# A nurse is caring for a 72-year-old client who underwent a splenectomy 48 hours ago. Which assessment finding would be the priority concern for the nurse?

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## 문제

A nurse is caring for a 72-year-old client who underwent a splenectomy 48 hours ago. Which assessment finding would be the priority concern for the nurse?

## 보기

1. Temperature of 101.2°F (38.4°C) with chills **✔ 정답**
2. Mild incisional pain rated 4/10
3. Decreased bowel sounds in all quadrants
4. Blood pressure of 128/82 mmHg

**정답: 1**

## 해설

Fever (101.2°F) with chills post-splenectomy indicates high infection risk due to loss of splenic immune function, requiring immediate intervention to prevent sepsis. Other findings (mild pain, decreased bowel sounds, normal BP) are less urgent post-operative concerns.

## 심화 해설

Understanding the Priority Concern After Splenectomy

Following a splenectomy, the body loses its primary filter for removing encapsulated bacteria from the bloodstream. The spleen is rich in macrophages that perform opsonization and phagocytosis, particularly against organisms such as Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Neisseria meningitidis. Without this defense mechanism, the client is at lifelong risk for overwhelming post-splenectomy infection (OPSI), a fulminant septic event that can progress from a mild febrile illness to septic shock and death within hours [1][2].

A temperature of 101.2°F (38.4°C) with chills in the early postoperative period is the classic presentation of a brewing systemic infection and must be treated as a medical emergency. The fever and rigors indicate that the immune system is attempting to mount a response, but the absence of splenic function significantly impairs the ability to clear the pathogen. This clinical picture aligns with the high-risk scenario described in post-splenectomy patient education literature, where any fever should prompt immediate evaluation and initiation of broad-spectrum antibiotics [2]. Case-based evidence further illustrates that severe, atypical infections, such as infective endocarditis caused by Gemella morbillorum, can emerge in the post-splenectomy period, highlighting the unpredictable and aggressive nature of infections in this population [3].

The other assessment findings, while requiring continued monitoring, do not represent immediate life threats. Mild incisional pain rated 4/10 is an expected postoperative finding and can be managed with prescribed analgesics. Decreased bowel sounds in all quadrants are a common manifestation of a postoperative ileus following abdominal surgery; this is a transient condition managed with bowel rest and gradual advancement of diet. A blood pressure of 128/82 mmHg is within a normotensive range and does not signal hemodynamic instability. The nurse's priority is to recognize that the combination of fever and chills in an asplenic client is the earliest and most critical indicator of a potentially fatal OPSI, necessitating immediate blood culture collection and prompt antibiotic administration as guided by institutional sepsis protocols .References (research sources)

- [1]Vaccination of Adults With Cancer: ASCO Guideline.GuidelineKamboj M, Bohlke K, Baptiste DM, Dunleavy K, Fueger A, Jones L, Kelkar AH, Law LY, LeFebvre KB, Ljungman P, Miller ED, Meyer LA, Moore HN, Soares HP, Taplitz RA, Woldetsadik ES, Kohn EC. (2024) · DOI: 10.1200/jco.24.00032

- [2]Development and evaluation of patient education material for splenectomy patients.Research articleKita M, Morita R, Shirano M. (2026) · DOI: 10.1016/j.pecinn.2026.100469

- [3]Infective endocarditis after splenectomy for ovarian cancer: a case report.Case reportYe L, Wang X, Zhao Q, Cheng X, Chen Y, Zhou B, Liu J, Ni J, Chen X. (2025) · DOI: 10.1186/s12893-025-03376-9

## 임상 시나리오

Post-Splenectomy Fever ProtocolImmediate Action for Suspected OPSI
Any temperature of 101°F (38.3°C) or higher in a post-splenectomy client is a medical emergency and must be treated as overwhelming post-splenectomy infection (OPSI) until proven otherwise.

Immediately obtain blood cultures and initiate empiric broad-spectrum IV antibiotics within 1 hour of presentation. Do not wait for culture results to start treatment.

CautionEven a low-grade fever with chills or rigors can herald rapid deterioration to septic shock. The absence of a spleen impairs clearance of encapsulated bacteria like S. pneumoniae, making early intervention critical.

## 핵심 개념

- **Overwhelming Post-Splenectomy Infection (OPSI)** — A fulminant, life-threatening septic event occurring at any time after splenectomy due to the body's impaired ability to clear encapsulated bacteria.
- **Splenectomy** — Surgical removal of the spleen, eliminating the primary filter for removing encapsulated bacteria from the bloodstream and increasing lifelong infection risk.
- **Encapsulated Bacteria** — Organisms such as Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis that are particularly dangerous post-splenectomy due to impaired opsonization.
- **Opsonization** — An immune process where pathogens are coated by antibodies or complement proteins to enhance phagocytosis, a function significantly reduced after splenectomy.

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