# A nurse is caring for a patient who underwent a splenectomy 24 hours ago. Which nursing intervention is the highest priority to prevent postoperative complications? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540643 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a patient who underwent a splenectomy 24 hours ago. Which nursing intervention is the highest priority to prevent postoperative complications? A 60-year-old patient had an emergency splenectomy following a motor vehicle accident that caused splenic rupture. The surgery was completed 24 hours ago, and the patient is now stable in the surgical unit. ## 보기 1. Encourage early ambulation to prevent deep vein thrombosis 2. Monitor for signs of bleeding at the surgical site 3. Assess pain levels and provide adequate analgesia 4. Monitor for signs of infection and implement infection prevention measures **✔ 정답** **정답: 4** ## 해설 Post-splenectomy patients are at high risk for overwhelming postsplenectomy infection (OPSI), making infection prevention the priority. Other interventions are important but do not address this unique, life-threatening complication. ## 심화 해설 Understanding the Priority After Splenectomy Following a splenectomy, the body loses its primary filter for bloodborne pathogens and a major site of antibody production, particularly IgM. This creates a lifelong, heightened susceptibility to overwhelming infection by encapsulated bacteria. While all listed interventions are important components of postoperative care, the physiological change in immune function makes infection prevention the most critical long-term safety consideration, even in the immediate 24-hour postoperative period. Why Infection Prevention is the Highest Priority The spleen is rich in macrophages that clear opsonized bacteria from the bloodstream. Without it, the patient is at extreme risk for overwhelming post-splenectomy infection (OPSI), a fulminant and rapidly fatal sepsis. The foundational research by Kita et al. emphasizes that enhancing patient understanding and adherence to infection prevention behaviors is a critical gap in care, directly addressing the life-threatening risk that begins immediately after surgery [1]. This makes proactive monitoring for early signs of infection and implementing strict prevention measures the nurse's highest priority to prevent a catastrophic complication. Analysis of Other Options - Option 1 (Encourage early ambulation): This is a standard postoperative intervention to prevent deep vein thrombosis and pulmonary complications. However, for a patient with a recent splenic rupture and emergency surgery, the timing of ambulation must be carefully evaluated against hemodynamic stability and surgical site integrity. It is not the highest priority compared to a life-threatening immunological risk. - Option 2 (Monitor for signs of bleeding): This is a critical assessment in the first 24 hours following any major abdominal surgery, especially after a traumatic splenic rupture. However, the scenario states the patient is now "stable," suggesting that the immediate, active hemorrhagic risk has been managed. While monitoring must continue, the insidious and rapidly fatal nature of OPSI elevates infection prevention above ongoing bleeding surveillance in a stable patient. - Option 3 (Assess pain levels and provide analgesia): Adequate pain control is essential for promoting mobility, deep breathing, and comfort. However, pain is a symptom to be managed, not a primary, life-threatening postoperative complication in itself. This intervention supports recovery but does not address the highest-priority risk of mortality from sepsis. Clinical Application of the Evidence The study by Kita et al. highlights that patient education materials are vital for improving self-efficacy and adherence to infection prevention [1]. For the nurse, this translates into immediate actions: performing meticulous hand hygiene, using aseptic technique for any invasive procedures, monitoring for subtle signs of infection (such as a slight temperature elevation to 38.0°C or a change in respiratory rate), and initiating early patient education about the critical importance of reporting any fever or malaise. The nurse must recognize that a fever in an asplenic patient is a medical emergency, not a routine postoperative finding, because the patient lacks the splenic macrophages necessary to clear even a small bacterial inoculum. This evidence-based understanding shifts the nursing focus from general postoperative tasks to a targeted, immunologically-informed surveillance plan.References (research sources) - [1]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 ## 임상 시나리오 Post-Splenectomy Infection PreventionPriority Nursing Actions for the Asplenic Patient The highest priority after splenectomy is preventing overwhelming post-splenectomy infection (OPSI), a rapidly fatal sepsis caused by encapsulated bacteria (e.g., S. pneumoniae, H. influenzae, N. meningitidis). This risk begins immediately post-op and is lifelong. Implement strict infection prevention: monitor vital signs and surgical site for early signs of infection (fever, redness, purulence) every 4 hours. Ensure strict hand hygiene and aseptic technique for all wound care. CautionA low-grade fever may be the only initial sign of OPSI. Do not dismiss it. Any sign of infection in an asplenic patient is a medical emergency requiring immediate blood cultures and broad-spectrum IV antibiotics. ## 핵심 개념 - **Overwhelming Post-Splenectomy Infection (OPSI)** — A fulminant, rapidly fatal sepsis occurring in asplenic patients due to the body's inability to clear encapsulated bacteria from the bloodstream. - **Splenectomy** — Surgical removal of the spleen, resulting in a lifelong immunocompromised state with a heightened risk for infection by encapsulated organisms. - **Encapsulated Bacteria** — Bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis that have a polysaccharide capsule, making them difficult to clear without splenic macrophages. - **IgM** — An antibody isotype produced by the spleen that is critical for the initial immune response against bloodborne pathogens. ## 같은 주제 문제 - [A nurse is caring for a 72-year-old client who underwent a splenectomy 48 hours ago. 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