Splenectomy (11 Questions)

1. M. Jacques Gagnon, 45 years old, returns to the unit 2 hours after an open splenectomy following a trauma. Upon admission to the room, he is drowsy but rousable. The nurse notes that his abdomen appears slightly distended. His dressing is dry and intact.

Medical Orders:
*Vital signs q15min.
*IV Lactated Ringer's at 125 mL/hr.
*Morphine 2 mg IV q2h PRN.

The nurse checks the vital signs: BP 88/54, HR 120, RR 22.

Question:
What is the nurse’s priority action? *

Increase the IV rate to a bolus and notify the surgeon immediately.

Check the dressing for external bleeding.

Administer Morphine for pain, as pain can cause tachycardia.

Place the patient in high-Fowler’s position to help breathing.

2. Mme. Lise Tremblay, 62 years old, is 1 day post-splenectomy. She is lying flat in bed and refuses to move or take deep breaths. She tells the nurse, "It hurts too much under my ribs when I breathe." The nurse auscultates the lungs and hears diminished breath sounds in the left lower base.

Medical Orders:
*Incentive Spirometry q1h.
*Hydromorphone 0.5 mg IV q3h PRN.
*Encourage early mobilization.

Question:
What is the nurse’s best intervention to prevent pneumonia? *

Allow her to rest quietly to reduce oxygen demand.

Apply oxygen at 2 L/min and reassess in 2 hours.

Notify the respiratory therapist to perform suctioning.

Administer the pain medication and then assist her to splint the incision with a pillow while deep breathing.

3. M. Pierre Roy, 30 years old, is being discharged 4 days post-splenectomy. The nurse is reviewing long-term safety precautions. M. Roy asks, "So now that my spleen is gone, do I need to worry about anything specific in the future?"

Medical Orders:
*Discharge home.
*Follow up in 2 weeks.

Question:
What is the most critical teaching point regarding infection? *

"You are no longer at risk for infection once the incision heals."

"You should take antibiotics every time you eat raw vegetables."

"If you develop even a minor fever or sore throat, you must see a doctor immediately."

"You should avoid contact with anyone who has a cold for the rest of your life."

4. Mme. Claire Bouchard, 55 years old, is 3 days post-splenectomy. The nurse reviews her morning Complete Blood Count (CBC).

Lab Results:
*Hemoglobin: 110 g/L (stable).
*WBC: 11.0 x 10⁹/L.
*Platelets: 650 x 10⁹/L (High).

Medical Orders:
*Dalteparin (Fragmin) 5000 units SC daily.
*Encourage ambulation.

Question:
How should the nurse interpret the platelet count? *

This indicates a severe infection; notify the MD.

This is an expected finding after splenectomy, but it increases the risk of blood clots (DVT).

This indicates internal hemorrhage; prepare for transfusion.

This is a laboratory error; request a repeat draw.

5. M. Robert Fortin, 40 years old, is scheduled for an elective splenectomy in 3 weeks due to Idiopathic Thrombocytopenic Purpura (ITP). He visits the pre-admission clinic.

Medical Orders:
*Pre-op blood work.
*Immunization review.

Question:
Which vaccines are essential for this patient to receive before surgery? *

Hepatitis A and B.

Tetanus and Diptheria.

Pneumococcal, Meningococcal, and H. Influenzae type b (Hib).

Shingles (Zoster) and MMR.

6. M. Sylvain Cote, 50 years old, is 2 days post-splenectomy. He complains of steady, severe pain in the left upper quadrant radiating to his back. He has vomited twice this morning.

Medical Orders:
*NPO.
*NG tube if vomiting persists.
*Check Amylase and Lipase levels.

Question:
What complication does the nurse suspect? *

Kidney stones.

Pancreatitis.

Incisional hernia.

Gastric ulcer.

7. Mme. Sophie Lemieux, 68 years old, is 12 hours post-op. She reports feeling extremely nauseated and "bloated." The nurse observes that her abdomen is distended and tympanic (drum-like) on percussion. Bowel sounds are absent.

Medical Orders:
*NPO.
*IV fluids.
*Insert Nasogastric (NG) tube PRN for severe distension/vomiting.

Question:
What is the nurse’s priority action? *

Administer Gravol (Dimenhydrinate) IM.

Encourage the patient to drink ginger ale to burp.

Insert the NG tube to decompress the stomach.

Ambulate the patient to move the gas.

8. M. André Desjardins, 25 years old, is being monitored after a traumatic injury to the spleen (non-operative management initially). He suddenly calls the nurse and says, "My left shoulder is killing me!"

Assessment:
*No injury to the shoulder.
*Abdomen is tender on palpation in the LUQ.
*BP has dropped from 120/80 to 100/60.

Medical Orders:
*Strict bed rest.
*Serial Hemoglobin q6h.

Question:
What is the clinical significance of the shoulder pain? *

It is referred pain from gas (laparoscopy).

It is Kehr’s Sign, indicating irritation of the diaphragm by fresh blood (hemorrhage).

It is muscle strain from the hospital bed.

It is a sign of myocardial infarction.

9. Mme. Valérie Turcotte, 33 years old, is being discharged post-splenectomy. She works as a travel guide and travels internationally often.

Medical Orders:
*Discharge home.
*Antibiotics on hand for travel.

Question:
What safety measure should the nurse recommend? *

"Carry a sterile surgical kit with you when you travel."

"Wear a MedicAlert bracelet or carry a card stating you are asplenic."

"Take a daily aspirin to prevent clots while flying."

"Avoid traveling to tropical countries forever."

10. M. Michel Lambert, 58 years old, is 2 days post-op. His NG tube was removed this morning. He asks the nurse, "When can I eat a real meal? I'm starving." The nurse auscultates hypoactive bowel sounds.

Medical Orders:
*Advance diet as tolerated.

Question:
What is the appropriate dietary progression? *

Start with a full tray of solid food immediately.

Keep NPO until he has a bowel movement.

Start with clear liquids (water, broth, Jell-O) and monitor for nausea/distension.

Give a protein shake to boost healing.

11. Mme. Isabelle Gagnon, 28 years old, had a splenectomy 5 days ago. She is a "foodie" and enjoys dining out. During discharge teaching regarding infection prevention, she asks the nurse, "My friends are planning a sushi dinner to celebrate my recovery next week. Is that okay?"

Medical Orders:
*Discharge home.
*Monitor for signs of infection.

Question:
What is the nurse’s most appropriate response? *

"Yes, sushi is healthy and high in protein, which helps healing."

"You can eat it as long as you dip it in soy sauce, which kills bacteria."

"You should avoid raw or undercooked meats and fish (like sushi)"

"You should only eat vegetarian sushi rolls to be safe."