Nursing Diagnosis and Nursing Intervention

Nursing Diagnosis for Thyroid Cancer

Thyroid cancer is a depressing malignancy in thyroid which has 4 types, namely: papillary, follicular, medullary and anaplastic. Thyroid cancer rarely causes enlargement of the gland, often causing small growth (nodule) in the gland. The majority of thyroid nodules are benign, thyroid cancer is usually curable.

Thyroid cancer often limits the ability to absorb iodine and limit the ability to produce thyroid hormone, but sometimes produce enough thyroid hormone, causing hyperthyroidism.

Thyroid cancer occurs in the cells of the thyroid gland (an organ shaped like a butterfly located on the nape of the neck), which serves to produce hormones to regulate the speed of the heart beat, blood pressure, body temperature and weight.

According to WHO, malignant epithelial thyroid tumors are divided into:

1. Follicular carcinoma.
There are roughly 25% of all thyroid carcinomas exist, especially regarding the age group above 50 years. Invade the bloodstream and then spread to the bone and lung tissue. Rarely spread to regional lymph nodes but can be attached / stuck in the trachea, neck muscles, and blood vessels of the skin, which then causes dyspnea and dysphagia. When the tumor on "The recurrent laryngeal Nerves", a hoarse voice clients. The prognosis is good if metastasenya still a bit by the time the diagnosis is set.

2. Papillary carcinoma.
Is a type of thyroid cancer that is often found, a lot of women or the age group above 40 years. Papillary carcinoma is a tumor that progress has been slow and can appear many years before spreading to regional lymph nodes. When the tumor is localized in the thyroid gland, the prognosis is good if the action Thyroidectomy partial or total.

3. Medullary carcinoma.
Parafolikular arising in thyroid tissue. Amount of 5-10% of all thyroid carcinomas and generally the people aged over 50 years. Spread through the lymph nodes and invade surrounding structures. These tumors often occur and are part of the Multiple Endocrine Neoplasia (MEN) Type II which is also part of the endocrine disease, where there is excessive secretion of calcitonin, ACTH, prostaglandin and serotonin.

4. Poorly differentiated carcinoma (anaplastic).
Tumor is growing quickly and outstanding aggressive. This type of cancer is directly attacking adjacent structures, which cause symptoms such as:
  • Stridor (sound raspy / hoarse, loud audible breath sounds).
  • Hoarseness.
  • Dysphagia
The prognosis is poor and most of the clients died about 1 year after diagnosis set. Clients with a diagnosis of anaplastic carcinoma can be treated with palliative surgery, radiation and chemotherapy.

Etiology of the disease is uncertain, whose role is to occur particularly well differentiated (papillary and follicular) are radiation and endemic goiter, and for medullary type is a genetic factor. Carcinoma who have not known a role for anaplastic and medullary cancers. Estimated cancer types derived from anaplastic thyroid cancer changes berdiferensia good (papillary and follicular), with the possibility of the follicular type twice as large.

Radiation is one of the etiologic factors of thyroid cancer. Many cases of cancer in children previously received radiation to the head and neck due to other diseases. Radiation effects usually appear after 5-25 years, but an average of 9-10 years. The old TSH stimulation is also one of etiological factors of thyroid cancer. Other risk factors are a family history of thyroid cancer and chronic goiter.

There are also factors such as genetic abnormalities predisposisilainnya, age, sex, race, and place of residence (coastal area).

Clinical suspicion of thyroid carcinoma is based on the observation that was confirmed by pathological examination and suspicion are divided into high, medium and low. Which includes high suspicion are:
  • Multiple endocrine neoplasia history in the family.
  • Rapid tumor growth.
  • Hard palpable nodules.
  • Fixation surrounding area.
  • Paralysis of the vocal cords.
  • Enlargement of regional lymph nodes.
  • The presence of distant metastases.

Nursing Diagnosis for Thyroid Cancer
  1. Ineffective airway clearance related to obstruction of the trachea by the pressure of the tumor mass
  2. Acute pain related to the pressure / swelling by tumor nodule
  3. Impaired verbal communication related to vocal cord injury
  4. Anxiety related to changes in health
  5. Imbalanced Nutrition: less than body requirements related to swallowing disorders
  6. Disturbed Body Image related to the incision secondary to thyroid cancer surgery
  7. Knowledge Deficit related to lack of information about the disease.

Nursing Diagnosis

Nursing Diagnosis


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