Splenectomy

  1. General information
    1. Indications
      1. Rupture of the spleen caused by trauma, accidental tearing during surgery, diseases causing softening or damage (e.g., infectious mononucleosis)
      2. Hypersplenism: excessive splenic damage of cellular blood components
      3. As the spleen is a major source of antibody formation in children, splenectomy is not recommended during the early years of life; if absolutely necessary, client should receive prophylactic antibiotics post-op
    2. Primary hypersplenism can be alleviated with splenectomy; procedure is palliative only in secondary hypersplenism
  2. Nursing interventions: pre-op
    1. Provide routine pre-op care and explain what to expect postoperatively.
    2. Administer pneumococcal vaccine as ordered since client will be at increased risk for pneumococcal infections for several years after splenectomy.
  3. Nursing interventions: post-op
    1. Be aware that it is crucial to monitor carefully for hemorrhage and shock as clients with pre-op bleeding tendencies will remain at risk post-op.
    2. Monitor post-op temperature elevation: fever may not be the best indicator of post-op complications such as pneumonia or urinary tract infection, as fever without concomitant infection is common following splenectomy.
    3. Observe for abdominal distension and discomfort secondary to expansion of the intestines and stomach; an abdominal binder may reduce distension.
    4. Know that post-op infection in a child is considered life threatening; administer prophylactic antibiotics as ordered.
    5. Ambulate early and provide chest physical therapy as location of the incision makes post-op atelectasis or pneumonia a risk.
    6. Emphasize to client the need to report even minor signs or symptoms of infection immediately to the physician.

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