Without surgical stabilization, what method of immobilization for the patient with a cervical spinal cord injury should the nurse expect to be used?

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.

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.