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Difficulty: MediumPhysiological Adaptation

An emergency department nurse receives a client who sustained a C5 spinal cord injury from a diving accident earlier in the day. The healthcare team is monitoring for the development of neurogenic shock. Which assessment findings should the nurse recognize as indicating the onset of this specific complication? Select all that apply.

  1. Apical heart rate of 48 beats/minAnswer
  2. Blood pressure of 82/44 mm HgAnswer
  3. Flushed, warm skin below the level of injuryAnswer
  4. D
    Sinus tachycardia with a rate of 122 beats/min
  5. E
    Cool, clammy, and pale skin
  6. F
    Narrowing of the pulse pressure

Answer

The assessment findings indicating neurogenic shock are an apical heart rate of 48 beats/min, a blood pressure of 82/44 mm Hg, and flushed, warm skin below the level of injury.
Neurogenic shock occurs when a spinal cord injury above T6 disrupts the sympathetic nervous system. This loss of sympathetic tone causes massive peripheral vasodilation (resulting in severe hypotension and warm, flushed skin) and leaves the parasympathetic nervous system unopposed (resulting in bradycardia). Therefore, a low heart rate, low blood pressure, and warm skin below the level of injury are the classic indicators.

Step-by-Step Solution

1
Analyze the client's history and current risk factors.
The client has a C5 spinal cord injury, which places them at high risk for neurogenic shock due to the potential disruption of sympathetic nervous system pathways.
Understanding the mechanism of injury helps anticipate specific physiological complications.
2
Differentiate the pathophysiology of neurogenic shock from other types of shock.
Neurogenic shock is a distributive shock characterized by a loss of sympathetic tone, leading to massive vasodilation and unopposed parasympathetic response (bradycardia), unlike hypovolemic shock which involves compensatory vasoconstriction and tachycardia.
Accurate identification relies on recognizing the unique hemodynamic profile of neurogenic shock.
3
Evaluate each assessment finding against the expected manifestations of neurogenic shock.
Bradycardia, hypotension, and initially warm/flushed skin match the vasodilation and parasympathetic dominance of neurogenic shock. Tachycardia, cool/clammy skin, and narrowing pulse pressure are signs of compensatory sympathetic activity seen in other shock states.
This confirms which clinical signs indicate the onset of this specific complication.

Key Concept

Neurogenic shock uniquely presents with hypotension, bradycardia, and initially warm/dry skin due to the loss of sympathetic tone and resulting massive vasodilation.
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Topics

Physiological Adaptation

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