Thyroidectomy is a surgical

procedure in which all or part of

the thyroid gland is removed.

The thyroid gland is located

in the forward (anterior) part of
the neck just under the skin and
in front of the Adam's apple. The
thyroid is one of the body's
endocrine glands, which means
that it secretes its products
inside the body, into the blood or
lymph. The thyroid produces
several hormones that have two
primary functions: they increase
the synthesis of proteins in most
of the body's tissues, and they
raise the level of the body's
oxygen consumption.
 The most common test is a blood test
that measures the level of thyroid-
stimulating hormone (TSH) in the
bloodstream.

Sonograms and computed

tomography scans (CT scans) help to
determine the size of the thyroid gland
and location of abnormalities.

A needle biopsy of an abnormality

or aspiration (removal by suction) of
fluid from the thyroid gland may also
be performed to help determine the
diagnosis.

Continued treatment with antithyroid

drugs may be the treatment of choice for
hyperthyroidism and goiter. Otherwise,
no other special procedure must be
followed prior to the operation.
 📈
Screening tests indicate that about
6% of the United States population
has some disturbance of thyroid
function, but many people with mildly
abnormal levels of thyroid hormone
do not have any disease symptoms.

It is estimated that between 12 and

15 million people in the United States
and Canada are receiving treatment
for Thyroid disorders as of 2002.

In 2001, there were approximately

34,500 thyroidectomies performed in
the United States. Females are
somewhat more likely than males to
require a thyroidectomy.
Thyroid surgery, which has traditionally
been an overnight hospital procedure
can be done safely in an outpatient
setting, and in fact is preferable
because it is less expensive, according
to a new study published in the April
issue of Otolaryngology-Head and
Neck Surgery.

Studies found not only were

complications low but conducting the
procedure in an outpatient
environment significantly lowered the
cost by several thousand dollars.
 The scarless thyroid surgery
is a new form of endoscopic
surgery. The technique uses the
latest Da Vinci three-
dimensional, high-definition
robotic equipment to make a
two-inch incision below the
armpit that allows doctors to
maneuver a small camera and
specially designed instruments
between muscles to access the
thyroid. The diseased tissue is
then removed endoscopically
through the armpit incision.
This technique safely removes the thyroid without leaving so much as
a scratch on the neck. The benefits of this new technique go beyond
aesthetics.
Unlike other forms of endoscopic thyroid surgery, it doesn't require
blowing gas into the neck to create space to perform the operation.
Those techniques can risk complications if the gas is retained in the
neck or chest after surgery, causing significant discomfort and
postoperative complications.
There is a reduced likelihood of laryngeal nerve damage and less risk
of trauma to the parathyroid glands, which are near the thyroid. There
is also significant faster recovery time and less discomfort on the part
of the patients.
A goiter is an abnormal enlargement
of your thyroid gland. Your thyroid is a
butterfly-shaped gland located at the
base of your neck just below your
Adam's apple. Although goiters are
usually painless, a large goiter can
cause a cough and make it difficult
for you to swallow or breathe.
The most common cause of goiters
worldwide is a lack of iodine in the
diet. In the United States, where the
use of iodized salt is common, a
goiter is more often due to the over-
or underproduction of thyroid
hormones or to nodules that develop
in the gland itself. Treatment depends
on the size of the goiter, your
symptoms and the underlying cause.
Small goiters that aren't noticeable
and don't cause problems usually
don't need treatment.
Non-modifiable risk factors

 Family history: patients with a family history of

thyroid disease are at an increased risk of developing
an autoimmune thyroid condition. Similarly, a family
history of autoimmune disease also increases the risk
of thyroid disorders, albeit to a lesser extent.

 Age – Your chances of developing one increase with

age, especially once you hit 40.

 Gender: the incidence of thyroid disorders is

reported to be higher in women than in men
Modifiable risk factors

 Diet low in iodine – When a person does not receive

enough iodine in their diet, the thyroid Gland
increases in size (development of a goiter) and
hypothyroidism can occur.

 Regular use of medications such as lithium,

propylthiouracil, phenylbutazone, or
aminoglutethimide – this causes the thyroid to
function more than its usual activity, which in the long
run, can cause enlargement of the thyroid gland. Too
much or too little secretions of hormones produced by
the thyroid gland can cause enlargement.
Modifiable risk factors
 Thyroid surgery / medical treatment: patients who have
undergone any form of thyroid surgery or radioactive iodine
treatment to remove part or all of the thyroid, may ecome
hypothyroid as a result. Certain medical treatments and drugs
can increase the risk of developing an underactive thyroid.
These include interferon β-1b, interleukin-4,
immunosuppressants, antiretrovirals, monoclonal antibodies
(Campath-1H), bone marrow transplant, lithium and
amiodarone, among others. In addition, treatment of hepatitis
C with interferon 2α has been associated with increased risk
of thyroid dysfunction, which usually resolved upon
discontinuation of treatment. Recent exposure to a surgical
antiseptic that includes iodine (such as Povidone) can
increase the risk of temporary thyroiditis, hypothyroidism or
hyperthyroidism.
Modifiable risk factors

 Radiation Exposure: Exposure of the neck area to

radiation, such as in the treatment of head or neck cancer,
or accidental environmental exposure, increases the risk
of autoimmune thyroid disease and thyroid cancer.
 Pregnancy: The risk of developing thyroid disorders
increases during pregnancy. Increased levels of human
chorionic gonadotropin (hCG) and estrogen are thought
to be responsible for alterations in the levels of thyroid
hormones.
 Smoking: Thiocyanate in cigarettes adversely affects the
thyroid. Smokers, therefore, have an increased risk of
developing autoimmune thyroid diseases, and smoking
can exacerbate existing symptoms of thyroid disease.
Non-modifiable risk factors

 Diet: Insufficient dietary iodine increases the risk of

hypothyroidism (most common in developing countries). In
contrast, dietary supplementation with iodine-containing
herbal remedies among individuals with sufficient dietary
iodine intake can increase the risk of autoimmune thyroid
disease. In susceptible people (usually those with underlying
thyroid autoantibodies), foods containing goitrogens
(chemicals that can promote goitre) can induce
hypothyroidism when eaten raw and in large quantities.
Some foods that are high in goitrogens include cabbage,
brussel sprouts, broccoli, turnips, rutabagas, kohlrabi,
radishes, cauliflower, African cassava, millet, soy and kale.
 Dysphagia – because of the enlargement of the thyroid gland, the
feeling of something that is stuck in your throat makes it difficult for
a person with enlarged thyroid gland to swallow.

 Hoarseness of voice – compression of the recurrent laryngeal

nerve by a goiter may result in vocal cord dysfunction and may
cause hoarseness of voice.

 Swelling of the neck – an enlarged thyroid gland results in a visible

swelling at the base of your neck.

 Coughing – thyroid nodules that cause the patient to cough are

almost always on the back side of the thyroid. The cough is caused
by the nodule irritating the trachea, or the vocal cord nerve. The
nodule can rub or stretch the nerve causing irritation and the need
to cough.

 Wheezing – breathe with a whistling or rattling sound in the chest,

as a result of obstruction in the air passages.
Thyroidectomy
 surgical removal of part or all of the thyroid gland
 allows treatment of hyperthyroidism, respiratory
obstruction from goiter, and thyroid cancer.
 Subtotal thyroidectomy, used to correct
hyperthyroidism when drug therapy fails or radiation
therapy is contraindicated, reduces secretion of
thyroid hormone. It also effectively treats diffuse
goiter. After surgery, the remaining thyroid tissue
usually supplies enough thyroid hormone for normal
function.
 Total thyroidectomy may be performed for certain
types of thyroid cancers, such as papillary, follicular,
medullary, or anaplastic neoplasms. After this surgery,
the patient requires lifelong thyroid hormone
replacement therapy.
Thyroidectomy
1. After the patient is
anesthetized, the
surgeon extends the
neck fully and
determines the incision
line by measuring
bilaterally from each
clavicle.

2. Then he cuts through the

skin, fascia, and muscle
and raises skin flaps
from the strap muscles.
Thyroidectomy
3.He separates these muscles
midline, revealing the thyroid's
isthmus, and ligates the thyroid
artery and veins to help prevent
bleeding.

4.Next, he locates and visualizes

the laryngeal nerves and
parathyroid glands and then
begins dissection and removal of
thyroid tissue, trying not to injure
these nearby structures.

5.Before the surgeon sutures the

incision, he may insert a Penrose
drain or a closed wound drainage
device such as a Hemovac drain.
 Surgery is indicated for some patients with chronic
thyroiditis, usually to ascertain that the patient does
not have carcinoma.
 It is indicated for any patient with a nodular goiter
causing tracheal compression, particularly if the
goiter is intrathoracic.
 It is the best treatment for patients with nodular goiter
in whom hyperthyroidism develops.
 Surgical excision is indicated to rule out cancer in
any patient who has a firm solitary nodule in the
thyroid gland. It should also not be forgotten that
carcinoma of the thyroid can develop in a patient
who has had a multiple nodular goiter for many
years.
 Surgery remains the mainstay of treatment of
thyroid carcinoma. It is the treatment of choice for
most patients with Graves' disease.
In experienced hands, thyroid surgery is generally very
safe. Complications are uncommon, but the most serious
possible risks of thyroid surgery include:

 bleeding in the hours right after surgery that could lead

to acute respiratory distress

These complications occur more

 injury to a recurrent laryngeal nerve that can cause frequently in patients with invasive
temporary or permanent hoarseness, and possibly even tumors or extensive lymph node
acute respiratory distress in the very rare event that involvement, in patients
both nerves are injured undergoing a second thyroid
surgery, and in patients with large
goiters that go below the
 damage to the parathyroid glands that control calcium collarbone into the top of the chest
levels in the blood, leading to temporary, or more rarely, (substernal goiter). Overall the
permanent hypoparathyroidism and hypocalcemia. risk of any serious complication
should be less than 2%.
(1)Needle holder (2) Straight mayo scissors

(4) Short needle holders (1) Baby Metzenbaum scissors

(6) Large towel clips (1) Regular Metzenbaum scissors

(1) Fine iris scissors (6) #10 blades

(4) #3 Knife handles (4) #15 blades

(1)#7 Knife handle (1) Short plain forceps

(1) Short multitoothed forceps (2) Regular Cushing forceps

(2) DEBAKEY forceps (1) Freer elevator

(1) Fine Cushing forceps (2) Kelly clamps

(2) Ochners (6) Straight mosquito clamps

(36) Criles (2) Babcock clamps

(12) Curved mosquito clamps 2) Senn rakes

(2) Pairs of double skin hooks (1) Adenoid suction

(1) Pair of single skin hooks (1) Pair Green retractors

(1) Pair vein retraction (2) Double-ended medium-

. small Richardson retractors
(1) McCabe nerve dissector (1) Fiberoptic headlight unit

(5) bullets (peanuts) (1) Bipolar cautery unit

(2) Army-navy retractors (1)Penrose drain

(1) Pack Steri
 Explain to the patient that thyroidectomy will remove
diseased thyroid tissue or, if necessary, the entire gland.
 Tell him that he'll have an incision in his neck; that he'll have a
dressing, and possibly, a drain in place after surgery; and that
he may experience some hoarseness and a sore throat from
intubation and anesthesia.
 Reassure him that he'll receive analgesics to relieve his
discomfort. z If thyroidectomy is being performed to treat
hyperthyroidism, ensure that the patient has followed his
preoperative drug regimen, which will render the gland
euthyroid to prevent thyroid storm during surgery.
 He probably will have received either propylthiouracil or
methimazole, usually starting 4 to 6 weeks before surgery.
Expect him to be receiving iodine as well for 10 to 14 days
before surgery to reduce the gland's vascularity and thus
prevent excess bleeding.
 He may also be receiving propranolol to block
adrenergic effects. Notify the doctor immediately
if the patient has failed to follow his medication
regimen.

 Collect samples for serum thyroid hormone

determinations to check for euthyroidism. If
necessary, arrange for an electrocardiogram to
evaluate cardiac status.

 Ensure that the patient or a responsible family

member has signed a consent form.
 During the operation, one of the scrub nurse’s primary
duties is selecting and passing instruments to the
surgeon.

 The scrub nurse’s role here is supporting the surgeon

while also maintaining patient safety.

 The nurse must know which instruments are used for

specific procedures and when they are needed, so she
can quickly hand them to the surgeon.
 The scrub nurse must also watch for hand signals to
know when the surgeon is ready for the next tool or
when he is done using a tool and is ready to hand it
back to the scrub nurse, who cleans the tools after use
and places each tool back in its place on the table.

 She also monitors the surgery to ensure everything

remains sterile.
 Preparing the operating room, he checks the stock of
supplies and instruments. Problem-solving is a
regular duty of a circulating nurse.

 Equipment must be checked and double-checked. If

something is missing or not in working order, the
circulating nurse finds a solution.

 As a patient advocate, the circulating nurse interacts

with the patient before surgery and serves as a patient
protector during surgery.
 Assessing the patient right before surgery is critical to
making sure that all required prep was completed.

 Serving as a patient advocate and safety monitor, the

circulating nurse observes the surgery and ensures that
no aspect of patient care is missed. She also studies data
and responds quickly if anything goes wrong.

 For outpatient surgery, the circulating nurse confirms

who will drive the patient home and who should receive
updates about the patient's progress.
 Keep the patient in high Fowler's position to promote
venous return from the head and neck and to decrease
oozing into the incision.

 Check for laryngeal nerve damage by asking the patient

to speak as soon as he awakens from anesthesia.

 Watch for signs of respiratory distress. Tracheal

collapse, tracheal mucus accumulation, laryngeal
edema, and vocal cord paralysis can all cause
respiratory obstruction, with sudden stridor and
restlessness.
 Keep a tracheotomy tray at the patient's bedside for 24
hours after surgery, and be prepared to assist with
emergency tracheotomy, if necessary. Z

 Assess for signs of hemorrhage, which may cause shock,

tracheal compression, and respiratory distress.

 Check the patient's dressing and palpate the back of his

neck, where drainage tends to flow. Expect about 50 ml
of drainage in the first 24 hours; if you find no drainage,
check for drain kinking or the need to reestablish
suction.
 Expect only scant drainage after 24 hours.

 Assess for hypocalcemia, which may occur when the

parathyroid glands are damaged. Test for Chvostek's and
Trousseau's signs, indicators of neuromuscular irritability
from hypocalcemia. Keep calcium gluconate available for
emergency I.V. administration.

 Be alert for signs of thyroid storm, a rare but serious

complication.
 As ordered, administer a mild analgesic to relieve a sore
neck or throat. Reassure the patient that his discomfort
should resolve within a few days.

 If the patient doesn't have a drain in place, prepare him for

discharge the day following surgery as indicated. However,
if a drain is in place, the doctor will usually remove it, along
with half of the surgical clips, on the second day after
surgery; the remaining clips, the following day, before
discharge.
 If the patient is discharged the day after surgery, teach him to
report any signs of respiratory distress or bleeding.

 If the patient has had a total thyroidectomy, explain the

importance of regularly taking his prescribed thyroid
hormone replacement.

 Teach him to recognize and report signs of hypothyroidism

and hyperthyroidism.

 If parathyroid damage occurred during surgery, explain to the

patient that he'll need to take calcium supplements. Teach him
to recognize the warning signs of hypocalcemia.
 Tell the patient to keep the incision site clean and dry. Help
him cope with concerns about its appearance. Suggest loosely
buttoned collars, high-necked blouses, jewelry, or scarves,
which can hide the incision until it has healed. The doctor may
recommend using a mild body lotion to soften the healing
scar and improve its appearance.

 Arrange follow-up appointments as necessary, and explain to

the patient that the doctor needs to check the incision and
serum thyroid hormone levels.
 Depending upon local practice and the extent of the operation,
patients may remain in the hospital overnight. Immediately
after the thyroid operation, most people will have a sore throat
from the breathing tube used for anesthesia.

 Pain at the incision is minimal (most liken it to a sore throat),

and patients generally require only mild pain medication (for
example, acetaminophen) by the first day after the operation. It
may be more comfortable to eat soft foods for a few days.

 Driving is not safe while taking pain medications that can cause
drowsiness, and patients should not drive until they can turn
their head comfortably from side to side (this may take up to a
week).
 There may be some numbness around the incision immediately
after the surgery; in most cases this resolves as the nerves in
the skin heal.

 The wound healing sometimes causes itching that can last for
several weeks. The incision will leave a scar, although these
scars usually heal quite well.

 Patients should avoid sun exposure to the wound for about six
months to improve the cosmetic outcome. Using vitamin E on
the skin may also help to improve the appearance of the scar.
 For most patients, walking and normal routines can resume the
day after the operation, but vigorous activity and heavy lifting
are not recommended for two weeks. Depending on their job
type, most people will need to take 1-2 weeks off work after
thyroid surgery.

 Some patients experience a sensation as though there is a

lump in the throat upon swallowing; this is normal and it
spontaneously subsides over time.

 Some patients may notice subtle voice changes or the voice

may tire by the end of the day; these voice alterations generally
resolve within 2-3 months. If voice changes persist, the surgeon
or endocrinologist should be advised, as further evaluation
may be necessary.
Thyroid gland resection has a high success rate, with virtually
no mortality rate.
Patients are required to stay in the hospital for a few days but
are expected to resume normal daily activities after a few
weeks.
The patient's calcium levels are monitored and hormone
replacement therapy is provided, depending on the extent of
the procedure (whether partial or complete removal of the
gland).
 MEDICINES ACTION INDICATION POSSIBLE EFFECTS
that the patient may
encounter
Acetaminophen(Ty Thought to produce  For pain or The most commonly
lenol) analgesia by inhibiting fever reported adverse
prostaglandin and other reactions have included
substances that nausea,
sensitizes pain vomiting, constipation.
receptors. Drug may
relieve fever through
central action in the
hypothalamic heat-
regulating center

Levothyroxin Stimulates the  Thyroid Insomnia, tremor,

sodium metabolism of all body hormone headache, fever, fatigue,
tissues by accelerating replacement anxiety, emotional
rate of cellular oxidation instability, diarrhea,
vomiting, menstrual
irregularities, and
abdominal cramps
 Assessment Nursing Scientific Goals & Interventions rationale Expected
Diagnosis Explanation objective Outcome
-Give patient -Anxiety may impair
S: Ø Anxiety related A vague uneasy Short Term: clear, concise patients cognitive Short
O: The patient to upcoming feeling of After 15-30 mins explanation of abilities Term:
may manifest: surgery discomfort or of nursing anything that’s After 15-30
 Restlessn dread intervention , about to happen mins of
ess accompanied the patient will and avoid nursing
 Increased by an automatic be able to information interventio
response; the verbalize overload n , the
wariness
source often understanding patient
 Impaired nonspecific of the need for -Listen shall be
attention icon unknown surgery. attentively and -This my allow able to
 Facial to the allow patient to patient to identify verbalize
individual; a Long term: express anxious and discover understan

flushing
Urinary feeling of After 1-2 days feelings source of anxiety ding of the NCP # 1:
urgency apprehension of nursing need for
 Decrease
caused by interventions, -identify and -Anxiety commonly surgery. Anxiety related to
anticipation of the patient will reduce any results from lack of
cardiac danger. It is an be able to environmental trust in the Long term: upcoming surgery
output altering signal practice stressors environment After 1-2
that warns of progressive days of
impending relaxation -Have patient -this gives patient an nursing
danger and techniques. state what kinds sense of control interventio
enables the of activities ns, the
individual to promote patient
take measures feelings of shall be
to deal with comfort , and able to
threat. encourage practice
patient to progressiv
perform them e
-Anxiety is usually relaxation
-Remain with related to fear of techniques
patient during being left alone .
severe anxiety
Assessment Nursing Scientific Goals & Interventions rationale Expected
Diagnosis Explanation objective Outcome
S: Ø
O: The patient Readiness for Pre-operative Short Term: -Verify patient’s-To ensure accuracy Short
manifest: enhanced care is the After 30 mins knowledge and completeness Term:
 Expressio knowledge preparation of nursing about specific of knowledge base After 30
n of related to pre- and intervention, topic for future learning mins of
interest to operative care management the patient will -to apply or use nursing
learn of a patient be able to -Assist patient information interventio
 Explains prior to verbalize to identify ways increases desire to n, the
knowledg surgery. It understanding to integrate learn and retain patient
e of the includes both of the and use information shall be
topic physical and operation information in able to
psychological all applicable verbalize
preparation. It Long Term: areas -incongruences may understan NCP # 2:
involves many exist, creating ding of
components
and may be
After 12-24hrs
of nursing
-Be aware of
informal
questions and
potentially
the
operation
Readiness for enhanced
done the day intervention, teaching and undermining knowledge related to
before the the nurse will role modeling process Long
surgery or on be able to that takes Term: pre-operative care
an out patient develop a plan place on -to provide
basis. for learning of ongoing basis additional After 12-
the patient opportunities for 24hrs of
anticipatory nursing
-discuss ways problems interventio
to verify n, the
accuracy of nurse
informational shalll be
resources able to
develop a
plan for
learning
of the
patient
Assessment Nursing Scientific Goals & Interventions rationale Expected
Diagnosis Explanation objective Outcome

S: Ø Acute Pain Acute pain is Short Term: -Monitor vital -Alterations from Short
O: The patient related to post- an unpleasant After 15-30 signs normal may be Term:
may manifest: surgical sensory and mins of nursing signs of infectionAfter 15-
 Guarding procedure emotional interventions 30 mins
behavior experience the patient will -Assess for -To help determine of nursing
 Facial arising from be able to referred pain possibility of interventio
expressio actual demonstrate underlying condition ns the
n of pain or potential use of or organ dysfunction patient
 Restlessn tissue damage relaxation skills of treatment shall be
ess or described in and diversional able to
 terms of such activities demonstr
Distractio
n
damage ate use of NCP # 1:
relaxation
behavior
 Diaphores
Long term:
-Note client’s
attitude toward
skills and
diversiona
Acute Pain related to
is and
changes
After 1-2 hrs of pain and use of l activities post-surgical procedure
nursing pain Long
in interventions, medications term;
behavior the patient will including any After 1-2
be able to history of hrs of
report relieved substance nursing
of pain abuse interventio
ns, the
patient
will be
able to
report
relieved of
pain
 Assessment Nursing Scientific Goals & Interventions rationale Expected
Diagnosis Explanation objective Outcome
-Establish -to gain trust and
S: Ø Impaired Impaired Short Term: therapeutic cooperation of the Short
O: Patient comfort comfort After 30 minutes relationship patient Term:
may manifest: related to perceived of nursing -Explain all the -to be aware to The
 (+) post-surgical lack of ease intervention the procedures to different procedure patient
restlessn procedure and relief. patient verbalize the patient that will be done to shall have
ess and The client sense of comfort him and to also verbalized
irritability has a or contentment. lessen his anxiety sense of
 (+) surgical -Assess vital -to obtain baseline comfort or
numbnes management signs and record data contentm
s on of Long term: -Evaluate -self-care places an ent
lower Thyroidecto After 4 hours of client’s ability to important part in
extremiti my which nursing provide self-care maintaining NCP # 2:
es alters his interventions the integrity of the skin
 (+)
guarding
comfort
because of
patient will
engage in
-Encourage the -to
patient to dehydration
prevent
Long
Impaired Comfort
behavior the presence behaviors or increase fluids term: related to post-surgical
 (+) of pain in the lifestyle changes -Review -to change behavior
The
moaning surgical area to increase level knowledge base and promote well- patient procedure
and of ease. and note coping being shall have
crying skills that have engaged
 Changes been used in
in previously behaviors
sleeping or lifestyle
pattern -Provide age- -to promote non- changes
 Fatigue appropriate pharmacological to
comfort pain management increase
measures like level of
change ease.
of position
-Encourage/ -to
plan care to prevent fatigue
allow individually
adequate rest
periods
ASSESSMENT NURSING SCIENTIFIC OBJECTIVES INTERVENTIONS RATIONALE EXPECTED
EXPLANATION
DIAGNOSIS OUTCOME

Subjective: Ø Risk for Contaminatio Short Term: -Establish -To gain trust Short term:
infection n of a wound After 2-3 hours of therapeutic towards the Client SO
Objective: related to surface with nursing communication client shall
postoperative microorganis intervention the verbalized
Patient may condition m thus these client SO will be -Monitor vital understandin
manifest: colonization able to verbalized signs -To have g of causative
 Pallor has a understanding of baseline data factors.
 Inflamed complete causative factors. -Facilitate oral
tissue new cells for care -To promote
surroundi oxygen and Long Term: wellness
ng
nutrition and After 1-2 days of -Monitor
 Increase
WBC
because nursing possible signs of -To promote NCP# 3:
count their by- intervention the infection wellness Long Term
products can
interfere with
client SO will
eliminate factors -Administer
Client
shall
SO Risk for infection
a healthy that predisposed antibiotic as -To destroy eliminate related to postoperative
surface the client to any ordered possible factors that
condition possible infection invading predisposed condition
that leads to pathogens the client to
infection. -Discuss to the any possible
client SO about -To avoid drug infection
the importance resistance
of proper taking
of antibiotics

-Maintain
adequate -To promote
hydration wellness