The health care provider has ordered IV dopamine (Intropin) for a patient in the emergency department with a spinal cord injury. The nurse determines that the drug is having the desired effect when what is observed in patient assessment?

Muscle relaxants can have significant side effects in patients with acute cervical spinal cord injury, including respiratory depression, hypotension, and sedation. In the early post-injury phase, careful consideration is needed because these medications may exacerbate already compromised respiratory function. The nurse should clarify the order to ensure it is appropriate for the patient’s current neurological and respiratory status.

Rationale for correct answer:
4. Muscle relaxants. The client will still be in spinal shock 24 hr following the injury. The client will not

experience muscle spasms until after the spinal shock has resolved, making muscle relaxants

unnecessary at this time.

Rationale for incorrect answers:
1. Glucocorticoids. Glucocorticoids are appropriate medications to administer at this time as they are not universally contraindicated.
2. Plasma expanders. These are standard in managing hypotension or neurogenic shock and are appropriate in acute SCI care.
3. H2 antagonists. Used prophylactically to prevent stress ulcers, which are common in immobile patients, and are safe for acute SCI management.

Take-home points:

• Muscle relaxants may impair respiratory function in cervical SCI and require careful evaluation before use.
• Clarify medication orders to ensure safety and appropriateness based on the patient’s condition.
• Standard medications like plasma expanders and H2 antagonists are generally safe and part of routine acute SCI care.

A C4 spinal cord injury can result in paralysis of the diaphragm and intercostal muscles, which significantly compromises respiratory function. The greatest risk is respiratory compromise, which can lead to hypoventilation, hypoxia, and potential respiratory failure. Maintaining airway patency and monitoring respiratory status are top priorities in acute care.

Rationale for correct answer:
4. Respiratory compromise. C4 injuries impair diaphragmatic and accessory muscle function, making the patient highly dependent on ventilatory support. Early recognition of respiratory difficulty and timely interventions are critical to prevent life-threatening complications.

Rationale for incorrect answers:
1. Neurogenic shock. While possible in high-level SCI, neurogenic shock typically occurs acutely and is managed; it is not as immediately life-threatening as respiratory compromise in C4 injuries.
2. Paralytic ileus. Paralytic ileus is more common in thoracic and lumbar injuries; it is secondary in priority to airway and breathing concerns.
3. Stress ulcer. Stress ulcers are a potential complication but develop later and are not an immediate threat to life compared with respiratory failure.

Take-home points:

• C4 SCI patients are at highest risk for respiratory compromise due to diaphragmatic paralysis.
• Continuous monitoring of oxygenation, ventilation, and airway is essential.
• Early intervention with mechanical ventilation or suctioning may be required to maintain life-sustaining respiration.