A Patient having idiopathic thrombocytopenic purpura undergoes splenectomy. What will be the specific post operative intervention for this patient?

1. A

   Ventilation

2. B

   Specific splenectomy vaccination

3. C

   Airway maintain

4. D

   Urine output

Appeared in: NORCET 2 -2021 (Shift-2)

Explanation

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• Splenectomy is a treatment for refractory ITP as the spleen is a major site of platelet destruction.
• However, the spleen is a vital immune organ responsible for clearing encapsulated bacteria from the bloodstream.
• Its removal puts the patient at a lifelong, high risk for Overwhelming Post-Splenectomy Infection (OPSI), a severe and often fatal form of sepsis.
• Therefore, the most critical and specific post-operative intervention is vaccination against the most common encapsulated organisms: Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis.

Why Other Options Were Wrong

• Option A: This is a general supportive measure for patients recovering from anesthesia or those with respiratory compromise, not a specific intervention for the consequences of spleen removal.
• Option C: Maintaining a patent airway is the highest priority for any patient immediately following general anesthesia (following the ABCs of resuscitation), but it is not specific to a splenectomy.
• Option D: Monitoring urine output is a standard of care to assess fluid balance, renal perfusion, and hemodynamic stability after any major surgery.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Post-splenectomy patient management and infection prevention to guide bedside assessment, documentation, and the next nursing action.
• Patient education is a critical nursing responsibility. Nurses must ensure the patient and their family understand the lifelong risk of OPSI and the importance of the vaccination schedule.
• Patients should be advised to wear a medical alert bracelet or carry a card indicating they are asplenic.
• Nurses must teach patients to seek immediate medical attention for any fever (e.g., temperature above 38°C or 100.4°F) or other signs of infection, as OPSI can be fatal within hours.

How to Approach the Question

• First, identify the key procedure in the question: splenectomy.
• Note the critical keyword "specific." This directs you to find an intervention directly related to the physiological consequence of removing the spleen, not a general post-surgical intervention.
• Recall the primary functions of the spleen. While it's involved in filtering blood cells (relevant to ITP), its major immune function is clearing encapsulated bacteria.
• Evaluate the options based on this knowledge. Are they general or specific? Ventilation, airway maintenance, and urine output monitoring are fundamental to all post-operative care.
• Recognize that vaccination directly addresses the loss of the spleen's specific immune function and the subsequent risk of OPSI.
• Therefore, select the option that is a unique requirement for a patient without a spleen.

Concept Tested & Keywords

• Concept Tested: Post-splenectomy patient management and infection prevention.
• Stem keywords: idiopathic thrombocytopenic purpura, splenectomy, post operative intervention
• Lead-in keywords: specific
• Negative lead-in flag: false

Question ID

QUfVU_sUV5ReYohA_R1ttC

Copy ID

Reference Book

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 859-861

E6 Medicine Harrison 22e Part 1 p. 523-525