Examkin

Soru

Zorluk: ZorPhysiological Adaptation

A client is receiving care in the intensive care unit 48 hours after sustaining a complete spinal cord transection at the T3 level. The bedside monitor suddenly alarms. Assessment reveals a blood pressure of 72/40 mm Hg, a heart rate of 42 beats/minute, and profoundly warm, flushed skin below the level of the injury. The client is lethargic but maintains a patent airway. Which intervention should the nurse implement first?

  1. Initiate a prescribed intravenous vasopressor infusion and prepare to administer atropine.Cevap
  2. B
    Assess the indwelling urinary catheter tubing for kinks and palpate the lower abdomen.
  3. C
    Elevate the client's lower extremities and place the bed in the Trendelenburg position.
  4. D
    Apply a forced-air warming blanket to address impaired autonomic thermoregulation.

Cevap

Initiate a prescribed intravenous vasopressor infusion and prepare to administer atropine.
A spinal cord injury at or above the T6 level disrupts sympathetic nervous system pathways. This client is exhibiting classic signs of neurogenic shock: unopposed parasympathetic stimulation leading to profound bradycardia, and a loss of vasomotor tone leading to massive vasodilation, which presents as severe hypotension and warm, flushed skin (unlike hypovolemic shock where the skin is cold and clammy). The immediate life-saving priority is to restore vascular tone and cardiac output using vasopressors and atropine.

Adım Adım Çözüm

1
Analyze the client's injury level, time since injury, and vital signs.
The client has a T3 spinal cord injury, is 48 hours post-trauma, and is presenting with profound hypotension, bradycardia, and warm, flushed skin.
Establishing the complete clinical picture is required to differentiate between various types of spinal cord complications.
2
Differentiate between neurogenic shock and autonomic dysreflexia based on hemodynamic parameters.
The presence of severe hypotension and bradycardia indicates neurogenic shock, whereas autonomic dysreflexia would present with severe hypertension.
Both conditions can occur with injuries above T6, but their hemodynamic profiles and required treatments are physiological opposites.
3
Determine the priority pharmacological intervention based on the physiological deficit.
The priority is to restore vascular tone and increase the heart rate using vasopressors and anticholinergics like atropine.
The loss of sympathetic nervous system outflow causes massive vasodilation and unopposed vagal tone, requiring immediate pharmacological circulatory support.

Anahtar Kavram

Early Recognition and Management of Neurogenic Shock
Bu soruyu puanla

Konular

Physiological Adaptation

Bu konudan daha fazla soru