NCLEX RN Practice Question # 469

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Spinal shock

Description

  • Spinal shock is also known as neurogenic shock.
  • A sudden depression of reflex activity in the spinal cord occurs below the level of injury (areflexia).
  • Spinal shock occurs within the first hour of injury and can last days to months.
  • The muscles become completely paralyzed and flaccid, and reflexes are absent.
  • Spinal shock ends when the reflexes are regained.

Assessment

  • Spinal Shock
  • Flaccid paralysis
  • Loss of reflex activity below the level of the injury
  • Bradycardia
  • Paralytic ileus
  • Hypotension
  • Autonomic Dysreflexia
  • Sudden onset, severe throbbing headache
  • Severe hypertension
  • Flushing above the level of the injury
  • Pale extremities below the level of the injury
  • Nasal stuffiness
  • Nausea
  • Dilated pupils or blurred vision
  • Sweating
  • Piloerection (goose bumps)
  • Restlessness and a feeling of apprehension

Interventions

  • Monitor for signs of spinal shock following a spinal cord injury.
  • Monitor for hypotension and bradycardia.
  • Monitor for reflex activity.
  • Assess bowel sounds.
  • Monitor for bowel and urinary retention.
  • Provide supportive measures as prescribed,
  • based on the presence of symptoms.
  • Monitor for the return of reflexes.

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