الفهرس 
Acknowledgment
Thyroidectomy and its complicationsOnly 14 pages are availabe for public view
 |  | from | 111 |  |  |
| | | from | 111 | | |
Abstract
The thyroid gland, or simply, the thyroid, is one of the largest endocrine glands which is found in the neck, inferior to the thyroid cartilage. The thyroid produces the hormones triiodothyronine (T3) and thyroxine (T4). These hormones regulate the body’s metabolism and affect the growth and many other functions of various systems of the human body. The thyroid also produces calcitonin, which plays a role in calcium metabolism. Thyroid diseases can be grouped into benign and malignant types. In benign cases, the common diseases encountered are thyroiditis (mostly Hashimoto thyroiditis), goiter, thyroid adenoma, and thyroid carcinoma. (1)
A thyroidectomy is an operation that involves the surgical removal of all or part of the thyroid gland. Thyroid surgery commonly falls into one of three categories: 1) total thyroidectomy, which aims to achieve complete macroscopic removal of thyroid tissue; 2) subtotal thyroidectomy, in which bilateral thyroid remnants are left; and 3) thyroid Lobectomy which involves removing the half of the thyroid gland that has the nodule. The choice of the thyroidectomy technique is currently largely a matter of surgeon preference, and a systematic review of the evidence base is required to determine which option offers the best outcomes for patients.(2)
Thyroidectomy has become one of the most frequent surgery and bilateral total thyroidectomy (TT) is performed in the majority of thyroid diseases. Thyroidectomy is indicated for patients with multi nodular goiter (MNG) that causes compressive symptoms, hyperthyroidism, or cosmetic concerns. Surgical resection is also indicated if there is suspicion of malignancy. (3)
Although complications following thyroidectomy are rare, their consequences can be life-threatening. It includes hypothyroidism, damage to or inadvertent removal of parathyroid glands causing hypoparathyroidism and hypocalcemia, hemorrhage, injury to the recurrent or superior laryngeal nerve, thyrotoxicosis, and infection. Recurrent laryngeal nerve damage leads to vocal cord paralysis. If both cords are paralyzed, spastic airway obstruction will occur, requiring an immediate tracheostomy. Respiration may also become difficult because of excess swelling of the neck tissues, hemorrhage, and hematoma formation.(4)
In addition, patients frequently experience discomfort symptoms in their neck such as neck pain, stress and pressure in the neck, shoulder stiffness, shoulder and neck movement difficulties. Discomfort symptoms occur because patients’ necks remain in a hyperextended position during the prolonged operation. Experiencing neck discomfort symptoms has negative effects on patients’ quality of life after a thyroidectomy. (5)
Improper preoperative and postoperative treatment could directly have a serious influence on patient’s recovery and even could endanger the lives of patients, seriously affecting the quality of life. Therefore, it is a crucial issue remaining to be solved in nursing after thyroid surgery how to carry out complete and effective preoperative and postoperative nursing care, observe the conditions, assist and cooperate with physician for treatment and aggressively handle with complications.(6)
It is the nursing responsibility to present the patient with the information that he/she needs to make decisions and to motivate him/her to appreciate the need for learning. Health education is viewed as a strategy for cost reduction when it is directed towards decreasing length of hospital stay and facilitating earlier discharge, and prevents rehospitalization. Therefore, implementation of nursing care program for thyroidectomy patients might improve patients care outcome by encouraging compliance with medical and surgical treatment regimens and promoting healthy lifestyles.(7)
The nurse must inform the patients about the purpose of preoperative tests if they are to be performed, and explains what preoperative preparation to expect, the nurse must instruct patients about signs and symptoms of potential complications, she should asses the intensity of pain and teach patient neck exercise which should continue until they are able to freely move their head and neck. written and verbal information regarding wound care, medications, nutrition, and follow-up visits with the physician.(8)
Significance of the study:
According to Assiut University Hospital records through (2015 to 2016); the incidence of thyroidectomy operations was about “224” & most of them developed complications as hypocalcemia, recurrent laryngeal nerve injury, surgical wound infection and hematoma, So this study will be the first nursing study carried out in this geographical location which will help such group of patients to increase their knowledge and practice in an attempt to decrease the incidence of these complications.
.
Aims of the Study
Aims of this study are:
1. To assess patient knowledge and practice about thyroidectomy.
2. To develop Designing Nursing Guidelines for patients Undergoing Thyroidectomy
3. To evaluate the effect of applying designed nursing guidelines on minimizing postoperative complications of patients undergoing thyroidectomy.
Hypothesis:
To fulfill the aims of the study the following research hypothesis were formulated :
1) The knowledge and practice of the study group patients after application of the nursing guidelines will be higher than those of the control group.
2) Post-operative complications associated with thyroidectomy will be less among the study group than the control group.
Subjects and method
Research design:
Quazi experimental research design will be utilized to conduct this study.
Setting:-
The study will be conducted in General Surgery Department and out patient surgery clinic at Assiut University Hospital.
Subjects:
A sample of 60 adult patients of both sex in General Surgery Department at Assiut University Hospital. Age ranges from 20 to 65 years, patients will be divided into two equal groups (study and control) 30 patients for each. The study group will receive the designed nursing guidelines while the control group will receive the routine hospital care.
Study tools:
Three tools will be used for data collection:
Tool (I): Patient assessment sheet: To assess socio-demographic data, medical data and knowledge developed by the researcher based on literature review., it includes four parts:
Part 1: Socio demographic data: It includes
Patient’s name, age, sex, level of education, marital status and occupation …etc.
Part 2: Patient medical data:
It includes medical diagnosis, health history, health habits …etc.
Part3: Physical examination; General and local examination to the thyroid gland.
Part4: Assessment of patient knowledge; regarding thyroidectomy operation (definition, types, indications, pre & post-operative care and complications)
Tool (II): ”Designing nursing guidelines”
This tool will be developed by the researcher based on patients assessment needs after reviewing current national and international literature to maintain health of patients and reduce postoperative complications. Nursing guidelines include: pre-operative and post-operative care as neck stretching exercise, deep breathing exercise, wound care, nutrition, medication, follow up and home instructions.
Tool (III): ”Thyroidectomy complication evaluation sheet”; it includes three parts.
Part 1: Neck pain and disability index questionnaire: (NDI)
Neck pain and disability index questionnaire (Vernon, 1991) has been designed to give information as to how neck pain has affected the ability to manage everyday life, The NDI consists of ten items: pain intensity, personal care, lifting, reading, headaches, concentration, work, driving, sleeping, and recreation. Each item has six different assertions expressing progressive levels of pain or limitation in activities, neck pain and related disability was checked before discharge and after 2 weeks of operation. (9)
Part2: Southampton Wound Assessment Scale.
Southampton scale was designed for use in the postoperative assessment of wound. The wounds were graded before discharge and after 10 – 14 days postoperatively into one of four categories; normal healing, minor complication, wound infection, and major haematoma. (10)
Part3: Assessment of other thyroidectomy complications; during hospitalization and then after 4 weeks from discharge, the patient will be assessed for air way obstruction, atelectasis, pneumonia, haemorrhage, recurrent laryngeal nerve injury, thyrotoxic crisis, parathyroid insufficiency, thyroid insufficiency through laboratory investigations and keloid scar.
Methodology
• An official permission will be obtained from the hospital director and head of department of the setting in which the study will be conducted.
• Patient’s agreement for voluntary participation will obtained, the purpose and nature of the study will be explained.
• The content and validity will be done by five experts (medical and nursing ) in the field of the study and necessary modification will be done.
• Pilot study will be conducted on 10% (6 patients) of the sample to evaluate the applicability and clarity of the tools