8520-8530). It is quite possible that his hematologic profile was further aggravated by splenomegaly-mediated exacerbation of the cytopenias through sequestrations and destruction of hematopeoitic elements. Splenectomy offered to him as a treatment modality would only reduce the splenomegaly-induced symptoms and functional abnormalities of his blood picture secondary to his marrow pathology.
Postoperative Phase: After the surgery, Mr. Spring was brought back to the ward with oxygen via nasal prongs on 2 L of oxygen with him saturating at 95%. His temperature was 36.8 and he was hypotensive. He was kept under observation. A stat dose of Lasix was given to reduce the fluid overload, and his urine output was 150 mL in the first hour following the injection and in the second hour, he passed another 100 mL. The dressing on the wound was clean, and there was no obvious ooze. The patient was provided with a patient controlled analgesia (PCA) morphine pump, and it was instructed to be on an as needed basis, since post surgical pain is important to prevent, and nursing has important role to play even though it is PCA . Intravenous opioids provide immediate relief and are short-acting, thus minimizing the potential for drug interactions or prolonged respiratory depression while anesthetics are still active in the patient's system (Marley & Swanson, 2001, 399-419). To prevent deep venous thrombosis, a stocking was in place with institution of intermittent calf compression.
Nursing Care Plan: Mr. Spring will be assessed for breathing, heart rate, rhythm, and other vital signs including continuous electrocardiographic monitoring, oxygen saturation, and the skin temperature. A complete review of systems will be undertaken on arrival of Mr. Spring from the operating theater.
Respiratory status will be monitored closely due to the fact that pulmonary complications are among the most frequent and serious problems encountered by the surgical patient (Woodrow 1999, 42-47). Airway patency and the quality of respirations, including depth, rate, and sound will be monitored, and chest auscultation will be done to verify that breath sounds are normal bilaterally, and the findings are documented as a baseline for later comparisons (Owen, 1998, 48-49). It is to be noted whether the breathing is noisy or shallow, since this may indicate secretions, aspirations, or cardiac failure. In this state when the patient lies on his back, the lower jaw and the tongue fall backward and the air passages become obstructed. Signs of occlusion include choking, noisy and irregular respirations, decreased oxygen saturation scores, and within minutes a blue, and cyanosis of the skin, and positioning is the best way to prevent hypoxia until the patient recovers. Oxygen therapy will be maintained as ordered (Bell, 1995, 297-300). It will be ensured that Mr. Spring maintains a clear airway by suction of the airway and positioning of the head.
Sepsis is a potential risk in this patient, and the early signs of sepsis are manifested by elevated temperature and an unstable profile of vital signs including temperature (Braun, Preston, Smith, 1998, 57-60). For this reason it is important to regularly monitor this patient. All care must be taken to provide