Mr. Spring had marked splenomegaly and profound constitutional symptoms including fatigue and night sweats. Due to anemia, there would be hemodilution, leading to an increased burden on the heart, thus resulting in congestive cardiac failure, and this was evident from his breathlessness and peripheral edema (Tefferi, 2005, p. 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 hematopoietic 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 an 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 the institution of intermittent calf compression.