A nurse is teaching a group of older adult clients at the senior center about chronic illnesses.
Which of the following acronyms should the nurse teach to the clients to help them remember common manifestations of a stroke?

Choice A rationale

Bradycardia is a common complication of cervical spinal cord injury, particularly in injuries at or above the T6 level. This occurs due to disruption of the sympathetic nervous system pathways that originate in the thoracic spinal cord, leading to unopposed parasympathetic (vagal) tone. The vagus nerve, which originates from the brainstem, then slows the heart rate significantly.

Choice B rationale

Hypotension, often referred to as neurogenic shock, is a significant complication of cervical spinal cord injury. Damage to the sympathetic pathways interrupts sympathetic outflow to the peripheral vasculature, leading to widespread vasodilation and pooling of blood in the extremities. This results in a decrease in systemic vascular resistance and subsequently, a profound drop in blood pressure.

Choice C rationale

Hyperthermia is less common immediately after a spinal cord injury compared to poikilothermia or hypothermia, where the body's temperature fluctuates with the ambient temperature due to impaired thermoregulation. The sympathetic nervous system, responsible for vasoconstriction and sweating, is disrupted, leading to an inability to regulate body temperature effectively. While hyperthermia can occur, it's not the primary immediate concern; rather, impaired thermoregulation generally manifests as difficulty maintaining a stable core temperature.

Choice D rationale

A weakened gag reflex is a critical complication of a high cervical spinal cord injury. Injuries affecting the brainstem or the cranial nerves that control swallowing (glossopharyngeal and vagus nerves) can impair the gag reflex and the ability to protect the airway. This increases the risk of aspiration, necessitating careful assessment of swallowing ability and potential airway protection.

Choice E rationale

Polyuria, meaning excessive urination, is not a typical immediate complication of cervical spinal cord injury. While neurogenic bladder can occur later, leading to issues with bladder emptying or incontinence, polyuria is not directly caused by the acute neurological injury. It could be a sign of diabetes insipidus, which is a rare complication of severe head trauma impacting the pituitary gland, not primarily spinal cord injury.

Choice A rationale

A myasthenic crisis is a life-threatening exacerbation of myasthenia gravis characterized by severe muscle weakness, particularly affecting the respiratory muscles. This can lead to impending or actual respiratory failure, necessitating immediate intervention with mechanical ventilation to support breathing and prevent hypoxemia and hypercapnia.

Choice B rationale

A vasoconstrictor would elevate blood pressure by constricting blood vessels. Myasthenic crisis primarily involves profound muscle weakness, not typically hypotensive states requiring vasoconstrictors. Administering a vasoconstrictor would not address the underlying respiratory compromise or muscle weakness.

Choice C rationale

Pursed-lip breathing is a technique used to prolong exhalation and improve ventilation in individuals with obstructive lung diseases like COPD. While it can help with dyspnea, it is insufficient to manage the severe respiratory muscle weakness seen in a myasthenic crisis and would not prevent respiratory failure.

Choice D rationale

Sedatives depress the central nervous system and can further impair respiratory drive and muscle function, which would be detrimental in a myasthenic crisis. The client's respiratory status is already compromised, and sedation would exacerbate hypoventilation and increase the risk of respiratory arrest.