RUPTURED

SPLEEN
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DEFINITION
 Is an emergency medical condition that occurs when the
capsule-like covering of the spleen breaks open, pouring
blood into your abdominal area.

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CAUSES
 Blunt trauma
 Motor vehicle crashes
 Direct blow to the abdomen
 Penetrating trauma
 Spontaneous Rupture
 Malaria
 Infectious mononucleosis

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SIGNS AND SYMPTOMS
 Pain in the upper left abdomen-may be severe with
tenderness and guarding due to injury on the spleen and
exposure of the nerve endings
 Left shoulder pain – due to raising pressure within the
abdomen from the internal bleeding.
 Pain radiates from the diaphgram to the left shoulder.

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 Hypotension – due to bleeding
 Tachycardia – due to the compensation of the heart by
pumping faster
 Restlessness, sweating, short of breath will be present as
shock sets in.
 Pallor in the conjunctiva and palms – due to rapid loss of
blood
 Loss of consciousness due to hypovolemia.
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POST OPERATIVE
MANAGEMENT
Medical Management
 History taking – quickly obtain history from both the
patient and relatives to establish the part of the body where
trauma was applied.
 Lab investigations
 Blood for Hb, grouping and x-match at least 2 pints of blood.
 Abdominal X-ray and Ultrasound – to establish the internal
bleeding or establish other causes of acute abdomen
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MEDICAL MANAGEMENT
 Physical examination
 Done gently and quickly.
 Palpate for the spleen
 Inspect the conjunctiva and palms for the degree of pallor to assess
the anaemia
 Spleenic angiography – may be done if time and facility
allows to visualize the splenic blood vessels
 IVF – NS for resuscitation while awaiting blood transfusion

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NURSING MANAGEMENT –
PRE OP
Objectives
 To resuscitate patient
 To alley anxiety
 To prevent further complications
 To prepare patient physically for operation

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RESUSCITATION
 Quickly provide a bed at the acute bay
 Establish an IV access and commence a drip of NS to
maintain the arterial pressure while awaiting blood
transfusion.
 Prescribed blood should be administered before patient
goes to theatre to prevent shock
 Oxygen must be administered if patient is dyspnoeic

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PSYCHOLOGICAL CARE
 Explain the condition to both patient and relatives that the
spleen is ruptured and is bleeding and that the only option
is to remove it so that the bleeding is stopped and to save
live
 Explain to patient that an incision will be made on the
abdomen to remove the spleen.

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CONT..
 Reassure them that there will be no change or effect in the
normal life after removal of the spleen
 Explain the expectations of the theatre environment to
allay anxiety
 Explain to them about the possible effects of anaesthesia
so that know what to expect post operatively

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CONSENT
 Obtain consent from the patient/ relatives and have a
consent form signed.

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OBSERVATIONS
 Initial obs to be done upon admission then quarter hourly
and baseline data before patients goes for theater
 Observe patients’ general condition to see if the condition
is improving or getting worse and institute measure
accordingly
 Monitor the patients response while receiving blood
transfusion every ¼ hourly initially.

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OBSERVATIONS
 Monitor intake and output and ensure there is a balance
 Record all observation findings and report to the
incharge/doctor each time until patient is taken to theater.

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PREMEDICATION
 Prescribed drugs like antibiotics must be administered.
 Ensure that the anaesthetist sees patient for an evaluation
and if any drugs eill be prescribed, they need to be
administered. E.g. atropine to reduce secretion and valium
to rex the patient

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PHYSICAL PREPARATION
 Skin preparation
 Quickly clean the patient if necessary, wipe out all dirt and
blood
 Shave the abdomen from nipple line to mid-thigh and
cleanse the skin with either soap and water and dry or
disinfectant to minimize risk of infections during and after
surgery

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CATHETERISATION
 Patient is catheterized to continuously drain the bladder
during surgery to avoid injuries

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NG TUBE INSERTION
 NGT is inserted to aspirate and empty the stomach
contents.
 This is important to prevent aspiration of contents during
and after surgery while patient is still under the effects of
anaesthesia
 Patient must be kept nil orally from admission

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LABELLING/SAFETY
 Provide identity of patient to avoid accidental operations
by labelling correctly patients details. i.e. name, age, sex,
diagnosis, procedure, and ward
 Remove all jewelry and dentures and store in a locked
cupboard or give to relatives around

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GOWNING
 Change the patient into a clean theater gown to lessen the
risk of infection

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TAKING PATIENT TO THEATER
 Collect all case notes, x-ray films, lab results, ultrasound
results and carry to theatre
 Carry already crossmatched blood for use in theater
 Put a patient on a stretcher, escort him/her in the company
of relatives and continue reassuring them
 Handover everything to the theater staff

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POST OPERATIVE BED
 While waiting for patients’ return, prepare a postoperative
bed
 Ensure the necessary equipment and accessories are
available in the cubicle.
 Working oxygen and suction machines should be made
available

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COMPLICATIONS OF
RUPTURED SPLEEN
 Haemorrhage – due to poorly ligated blood vessels during operation

 Wound infection – manifested by fever due to lack of use of aseptic techniques or

contamination from linen
 Dehiscence due to excessive strain on a wound resulting from coughing, malnutrition and
general debilitation
 Atelectasis and pneumonia

 Pancreatitis and pancreatic fistula formation: due to its proximity to the spleen, pancrease
maybe infected or have a fistula from the spleen site
 Overwhelming life-threatening infection following splenectomy

 Shock

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THE END

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