A patient is admitted to the hospital with a C4 spinal cord injury after a motorcycle collision. The patient’s BP is 84/50 mm Hg, his pulse is 38 beats/minute, and he remains orally intubated. The nurse determines that this pathophysiologic response is caused by:
increased vasomotor tone after injury
a temporary loss of sensation and flaccid paralysis below the level of injury
loss of parasympathetic nervous system innervation resulting in vasoconstriction
loss of sympathetic nervous system innervation resulting in peripheral vasodilation
The Correct Answer is D
A spinal cord injury at the C4 level interrupts sympathetic nervous system innervation, leading to neurogenic shock. This is characterized by hypotension, bradycardia, and vasodilation due to unopposed parasympathetic activity. The loss of sympathetic tone prevents normal vasoconstriction and heart rate regulation, resulting in decreased cardiac output and systemic vascular resistance.
Rationale for correct answer:
4. Loss of sympathetic nervous system innervation resulting in peripheral vasodilation. Sympathetic pathways originate from the thoracic spinal cord; injury above this region disrupts their function. Without sympathetic input, systemic vasodilation and bradycardia occur, producing the hallmark signs of neurogenic shock.
Rationale for incorrect answers:
1. Increased vasomotor tone after injury. This is incorrect because the problem is not increased but decreased vasomotor tone. Loss of sympathetic control leads to vasodilation, not vasoconstriction.
2. A temporary loss of sensation and flaccid paralysis below the level of injury. This describes spinal shock, which causes motor and sensory deficits, but it does not account for the hemodynamic instability seen in this case.
3. Loss of parasympathetic nervous system innervation resulting in vasoconstriction. Parasympathetic innervation is not lost; instead, it remains unopposed when sympathetic tone is absent. This results in vasodilation and bradycardia, not vasoconstriction.
Take-home points:
- A high cervical injury can cause neurogenic shock due to loss of sympathetic tone.
- The classic signs are hypotension, bradycardia, and vasodilation.
- Differentiating between spinal shock (motor/sensory loss) and neurogenic shock (hemodynamic instability) is critical for accurate care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Older adults with spinal cord injury still require routine age-appropriate health screenings, including annual mammograms for women over 65. Preventive care remains critical, as persons with SCI may face increased risks of secondary complications, but they are not exempt from general health risks such as breast cancer.
Rationale for correct answer:
1. A mammogram is needed every year. Standard health maintenance is essential for SCI patients, and regular mammography helps with early detection of breast cancer.
Rationale for incorrect answers:
2. Bladder function tends to improve with age. Neurogenic bladder does not improve with aging; in fact, complications (UTIs, renal impairment, incontinence) may worsen.
3. Heart disease is not common in persons with spinal cord injury. Heart disease is common in SCI patients due to immobility, altered lipid metabolism, and reduced physical activity.
4. As a person ages, the need to change body position is less important. Pressure injury risk increases with both aging and immobility, making repositioning even more important.
Take-home points:
- Routine age-appropriate cancer screenings (like mammograms) remain a priority for SCI patients.
- Neurogenic bladder and cardiovascular disease risk persist or worsen with age.
- Skin care and pressure relief measures remain crucial throughout the lifespan.
Correct Answer is B
Explanation
These manifestations indicate autonomic dysreflexia, a medical emergency in patients with spinal cord injuries at or above T6. The first priority is to sit the client upright to lower blood pressure and reduce the risk of stroke. Immediate interventions focus on relieving the precipitating stimulus while monitoring cardiovascular status.
Rationale for correct answer:
2. Sit the client upright in bed. Elevating the head of the bed promotes venous pooling in the lower extremities, reducing systemic blood pressure and mitigating the acute risks of hypertensive crisis. This is the fastest and most effective initial intervention while assessing the cause of the episode.
Rationale for incorrect answers:
1. Notify the provider. Important, but provider notification should occur after immediate safety measures are initiated. Delaying action could increase risk of stroke or seizure.
3. Check the client’s urinary catheter for blockage. Bladder distention is a common trigger, but assessment of the cause comes after immediate BP control.
4. Administer antihypertensive medication. Medication may be needed if symptoms persist, but nonpharmacologic interventions (sitting upright, removing stimuli) are first-line emergency care.
Take-home points:
- Autonomic dysreflexia is a life-threatening emergency marked by severe hypertension, headache, and diaphoresis.
- Immediate priority is to sit the patient upright to reduce blood pressure.
- Identify and remove the triggering stimulus promptly to prevent complications such as stroke or seizure.
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