA
6:00 PM A: Secured 2 units of PRBC, type and crossed match for OR
use.------------------------------------------------------------------------------AA
R: Blood products ready for OR use. -----------------------------------AA

8: 00 PM Anxiety D: “Natatakot ako baka kung anong mangyari sa akin bukas

habang inooperahan ako (I feel afraid for what might happen to
me during the operation tomorrow),” as verbalized.-----------------AA
A: Encouraged to share thoughts and feelings. Provided an open
8:30 PM
environment in which the client feels safe to discuss feelings.
Provided accurate, consistent information regarding diagnosis and
operation for tomorrow.-----------------------------------------------------AA
9:30 PM R: Displayed appropriate range of feelings and lessened fear.
Appear relaxed and reported anxiety reduced to a manageable
level.-----------------------------------------------------------------------------AA

Endorsed to next NOD.

Aizel Agustin, SN Eleanor Manuel, RN Staff:
 POST-OPERATIVE

● Sahali, Sanaani

POST OPERATIVE

SIDE NOTES DOCTOR’S ORDER SHEET C A R E D Time/Sign

14/2/2022 Transfer client to the surgical unit from PACU / 12:00 PM A.A
1:00 PM

Monitor Vital signs q 1 hour

Blood transfusion 1 unit of PRBC type “O” at 25 gtt/min / 1:00 PM A.A

IVF D5LR 1L regulated at 30gtts/min; Left Metacarpal vein / 1:00 PM A.A

Follow IVF with Plain NSS 1L regulated at 30 gtt/min / 1:00 PM A.A

Turn to side: high fowler's position / 8:30 AM C.R

Metoclopramide 10 mg IV every 8 hours for vomiting, / 4: 00 PM Y.U

Cefazolin 1 gm IV q 8 hours / 4: 00 PM Y.U

 Nubain 10 mg IV q 4 hours x 5 doses / 4: 00 PM Y.U

Tranexamic Acid 500 mg IV q 8 hours / 4: 00 PM Y.U

Transfuse 2nd unit of blood to consume in 6 hours / 8:20 AM Y.U

For CBC, Ca, & Mg determination in AM /

Refer for Bleeding & any unusual S/Sx /

VITAL SIGNS MONITORING CHART

Name: Mrs. H.F Age: 54 Sex: Female

Hospital record No: 0 Ward: 4

Date & Time BP PR RR Temp O2 sat Remarks

14/2/2022 SIGNED
12:00 PM 120/80mmHg 110bpm 25bpm 36.9 96% WARD NOD

2:30pm 100/80mmHg 100bpm 23bpm 36.5 96% SIGNED

WARD NOD
DATE/TIME FOCUS DATA, ACTION, RESPONSE

14/02/2022 Acute Pain Received patient awake, conscious, lying on bed side rails up
and locked with IVF D5LR 1L regulated at 30gtts/min; Left
Metacarpal vein and 1 unit of blood bag of PRBC type “O” at 25
gtt/min.

1:30 PM D: Verbalized “medyo namamaga po at nananakit yung aking

leeg at lalamunan nurse. Pain scale of 5 with narrowed focus;
guarding behavior; restlessness with facial grimace. Post-total
thyroidectomy.

1:35 PM A: Assessed verbal and nonverbal reports of pain, noting

location, intensity (0–10 scale), and duration; Placed in semi-
Fowler’s position and supported head and neck with sandbags
or small pillows; Maintained head and neck in a neutral position
and support during position changes; Instructed to use hands to
support the neck during movement and to avoid hyperextension
of the neck; Kept call bell and frequently needed items within
easy reach.---------------------------------------------N.S
1:45 PM A: Gave cool liquids or soft foods, such as ice cream or
popsicles; Provided ice collar.-------------------------------------N.S

3:00 PM R: Reported relief or control of pain; demonstrated the use of

relaxation skills and diversional activities appropriate to the
situation.------------------------------------------------------------------NS

Endorsed to the next NOD.---------------------------------------- NS

Nur Sanaani, SN/Eleanor Manuel, RN/Staff Nurse

DATE/TIME FOCUS DATA, ACTION, RESPONSE

14/02/2022
3-11 shift
4:00 PM Risk for Ineffective Airway D: “Di pa rin ako makalunok ng maayos at nakakaramdam pa
Clearance rin po ako ng kaunting sakit sa leeg.”, as verbalized by the
patient; No evidence of total impaired verbal communication;
RR: 24 bpm, PR: 96 bpm and O2 sat is 96%.------------------- JSS

5:00 PM A: Assessed respiratory rate, depth, work of breathing and gag

reflex; Auscultated breath sounds and was monitored for
presence of rhonchi; Dressings were checked frequently;
Assisted with repositioning, deep breathing exercises, and
coughing as indicated; Educated to avoid bending neck and to
support the head with pillows; call button was placed near to
patient.------------------------------------------------------------ JSS
5:20 PM
A: Suctioned mouth and trachea as indicated by the attending
5:30 PM physician; color and characteristics of sputum was noted.
Instructed to report difficulty swallowing and monitored for
drooling of oral secretions. —--------------------------------------- JSS
7:00 PM
R: Risk for impaired airway clearance was prevented; Reported
a sense of comfort, and have slept without the presence of pain;
RR: 20 bpm, PR: 85 bpm, and O2 Sat: 98%. —--------------- JSS

Jorgee Sahali, SN/Eleanor Manuel, RN/Staff Nurse

 Nursing Care Plan

Assessment Nursing Outcomes Intervention Rationale Implementation Evaluation

Diagnosis

S: Patient Acute pain After the 8 Monitor patient’s This creates Monitored the After the 8 hours
reports of pain related to hours shift and vital signs, baseline patient’s vital signs, shift and nursing
as verbalized mechanical nursing especially noting information for especially noting interventions,
“medyo trauma to interventions, parameters of patient condition parameters of
and helps plan for
namamaga at the tissues the patient is respiratory respiratory function Goals Met:
effective care.
na-nanakit yung secondary to expected to: function such as such as depth, Patient reported
aking lalamunan surgery depth, rhythm, and rhythm, and rate. relief or
nurse”. ● Report rate. decreased
relief or intensity of pain
O: Patient went decreased Assess the Determining the Assessed patient’s as verbalized
on a total intensity of patient's exact perception of perception of pain, “Miss nurse,
thyroidectomy. pain perception of pain, the patient on pain noting how he medyo okay na
Presented ● Manifest noting how he sensation helps the determines it po yung aking
restlessness ability to determines it nurse plan for according to scale. lalamunan, hindi
effective care for
and irritability, use according to scale Assessed for the na siya gaano
the patient.
and guarding diversionar (with 0 indicating PQRST of pain. ka sakit”
behavior y no pain and 10 to
towards the measures denote Goals Met:
operative site. to help excruciating pain). Demonstrated
Has a narrowed decrease Also, assess for and perform the
focus pain the PQRST of use diversionary
perception pain. measures to
HR: 120 help decrease
RR: 29 Position the Placing the head Positioned the pain perception
and neck in Semi-
BP: 130/90 patient in a Semi- patient in a Semi-
Fowler’s position
mmHg Fowler’s position, Fowler’s position,
Pain Scale: 8/10 ensuring the head prevents ensuring the head
and neck are hyperextension of and neck are
supported with the neck and supported with
sandbags. relieves pressure sandbags.
on the suture line.
The sandbags at
each side of the
neck help keep the
head and neck in
the midline
position.

Teach patient how This action Taught patient how

to support the prevents additional to support the head
strain on the suture
head and the neck and the neck during
line, decreasing
during movements,
pain perception
movements, while allowing the placing the hands
placing the hands patient mobility on behind the neck
behind the neck the head and neck. and slowly moving
and slowly moving when needed.
when needed.

Provide the patient Cooled liquids may Provided the

with cool liquids be soothing to the patient with cool
throat and neck
such as juices or liquids such as
while also allowing
popsicles. Ice juices or popsicles.
the patient to
cream and sorbet swallow easier. Ice cream and
may also be given. sorbet may also be
given.
If the patient is
allowed to have
oral feeding, he Mashed or Provided the
may also be softened foods also patient with
provided with help decrease the softened or mashed
softened or risk of aspiration for foods if allowed to
patients who were
mashed foods. have oral feeding.
just cleared to take
oral feedings.
Encourage the
patient to explore Encouraged the
non- These activities patient to explore
pharmacologic help shift away non-pharmacologic
measures to divert from the focus of measures to divert
attention away the patient from the attention away from
from pain pain and into pain perception.
perception. something else. Instructed with
When used prior to
Techniques such different
the peak of pain
as guided techniques.
perception, these
imagery, soft measures also can
music, and use of decrease the
progressive overall pain scale
relaxation may be rating.
used for this aim.

Prepare to
administer/provide NOTE: For patients
with ice collars,
the patient with an
ensure that proper
ice collar if Administered the
site assessment is
necessary. done while patient with an ice
applying the collar collar.
to prevent skin
breakdown.
 Nursing Care Plan

Assessment Nursing Outcome Intervention Rationale Implementation Evaluation

Diagnosis

S: “Di pa rin Risk for After the 8 hours Assess Respirations may Respiratory rate After the 8 hours shift
ako makalunok Impaired shift and nursing respiratory rate, remain somewhat was taken and and nursing
ng maayos sa Airway interventions, the rapid, but the depth and work of interventions,
depth, and work development of
tuwing Clearance patient is expected breathing was
of breathing respiratory distress is
kumakain ako,” to: observed. Goal met: Patient
indicative of tracheal
as verbalized compression from maintained a patent
by the patient. ● Maintain edema or airway.
clear and hemorrhage
O: open Auscultate Auscultation on the Goal met: Aspiration
- No evidence airways breath sounds Rhonchi may indicate chest was done. was prevented.
of total ● Prevent and was airway obstruction
Impaired verbal aspiration and accumulation of Goal partially met:
monitored for copious thick
communication Patient demonstrated
presence of secretions. ability to swallow.
rhonchi
RR: 20 bpm
Check the If there is bleeding, Dressing of the PR: 85 bpm
RR: 28 bpm, dressing the anterior dressing patient was O2 Sat: 98%
PR: 96 bpm frequently. may appear dry checked frequently
O2 sat: 96% because blood pools and changed daily.
dependently.

Assist with Repositioned

repositioning, Maintains clear client, assisted in
airway and doing deep
deep breathing
ventilation. Although
exercises, and breathing
“routine” coughing is
coughing as not encouraged and exercises and
coughing
indicated may be painful, it may
be needed to clear
secretions.
Educate to
The patient's head
avoid bending
was placed with
neck and to Reduces the
likelihood of tension pillows and was
support the instructed to not
on the surgical
head with wound. bend the neck
pillows

Side rails were Side rails of the

For protection and patient was raised
raised and a call security of the patient, and there's a call
button was so that the patient button placed near
placed near the won't fall. Call button
the patient's bed
is for emergency
patient.
purposes.

Suction mouth Patient's mouth

and trachea as Edema and pain may was suctioned as
indicated by the impair the patient’s indicated by the
attending ability to clear own physician.
airway.
physician.

Instruct to report Patient was

difficulty Difficulty swallowing instructed to tell
swallowing and and drooling of oral the nurse on duty if
monitored for secretions may she’s experiencing
drooling of oral indicate edema or any difficulty in
secretion. sequestered bleeding swallowing and
in tissues surrounding drooling of any oral
the operative site secretions
 a. mL, 1000mg/100m
MEDICAL CARD FOLLOW UP CARD
Patient Name: Mrs.H.F
Address:Lamitan Age: 54 Sex: F
Date of Admission:2/12/22 @ 6:30 am Date of Discharge:
Diagnosis: Papillary Thyroid Ca stage II (S/P FNAB)

Procedure and Treatment:Total thyroidectomy

FOLLOW UP INSTRUCTIONS:
A. HOME MEDICATION

Medicines Breakfast Lunch Dinner Bed Time Remarks

Before After Before After Before After Before After

citracal calcium (Calcium i Drink with a full glass of water

and vitamin D
supplement) calcium
citrate 650 mg with 1000
IU vitamin D3 PO OD

Synthroid / Drink with a full glass of water

(Levothyroxine) 25 mcg
OD

B. Patient Education:
● Be sure to take plenty of liquids with your medications, as they may cause constipation.
● Do not crush, chew, or break an extended-release tablet. Swallow it whole.
C. Fatigue
 a. You can expect to feel very tired for the first week after surgery, it is recommended to take 3-7 days off of work to
recover.
D. Diet
● Eat a bland light meal or a liquid diet on the first day after surgery. Increase your regular diet as tolerated.
● Make sure you eat a healthy, balanced diet and exercise regularly
● Make sure to drink at least 2000mL of water daily
E. Incision Care
a. Keep the incision site clean and dry.
b. Do not scrub your incision when cleaning.
c. Do not soak your incision in a tub or in a pool, as this may introduce infection.
F. Other Special Home Instructions
● Avoid tasks that require alertness and motor skills
● Monitor diet and exercise to prevent excessive weight gain
● Stay at home
G. Pain
a. You may apply a cold pack over your incision to relieve any pain and help minimize swelling
b. You may take NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), naproxen (Naprosyn,
Aleve), or acetaminophen (Tylenol) when pain is intolerable with non-pharmacologic measures.

Follow up Date & Time: Visit Facebook Page of the Department of Ward 4 of Zamboanga City Medical Center. Go to Messenger for
private messages and further inquiries.

Physician Name: Dr. J.G.

b.
 NURSING SKILLS OUTPUT
(Blood Transfusion)
ILLUSTRATIONS:

PATIENT’S PURPOSE MATERIALS/ STEPS RATIONALE NURSING

PREPARATION EQUIPMENT RESPONSIBILITIES
NEEDED

-To prepare for a -To increase circulating IV access - Blood Before Transfusion Before Transfusion: Verify doctor’s order.
non emergency blood volume after components may be a.Find current type and a.The goal of blood Inform the client and
blood transfusion, surgery, trauma, or provided through a crossmatch typing and explain the purpose of the
maintain normal hemorrhage number of central crossmatching is to find procedure.
diet and activities a compatible blood
venous access devices b.Obtain informed
before the type for transfusion. Check for cross matching
-To increase the (CVAD) or peripheral consent and health
procedure. Most The results of blood and typing. To ensure
number of RBCs and to intravenous catheters. history typing will tell you if you compatibility
nonemergency You might want to
maintain hemoglobin are type A, B, AB, or O
transfusions are consider the below sizes. c.Obtain large IV bore
levels in clients with and if you are Rh Obtain and record baseline
done in an access negative or positive. vital signs
severe anemia.
outpatient clinic. The results will tell your
20-22 gauge for routine
Check with your healthcare provider Practice strict asepsis
-To provide selected transfusions in adults. d.Assemble supplies
doctor to see how what blood or blood
much time to set cellular components as 16-18 gauge for rapid
components will be Warm blood at room
replacements therapy transfusions in adults. e.Obtain vital signs
aside for the safe to give you. temperature before
procedure. The (e.g. clotting factors, 22-25 gauge for transfusion to prevent
procedure lasts at platelets, albumin) pediatrics. f.Obtain blood from b.To understand the chills.
least an hour, and blood bank state of health of the
can last up to four Administration sets - patient further Identify the client properly.
hours. The requirements for
Initiating the c.Catheters larger in Monitor vital signs. Altered
these sets might vary.
-Before a blood diameter and shorter in vital signs indicate adverse
Check the facility-specific Transfusion
transfusion, a length will give us reaction
policy first. a.Verify Blood product
higher flow rates and
technician tests the
are more desirable. Do not mix medications
patient’s blood to Sets for blood b.Educate the patient d.The patient's vital with blood transfusion to
find out what blood components - signs (temperature, prevent adverse effects.
type they have (that Administering blood pulse, respirations, and Do not incorporate
c.Assess and
is A, B, AB or O and components requires the blood pressure) should medication into the blood
document the patient’s
Rh positive or be recorded shortly transfusion. Do not use
use of a blood filter, status
negative). before transfusion and blood transfusion lines for
which may range in pore
after the first 15 IV push of medication.
size from 170 to 260 d.Start the blood minutes, and compared
microns. It’s intended to transfusion to baseline values. Administer 0.9% NaCl
remove clots, cellular before; during or after BT.
debris, and coagulated During Transfusion Initiating the Never administer IV fluids
protein. Transfusion with dextrose. Dextrose
a.Look for any
transfusion reaction a.identity check based IV fluids cause
Sets for PPPs - between patient and hemolysis.
blood component is the
The administration of b.If reaction is crucial final opportunity Observe potential
platelet-poor plasmas suspected, to avoid potentially fatal complications. Notify the
(PPPs) may require a Stop the transfusion mistransfusion. physician.
number of supplies, immediately
which often differ by b.Education helps Document and record
product and brand. c.Disconnect the blood patients make informed accurately
Facilities should refer to tubing from the patient decisions. Ensuring
the product monograph informed decision-
and local policy to d.Stay with the patient making relies heavily
determine what filtration and assess their status on patient education.
is required. When patients are
e.Continue to check for
more knowledgeable
status changes every
about their care and
Infusion devices - five minutes
potential treatment
Infusion devices can be options, they are better
used to transfuse blood f.Notify the doctor and able to identify how
components (i.e. infusion blood bank they do or do not want
pumps, rapid infusers, to receive their
blood warmers, and g.Prepare for further healthcare.
pressure devices). doctor’s orders
c.The vital signs
 (temperature, blood
Pressure infusion h.Document everything pressure, and heart
rate) are checked
devices -
before, during, and
A pressure infusion After Transfusion after the transfusion.
device may be used for a.Flush Y tubing with
the rapid administration normal saline During Transfusion
of blood components. a. There are possible
b.Dispose of Y tubing signs of an allergic or
Blood warmer devices - in a red biohazard bin other type of reaction,
including rash, fever,
A blood warmer device
c.Obtain post- headache, or swelling.
is often used to prevent
transfusion vital signs
hypothermia during and document patient b.Giving contaminated
rapid administration of status blood to a recipient can
cold-blood components, lead to infection, shock,
such as the operating and death. A
room or a trauma transfusion reaction
setting. can also occur if a
person receives too
much blood. This is
known as transfusion-
associated circulatory
overload

c.Lookout for
manifesting
complications

d.Any adverse reaction

to the transfusion of
blood or blood products
should be reported to
the patient's treating
doctor and to the
hospital blood bank as
 soon as possible.
Speed is essential
because of the possible
life-threatening nature
of acute transfusion
reactions.

After Transfusion
a. Standard practice at
many hospitals to
follow blood component
transfusions with a
normal saline (0.9%
NaCl) flush. This
serves the dual
purpose of
administering to the
patient any residual
blood left in the
administration set (up
to 40 mL), and it
flushes the line for later
use.

b.After the procedure,

patients may
experience some
soreness near the
puncture site, but this
side effect should
dissipate quickly. In
addition, the patient’s
doctor might request a
checkup after the
transfusion.
References:
https://nurseslabs.com/blood-transfusion-therapy-nursing-management/
 Total Thyroidectomy
PREOPERATIVE

Definition
The scope of activities during the preoperative phase in a Total Thyroidectomy includes the establishment of the patient’s
baseline assessment in the clinical setting or at home, carrying out preoperative interviews and preparing the patient for the
anesthetic to be given and the surgery.

Goal
While the physician is responsible for discussing the surgical procedure to the patient, the patient may have questions about
the surgery answered by the nurse. There may be unique surgical learning requirements that the patient and support persons should
be aware of. A nursing care plan should be implemented, as well as a teaching plan. This phase emphasizes the following:

● Assessing and correcting physiological and psychological problems that may increase surgical risk.
● Giving the patient and significant others complete learning and teaching guidelines regarding the surgery.
● Instructing and demonstrating exercises that will benefit the patient postoperatively.
● Planning for discharge and any projected changes in lifestyle due to the surgery.

Physiologic Assessment Managing Nutrition and Fluids

The following are the physiologic assessments necessary during
the preoperative phase:
● Age
● Health history and perform a physical examination for
the database and future comparisons.
● Assess the patient's usual level of functioning.
● Assess mouth for dental caries, dentures, and partial
● Provide nutritional support as ordered to correct any
nutrient deficiency before surgery to provide enough
protein for tissue repair.
● Instruct patients that oral intake of food or water should
be withheld 8 to 10 hours before the operation (most
common), unless the physician allows clear fluids up to 3
to 4 hours before surgery.
● Inform patients that a light meal may be permitted on the
 plates that may become dislodged during intubation for preceding evening when surgery is scheduled in the
anesthetic delivery and occlude the airway. morning, or provide a soft breakfast, if prescribed, when
● Nutritional status and needs surgery is scheduled to take place after noon and does
● Fluid and Electrolyte Imbalance Infection not involve any part of the GI tract.
● Drug and alcohol use
● Respiratory status
● Cardiovascular status
● Hepatic and renal function
● Presence of trauma
● Endocrine function
● Immunologic function
● Previous medication therapy
● Adrenal corticosteroids

Psychological Assessment Psychological Nursing Interventions

Psychological nursing assessment during the preoperative ● Explore the client’s fears, worries and concerns.
period: ● Encourage patient verbalization of feelings.
● Fear of the unknown ● Provide information that helps to allay fears and
● Fear of death concerns of the patient.
● Fear of anesthesia ● Give empathetic support.
● Concerns about loss of work, time, job and support from
the family
● Concerns on threat of permanent incapacity
● Spiritual beliefs
● Cultural values and beliefs
● Fear of pain

Informed consent
● Reinforce information provided by the surgeon.
 ● Notify the physician if a patient needs additional information to make his or her decision.
● Ascertain that the consent form has been signed before administering psychoactive premedication. Informed consent is
required for invasive procedures, such as incisional, biopsy, cystoscopy, or paracentesis; procedures requiring sedation
and/or anesthesia; nonsurgical procedures that pose more than slight risk to the patient (arteriography); and procedures
involving radiation.
● Arrange for a responsible family member or legal guardian to be available to give consent when the patient is a minor or is
unconscious or incompetent (an emancipated minor [married or independently earning own living] may sign his or her own
surgical consent form).
● Place the signed consent form in a prominent place on the patient’s chart.

An informed consent is necessary to be signed by the patient before the surgery. The following are the purposes of an
informed consent:

● Protects the patient against unsanctioned surgery.

● Protects the surgeon and hospital against legal action by a client who claims that an unauthorized procedure was performed.
● To ensure that the client understands the nature of his or her treatment including the possible complications and
disfigurement.
● To indicate that the client’s decision was made without force or pressure.

Criteria for a Valid Informed Consent

● Consent voluntarily given. Valid consent must be freely given without coercion.
● For incompetent subjects, those who are NOT autonomous and cannot give or withhold consent, permission is required from
a responsible family member who could either be apparent or a legal guardian. Minors (below 18 years of age), unconscious,
mentally retarded, psychologically incapacitated fall under the incompetent subjects.
The consent should be in writing and should contain the following:
● Procedure explanation and the risks involved
● Description of benefits and alternatives
● An offer to answer questions about the procedure
● Statement that emphasizes that the client may withdraw the consent
● The information in the consent must be written and be delivered in language that a client can comprehend.
● Should be obtained before sedation.
 Promoting Optimal Respiratory and Preparing Patient for Surgery Transporting Patient to Operating
Cardiovascular Status Room

● Teach patient breathing exercises ,
purse lips breathing, coughing
exercise and how to use an incentive
spirometer if indicated.
● Teaching client to maintain a neutral
neck alignment and position to
prevent breathing difficulties after the
procedure.
● Assess patients with underlying
respiratory disease (eg, asthma,
chronic obstructive pulmonary
disease [COPD]) carefully for current
threats to pulmonary status; assess
patient’s use of medications that may
affect postoperative recovery.
● Instruct patients to use detergent– ●
germicide for several days at home (if
the surgery is not an emergency).
● If hair is to be removed, remove it
immediately before the operation
using electric clippers.
● Dress the patient in a hospital gown
that is left untied and open in the
back.
● Cover the patient's hair completely ●
with a disposable paper cap; if the
patient has long hair, it may be
braided; hairpins are removed.
● Inspect the patient's mouth and
remove dentures or plates.
Send the completed chart with the
patient to the operating room; attach
surgical consent form and all
laboratory reports and nurses’
records, noting any unusual last
minute observations that may have a
bearing on the anesthesia or surgery
at the front of the chart in a prominent
place.
Take the patient to the preoperative
holding area, and keep the area quiet,
avoiding unpleasant sounds or
conversation.

POSTOPERATIVE

Definition
The postoperative phase in Total Thyroidectomy of the surgical experience extends from the time the client is transferred to
the recovery room or postanesthesia care unit (PACU) to the moment he or she is transported back to the surgical unit, discharged
from the hospital until the follow-up care.

Goals
During the postoperative period, it is essential to reestablish the patient’s physiologic balance, pain management and
prevention of complications related to total thyroidectomy should be the focus of the nursing care. To do these it is crucial that the
nurse perform careful assessment and immediate intervention in assisting the patient to optimal function quickly, safely and
comfortably as possible.

● Maintaining adequate body system functions.

● Restoring body homeostasis.
● Pain and discomfort alleviation.
● Preventing postoperative complications.
● Promoting adequate discharge planning and health teaching.

mnemonic “POSTOPERATIVE”:

P P – Preventing and/or relieving complications

O O – Optimal respiratory function

S S – Support: psychosocial well-being

T T – Tissue perfusion and cardiovascular status maintenance

O O – Observing and maintaining adequate fluid intake

P P – Promoting adequate nutrition and elimination

E E – Encouraging activity and mobility within limits

R R – Renal function maintenance

A A – Adequate fluid and electrolyte balance

T T – Thorough wound care for adequate wound healing

I I – Infection Control

V V – Vigilant to manifestations of anxiety and promoting ways of relieving it

 E E – Eliminating environmental hazards and promoting client safety

To PACU
Patient Care during Immediate Postoperative Phase: Transferring the Patient to RR or PACU

Patient Assessment Bleeding Precaution:

Special consideration to the patient’s incision site, Lots of blood flows through the thyroid gland, and
vascular status and exposure should be implemented by the bleeding is a potentially life-threatening complication after a
nurse when transferring the patient from the operating room to thyroidectomy. A nurse must monitor the patient carefully for
the postanesthesia care unit (PACU) or postanesthesia recovery bleeding following this surgery, by frequently checking patient’s
room (PARR). Every time the patient is moved, the nurse should wound dressing for blood, and check behind their neck to make
first consider the location of the surgical incision to prevent sure blood is not pooling behind them
further strain on the sutures and possible complication such as
dehiscence and evisceration.
1. Assess air exchange status and note patient’s skin color
2. Verify patient identity. The nurse must also know the
type of operative procedure performed and the name of
the surgeon responsible for the operation.
3. Neurologic status assessment. Level of consciousness
(LOC) assessment and Glasgow Coma Scale (GCS) are
helpful in determining the neurologic status of the
patient.
4. Cardiovascular status assessment. This is done by
determining the patient’s vital signs in the immediate
postoperative period and skin temperature.
5. Operative site examination. Dressings should be
checked.
Positioning
When a patient comes back from having their
thyroidectomy operation, it is essential that the patient will be
placed in a semi-fowler’s position. Sitting entirely upright would
put the patient at a 90 degree angle, but in a semi-Fowler’s
position they are tilted between 15 and 45 degrees.
Support their head and neck using either sandbags or
pillows to keep everything in a neutral position. A nurse does not
necessarily want the patient to hyperextend their neck by
bending it too far backwards, or having their head slump down
in front. Keep the patient’s head at the midline to avoid
damaging the suture line across their throat.
Airway
Keep the airway in place until the patient is fully awake
and tries to eject it. The airway is allowed to remain in place
while the client is unconscious to keep the passage open and
prevents the tongue from falling back. When the tongue falls
back, airway passage obstruction will result.
Circulation
● Obtain a patient's vital signs as ordered and report any
Hypocalcemia:
Signs and symptoms of parathyroid damage are signs
and symptoms of hypocalcemia, which includes numbness,
tingling around the mouth, muscle twitching, GI upset, and
positive Chvostek’s and Trousseau’s signs must be frequently
assessed largely due to the sudden shift of serum calcium in the
body as a result of the surgery.
Breathing
A nurse must frequently perform for the following:
● Bilateral lung auscultation frequently.
● Encourage the patient to take deep breaths. This aerates
the lung fully and prevents hypostatic pneumonia.
● Assess and periodically evaluate the patient’s orientation
to name or command. T – Turn the patient every 1 to 2
hours to facilitate breathing and ventilation.
● Humidified oxygen administration.
Thermoregulation
● Hourly temperature assessment to detect hypothermia or
 abnormalities.
● Monitor intake and output closely.
● Monitor color of the incision for adequate perfusion
● Recognize early symptoms of shock or hemorrhage such
as cold extremities, decreased urine output – less than 30
ml/hr, slow capillary refill – greater than 3 seconds,
dropping blood pressure, narrowing pulse pressure,
tachycardia – increased heart rate.
hyperthermia.
● Report temperature abnormalities to the physician.
● Monitor the patient for post anesthesia shivering or PAS.
This is noted in hypothermic patients, about 30 to 45
minutes after admission to the PACU. PAS represents a
heat-gain mechanism and relates to regaining the thermal
balance

Fluid Volume Safety

● Assess and evaluate patient’s skin color and turgor, mental
status and body temperature.
● Monitor and recognize evidence of fluid and electrolyte
imbalances such as nausea and vomiting and body
weakness.
● Monitor intake and output closely.
● Recognize signs of fluid imbalances.
● Avoid nerve damage and muscle strain by properly
supporting and padding pressure areas.
● Frequent dressing examination for possible constriction.
● Raise the side rails to prevent the patient from falling.
● Protect the extremity where IV fluids are inserted to prevent
possible needle dislodge.
● Make sure that bed wheels are locked.

Evaluation

Patients in PACU are evaluated to determine the client’s discharge from the unit. The following are the expected outcomes in
PACU:
● Patients breathing easily.
● Clear lung sounds on auscultation.
● Stable vital signs.
● Stable body temperature with minimal chills or shivering.
● No signs of fluid volume imbalance as evidenced by an equal intake and output.
● Tolerable or minimized pain, as reported by the patient.
● Intact wound edges without drainage.
● Raised side rails.
 ● Appropriate patient position.
● Maintained a quiet and therapeutic environment.

Reference:
LevelUpRN. (2022). Med-Surg Endocrine System, part 16: Thyroidectomy: Nursing Care. LevelUpRN.

https://www.leveluprn.com/blogs/medical-surgical-nursing/endocrine-system-16-thyroidectomy-nursing-care

RNpedia. (2015, January 8). Thyroidectomy Nursing Care Plan & Management. RNpedia.

https://www.rnpedia.com/nursing-notes/medical-surgical-nursing-notes/thyroidectomy/

RNspeak. (2017, November 5). Thyroidectomy Nursing Care Plan. Nursing Journal | RNspeak.

https://rnspeak.com/thyroidectomy-nursing-care-plan-2/

Vera, M., BSN, & R.N. (2013, July 15). 5 Thyroidectomy Nursing Care Plans. Nurseslabs. https://nurseslabs.com/5-

thyroidectomy-nursing-care-plans/