Question

Ms. S is a 64 year-old retiree who was admitted to the hospital for an emergency splenectomy following a fall. Her medical history includes: Type II diabetes for the past 10 years, hypothyroidism, atrial fibrillation, and obesity. Until her fall, she had not had any problems related to her spleen. Her mother was also had diabetes and all of her siblings have atrial fibrillation. Medications: Synthroid, Metformin, atenolol, and a baby aspirin a day.

It is now three days post op and the large abdominal wound from her surgery is red and draining yellow drainage. Her vital signs are 145/80; HR-90, R-20, T-100.8 F.

In your concept/patho map be sure to include all the steps from the risk factors to the development of the diseases or problems following her splenectomy. The more details you can provide the better.

Here are the areas to be sure to include in your concept map:

> Splenectomy: relationship among splenectomy and infectious processes; impact on red blood cells and oxygenation; stress related to surgery; impact on blood glucose.

> Hypothyroidism: impact on cardiac system; blood glucose, skin, immunity, tissue perfusion

> Diabetes: relationship among obesity, insulin resistance, changes in vessels, circulation, WBCs, relationship between blood glucose and pathogens

> Atrial fibrillation: what happens to cardiac output, WBCs, oxygenation of tissues, impact on infection

> Systems connectivity: indicate all relationships between and among the various systems

build a concept map

Answer 1

Purulent leakage, best referred to as pus, in an incision is not a natural finding. There can be a variety of colours including white , yellow, grey, green, pink, and brown.

Suppose this kind of drainage is a sign of infection unless otherwise confirmed. Color alone does not mean infection, but the surgeon should be informed of a transition from plain drainage to colourful drainage.

Splenectomy can be recommended for the treatment of ITP, and platelet counts increase dramatically in most patients when the spleen is removed. In any of the diseases in which the spleen eliminates unnecessary blood cells, splenectomy will most frequently increase peripheral RBC, WBC, and platelet counts

No proper control of RBC following splenectomy may cause anaemia. Decreased WBC number raises the risk factor of infection. Reduced blood platelets cause blood clot inability which leads to bleeding both externally and eternally.

But other organs such as the liver will compensate for a lot of spleen function in the absence of spleen. There are large numbers of cases that live their lives without spleen this is because the absence of spleen is coped with by liver and other immunoresponsive organs. There is, however, a small amount of infection that could develop quickly. But the risk is very high if you have taken the right vaccine in your early life.

The wound healing ability will be poor after splenectomy (because the removal of dead blood cells is challenged), and the patient suffers from DMII, the risk of wound healing ability increases again.

This operation can be operated by laparoscopy but didnot understand why this patient went to major open surgery by understanding she has DMII and atrial fibrillation.

Hypothyroidism and DMII both have an additive effect of obesity since the metabolic activity is decreased. But both are problem related to age, and it is normal in old female hypothyroidism. So with these nothing to worry with spleen you have to do more physical work and proper iodine in diet solve the rest issues.

DMII increases blood glucose levels and this contributes to glucose toxicity in the brain and other peripheral organs. This eventually contributes to the destruction of neuropathy and brain activity. This further affects several functions so this needs to be regulated by medicine or physical work on the blood glucose.

The key problem is atrial fibrillation (AF) that can cause many harm. In AF heart is unable to pump blood to the organs and blood clot form in the heart that pumped into brain and heart so if this clot blocks heart attack can occur or this can cause stroke in brain. Both conditions are fatal, and when patient is not involved the event increases. The dilemma here, as well as the positive thing, is that AF causes blood clotting and late blood clotting causes spleen removal. It balances each other under normal conditions, but at the time of haemorrhage, blood clotting medication increases the risk of heart attack and anticoagulant increases the bleeding.