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Difficulty: HardPhysiological Adaptation

A nurse in the emergency department evaluates a client who sustained a complete spinal cord injury at the T6 level in a traumatic incident 2 hours ago. During the assessment, the nurse notes the client's abdomen is firm, distended, and dull to percussion. The client's current vital signs are:

Blood pressure: 84/48 mm Hg
Heart rate: 128 bpm
Respiratory rate: 24/min

Based on the clinical presentation, which physiological complication should the nurse identify?

  1. Hypovolemic shock, as indicated by the compensatory tachycardia and abdominal findings.Answer
  2. B
    Neurogenic shock, resulting from an acute loss of sympathetic vascular tone below the injury.
  3. C
    Autonomic dysreflexia, triggered by a noxious visceral stimulus from the distended abdomen.
  4. D
    Spinal shock, leading to a temporary loss of systemic autonomic and motor reflexes.

Answer

The correct answer is hypovolemic shock, as indicated by the compensatory tachycardia and abdominal findings.
The client's clinical presentation of hypotension combined with significant tachycardia (128 bpm) and a firm, distended abdomen strongly indicates acute blood loss (hypovolemic/hemorrhagic shock). In a T6 spinal cord injury, the sympathetic cardioaccelerator fibers (T1-T4) remain intact, allowing the heart to mount a compensatory tachycardia in response to the decreasing intravascular volume.

Step-by-Step Solution

1
Analyze the client's vital signs and physical assessment findings.
The client is hypotensive (84/48 mm Hg) and tachycardic (128 bpm) with a firm, distended abdomen that is dull to percussion.
Identifying the specific hemodynamic profile is necessary to differentiate between various types of shock in a trauma patient.
2
Evaluate the findings in the context of a T6 spinal cord injury.
The tachycardia indicates an intact sympathetic cardioaccelerator response (T1-T4) to hypovolemia, while the abdominal findings suggest active intra-abdominal bleeding.
Patients with acute spinal cord injuries are at risk for multiple concurrent complications. Recognizing that neurogenic shock typically causes bradycardia helps rule it out, shifting the focus to a hemorrhagic source.

Key Concept

Differentiating shock states in spinal cord injury based on hemodynamic profiles
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Topics

Physiological Adaptation

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