Post Operative Care in Nursing: Splenectomy Complications Analysis

This report delves into the critical aspects of post-operative care in nursing, specifically focusing on complications arising from splenectomy surgery. It examines two primary complications: hemorrhage in the portal vein and injury to the pancreas. The report explores the pathophysiology of each complication, detailing how they occur and the potential impact on patient recovery. It also discusses management strategies, including the use of clot-dissolving factors, anticoagulants, pain management techniques, and interventions to address specific symptoms like portal hypertension and pancreatic injury. The report emphasizes the importance of diligent patient assessment and the implementation of both pharmacological and non-pharmacological interventions to ensure optimal patient outcomes and minimize risks. The report highlights the significance of understanding the underlying mechanisms of these complications to provide effective and timely nursing care.

Running head: POST OPERATIVE CARE IN NURSING
Post operative care in nursing
Name of the student:
Name of the university:
Author note:

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Table of Contents
Introduction:....................................................................................................................................2
Hemorrhage in the portal vein after splenectomy:..........................................................................3
Injury to the pancreas:.....................................................................................................................5
Conclusion:......................................................................................................................................7
References:......................................................................................................................................9

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015604/
Introduction:
It is very important for the health care professionals to be careful regarding the different
postoperative care complications that the patient can acquire and how it can be managed properly
to ensure that the patient is in optimal safe and comfortable stay while in the postoperative unit
and there are no risks to the patient. For this assignment, the case study of a patient aged 48 years
is chosen who had undergone a splenectomy surgery. For this assignment two different
postoperative complications are taken into consideration in order to understand the
pathophysiology of how these post operative complications occur and how best to prevent them
from threatening the health and wellbeing of the patient. For this study, the first chosen
complication is blood clotting in the vein that supplies blood to the liver of the patient (Coldwell,
Hollingsworth & Wilson, 2011). Now it has to be mentioned that this is the portal vein, which
supplies oxygenated blood to the liver. Following a splenectomy, that portal vein can be
obstructed very easily and can lead to many secondary exacerbic complications threatening the
recovery timeline of the patient and in certain cases even can lead to fatal consequences
facilitating tissue necrosis in the liver (Subramanian, Raina & Gupta, 2016). The second
exacerbation chosen for the study is injury to pancreas, which is also a very common post-
operative complication after a splenectomy surgery. This assignment will attempt to discover the
underlying pathophysiology of the complications, their correlation and the plausible management
for the complications.

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Hemorrhage in the portal vein after splenectomy:
Splenectomy is a surgery that involves partial or complete removal of the spleen, a fist
sized organ situated under the left side of the rib cage around the stomach. It has to be mentioned
that spleen is a very important element of the immune system of the human body and hence
removal of this particular organ can lead to various complications and exacerbations in the
patients. On a more elaborative note, the main two functions performed by the spleen include
containing the white blood cells that acts like the first line of defence in the body in order to fight
the most common infections in the body by targeting and destroying foreign particles. Along
with that, the other functions performed by the spleen include removing or filtering the old red
blood cells from the circulatory system (Jiang, Luo, Sun & Gao, 2017). In this case, Francine, the
patient in the case study had been through an accident that caused her severe abdominal injuries,
especially to her spleen and hence the surgical intervention was administered to save her life.
However, it has to be mentioned that the patient had been a chain smoker and smoked 20
cigarettes a day for past 35 years of her life and hence the chances of her acquiring a few
postoperative complications are extremely high. The first post operative complication that she
can develop is the damage to the hepatic portal vein of the patient after the surgical removal of
the spleen (Davidson, Yaghoobi, Davidson & Gurusamy, 2017).
According to the Dong, Xu, Wang and Petrov (2013), the hepatic portal vein can be
defined as the vessel that helps in circulating the blood from the spleen and gastrointestinal tract
to the liver. The size of this particular vein is usually 3 to 4 inches in length, it is generally
formed by the superimposition of the superior mesenteric and splenic veins behind the upper
edge of the head of the pancreas. It has to be mentioned in this context that the hepatic portal
vein is responsible for supplying almost 75 % of the blood flow to the liver, however it is not a

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true vein. Researchers are of the opinion that the portal vein thrombosis has become recognized
as the one of the key postoperative complications associated with abdominal surgeries, especially
the splenectomy surgeries. On a more elaborative note, it has to be mentioned that this particular
postoperative complication is associated with a wide array of severity and can even threaten the
life of the patient. According to the article by Gurusamy, Pallari, Hawkins, Pereira and Davidson
(2016), the occurrence of hepatic portal vein thrombosis is a very common phenomenon
resulting from an abdominal surgery, in case of splenectomy, the incidence rate of hepatic portal
vein thrombosis is 10 to 15% in the adult patients. Exploring the underlying pathophysiology of
the disease, it has to be mentioned that this particular postoperative complication is facilitated by
the surgical trauma in the abdomen. It has to be mentioned in this context that, in the preliminary
48 hours after the surgery the chances of surgical site being inflamed is extremely high. The
inflammation of the surgical site often exerts a crucial pressure on the surrounding organs and
venous system around the area. Now, the hepatic portal is already a narrow structure and the
excessive pressure on the vein causes it be constructed and hence blockage is facilitated in the
hepatic portal vein. This blockage disrupts the blood flow to the liver, as the hepatic portal
supplies nutrient rich blood to the liver, blockage of the hepatic portal leads to tissue starvation
in the liver and paves way for more compliactioons in the patients (Peng et al., 2015 pan).
Considering the management of hepatic portal thrombosis, the preliminary intervention
for the hepatic portal thrombosis is targeted at dissolving the blood clot that has formed in the
hepatic portal. In this case, the nursing professional will have to assess the patient diligently for
signs of hepatic portal vein bleeding and tissue necrosis. In case the patient is exhibiting the
signs and symptoms of the same, administration of clot dissolving factors is the most important
intervention technique (Cheng et al., 2015). The patient would need to be given tissue

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plasminogen activator is generally provided in order to facilitate thrombolysis that will dissolve
the blood clot. In case the patient does not respond to the above mentioned intervention, more
severe anticoagulants will be administered to the patient such as the heparin along with the
plasminogen activator so that the clot can no increase in size. Along with that, in case portal
hypertension facilitated by the blood clot causes varicose vein bleeding in the esophagus,
administration of antihypertensive drugs such as the beta blockers and nitrates can also be
administrated to reduce the portal vein pressure which in turn will reduce the bleeding in the
esophagus (Petermann et al., 2012).
Injury to the pancreas:
It has to be mentioned in this context, that another post- operative complication that can
occur to the patient includes the injury to the pancreas. On a more elaborative note, pancreatic
injury can be defined as any trauma sustained by the pancreas due to any blunt forces wor by anu
abdominal surgeries. As per the evidence, the rate of the patient acquiring pancreatic trauma
following a splenectomy surgery is 3 to 5 %. The injury to the pancreas following a spleen
removal surgery generally leads to high serum amylase levels, which is generally clinically
unrecognized (Ahmed Ali et al., 2012 pan). However, in certain cases, depending on the health
status of the patient and the severity of the surgical procedure, the injury to pancreas can even
lead to clinical pancreatitis and pancreatic fistula. Both of the conditions are known to exert a
huge burden on the condition of the patient who is recovering from the splenectomy and accident
trauma. Exploring more on the pathophysiology of how the post operative disorder develops, it
has to be mentioned that, immediately after the splenectomy the enhanced hepatic portal

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hypertension often causes the vein to bleed in the surrounding areas. As a result fluid back up is
created in the left subphrenic space immediately after the splenectomy leading to pancreatic
fistula. However, Cheng et al. (2017), have contradicted that the pancreatic injury takes at least
24 to 48 hours to develop completely to become clinically recognizable. Moreover , due to this
particular complication facilitated in the patient that vascular supply to the pancreatic tail is cut
off, which has been reported as the clinical indication of the pancreatic injury in the patient.
However, on the contrary, the Ahmed Ali et al. (212), have stated in the article that the most
abundantly reported clinical indication of pancreatic injury, which facilitates easy clinical
recognition, is by the formation of a well capsulated pancreatic pseudocyst. As mentioned by the
Dong, Xu, Wang & Petrov (2013), in their article the failure of the nursing management to
diagnose this condition properly leads to subphrenic abscess leading to protracted post- operative
clinical course. Lack of careful manipulation of the pancreatic tail while performing the surgery
has also been recognized as a significant cause to pancreatic injury in the patients.
The most important diagnostic intervention to check the presence of pancreatic injury is
to perform Serum amylase or lipase determination on the second day of the surgery. Researchers
are of the opinion that the signs and symptoms of pancreatic injury take at least 24 to 48 hours to
manifest completely. As mentioned by the Qu, Ren, Li, Qian and Liu (2013), the chances of a
patient with abdominal post surgery hemorrhage to acquire pancreatic injury is as high as 30%.
Hence, with the possibility of the hemorrhage being high in the patient under the case study as
well, the chances of the patient attaining pancreatic injury is also significantly high.
Considering the nursing management of the pancreatic injury, it is generally associated
with acute pain in the patients. Hence, the nursing professional will have to focus on both nom
pharmacological and pharmacological pain management. Hence, the nursing professional will

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have to administer mild analgesic to patient after successful assessment of the pain score using
any recognized pain assessment tool. Along with that, the nurse will have to asminister
nonpharmacological pain management such as relaxation and change of posture will alse be able
to help the patient (Kehoe et al., 2009). The nursing professional will also have to encourage the
patient to maintain the fluid volume in order to prevent renal failure in the patient due blood loss
and low albumin levels. Along with that nurse will have to consider mild respiratory
management in the patient to facilitate better breathing that can be obstructed by high risk to
elevation of diaphragm, pulmonary infiltrates and even effusion. Lastly, the nurse will have to
manage the biliary drainage by the placement and better management of biliary drains and
indwelling tubes or stents that are placed in the pancreatic duct will also facilitate better drainage
of the pancreas (Krauth, Lechner, Neugebauer & Pabinger, 2008)
Conclusion:
Post operative care can be defined as the extensive range of the care pattern followed for
a patient after the patent had gone through a surgery. It has to be mentioned in this context that
the impact of the surgery can have a huge burden on the patents in the initial period after the
surgery. On a more elaborative note, the extent and nature of the post operative care depends on
the particular type of the surgery that the patient has gone through, the type of the surgery that
the patient has gone through decides the kind of pain management, wound management,
injection control and other post operative care requirements that the patent will require. It has to
be mentioned that within the 48 to 72 hours after the surgery, the patents is said to be under the
most of the danger or threat to different post operative complications, which can even lead to
fatal consequences for the patient if it is not adequately managed. Hence, it is crucial for the
postoperative care team to understand the exact condition that the patient is under to be able to

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protect the patient from any possible postoperative complications. This essay has given key
insights regarding two postoperative complications that can occur in case of the splenectomy
along with key nursing managements

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References:
Coldwell, C., Hollingsworth, A., & Wilson, C. H. (2011). Spleen conserving surgery versus
splenectomy for injured patients with splenic trauma. The Cochrane Library. Doi:
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Jiang, T. T., Luo, X. P., Sun, J. M., & Gao, J. (2017). Clinical outcomes of transcatheter selective
superior mesenteric artery urokinase infusion therapy vs transjugular intrahepatic
portosystemic shunt in patients with cirrhosis and acute portal vein thrombosis. World
journal of gastroenterology, 23(41), 7470. doi: 10.3748/wjg.v23.i41.7470
Davidson, T. B. U., Yaghoobi, M., Davidson, B. R., & Gurusamy, K. S. (2017). Amylase in drain
fluid for the diagnosis of pancreatic leak in post‐pancreatic resection. The Cochrane Library.
Doi: 10.1002/14651858.CD012009.pub2/full
Dong, Z., Xu, J., Wang, Z., & Petrov, M. S. (2013). Stents for the prevention of pancreatic fistula
following pancreaticoduodenectomy. Cochrane Database Syst Rev, 6. Doi:
10.1002/14651858.CD008914.pub2/full
Gurusamy, K. S., Pallari, E., Hawkins, N., Pereira, S. P., & Davidson, B. R. (2016). Management
strategies for pancreatic pseudocysts. The Cochrane Library. Doi:
10.1002/14651858.CD011392.pub2/full
Peng, S., Cheng, Y., Yang, C., Lu, J., Wu, S., Zhou, R., & Cheng, N. (2015). Prophylactic
abdominal drainage for pancreatic surgery. Cochrane Database Syst Rev, 8. Doi:
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Cheng, Y., Briarava, M., Lai, M., Wang, X., Tu, B., Cheng, N., ... & Mocellin, S. (2017).
Pancreaticojejunostomy versus pancreaticogastrostomy reconstruction for the prevention of
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