Study Guide for Exam 3- Chapter 48 and 50

Study Guide for Exam 3- Chapter 48 and 50 - Study Guide for...

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NURS 319 Spring 10 Chapter 48 Endocrine Assessment How to you assess a thyroid gland? – pg 1245 o When inspecting the thyroid gland, observation should be made first in the normal position (preferably with side lighting), then in slight extension, and then as the patient swallows some water. The trachea should be midline and the neck should appear symmetric. Any unusual bulging over the thyroid area should be noted. If there is no noticeable enlargement of the thyroid gland, palpation can be done. (Because palpation can trigger the release of thyroid hormones, palpation should be deferred in the patient with a visibly enlarged thyroid gland.) When an enlarged thyroid is noted, the lateral lobes should be auscultated with the stethoscope bell to determine the presence of a bruit. (bend head forward and slightly right) (displacing=use left thumb to palpate and right thumb to displace). o The thyroid gland is difficult to palpate. Thyroid palpation requires considerable practice, as well as validation by a more experienced examiner. Water should always be available for the patient to swallow as part of this examination. There are two acceptable approaches to thyroid palpation: anterior or posterior. For anterior palpation the nurse stands in front of the patient, with the patient's neck flexed. The nurse places the thumb horizontally with the upper edge along the lower border of the cricoid cartilage. The thumb is then moved over the isthmus as the patient swallows water. The fingers are then placed laterally to the anterior border of the sternocleidomastoid muscle, and each lateral lobe is palpated before and while the patient swallows water. o For posterior palpation the examiner stands behind the patient. With the thumbs of both hands resting on the nape of the patient's neck, the nurse uses the index and middle fingers of both hands to feel for the thyroid isthmus and for the anterior surfaces of the lateral lobes. To facilitate the examination of each lobe and to relax the neck muscles, the nurse asks the patient to flex the neck slightly forward and to the right. The thyroid cartilage is displaced to the right by the left hand and fingers. The nurse palpates with the right hand after placing the thumb deep and behind the sternocleidomastoid muscle with the index and middle fingers in front of it; the area is palpated with the right hand (Fig. 48-12 ). While this is done, the patient is asked to swallow water. This procedure is then repeated on the left side. The thyroid is palpated for its size, shape, symmetry, and tenderness and for any nodules. o In a normal person the thyroid is often not palpable. If palpable, it usually feels smooth, with a firm consistency, and is not tender with gentle pressure. Nodules, enlargement, asymmetry, or hardness is abnormal, and the patient should be referred for further evaluation. A potential adverse effect of palpation of the thyroid gland is:
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This note was uploaded on 05/08/2011 for the course NURSING 318 taught by Professor Turner during the Spring '11 term at Southwestern Adventist.

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Study Guide for Exam 3- Chapter 48 and 50 - Study Guide for...

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