A client after automobile accident brought to the emergency department, his blood pressure 100/80 mm hg, and heart rate 52 per minute, warm and dry skin, patient may suffer from?

1. A

   Spinal shock

2. B

   Autonomic dysreflexia

3. C

   Infection

4. D

   Hypoxia

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

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• The patient's presentation after an automobile accident (a common cause of spinal cord injury) includes the classic triad of neurogenic shock: hypotension, bradycardia, and warm, dry skin.
• Neurogenic shock develops from the loss of sympathetic nervous system function below the level of a spinal cord lesion, typically T6 or higher.
• This loss of sympathetic tone causes peripheral vasodilation (leading to hypotension and warm skin) and unopposed parasympathetic (vagal) stimulation (leading to bradycardia).
• Spinal shock refers to the temporary loss of reflex activity below the injury, and neurogenic shock is the hemodynamic consequence of this injury.

Why Other Options Were Wrong

• Option B: Autonomic dysreflexia is characterized by severe hypertension (high blood pressure), not hypotension. It also typically presents with a pounding headache and flushing/sweating above the level of the injury.
• Option C: Infection, particularly sepsis, would cause hypotension but is almost always accompanied by tachycardia (a high heart rate) and fever, not bradycardia.
• Option D: Hypoxia (low oxygen levels) typically causes a compensatory tachycardia (fast heart rate) as the body tries to increase oxygen delivery. The skin would likely be cool, clammy, and possibly cyanotic (bluish).

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Recognition of Neurogenic/Spinal Shock in acute care settings.
• Recognizing neurogenic shock is critical for nurses because it requires different management than other forms of shock. While most shock states are treated with large volumes of IV fluids, excessive fluid administration in neurogenic shock can lead to pulmonary edema due to the already dilated vascular system.
• Immediate nursing priorities for a patient with suspected spinal cord injury and neurogenic shock include immobilizing the cervical spine, maintaining a patent airway (ABCs), administering oxygen, and preparing for interventions to manage hemodynamics, such as vasopressors (e.g., norepinephrine) to counteract vasodilation and atropine to treat severe bradycardia.
• What if? - If the patient's heart rate was 120/min and their skin was cool and clammy, the primary diagnosis would shift to hypovolemic shock due to internal bleeding, and the immediate priority would be rapid infusion of crystalloids and blood products.

How to Approach the Question

• First, identify the context: a patient after a major trauma (automobile accident), which carries a high risk of spinal cord injury (SCI).
• Next, analyze the vital signs presented in the stem: BP 100/80 mmHg (hypotensive), HR 52/min (bradycardic), and skin that is warm and dry.
• Recognize the paradoxical combination of hypotension and bradycardia. In most shock states (like hypovolemic shock from bleeding), the body compensates for low blood pressure with a fast heart rate (tachycardia).
• This unique pattern (low BP + low HR + warm skin) is the hallmark of neurogenic shock, which is associated with acute SCI.
• Evaluate the options: 'Spinal shock' encompasses the clinical picture of acute SCI, including neurogenic shock. The other options (autonomic dysreflexia, infection, hypoxia) are inconsistent with the patient's vital signs.

Concept Tested & Keywords

• Concept Tested: Recognition of Neurogenic/Spinal Shock
• Stem keywords: automobile accident, blood pressure 100/80 mm hg, heart rate 52 per minute, warm and dry skin
• Lead-in keywords: may suffer from
• Clinical cues: The combination of hypotension and bradycardia after trauma is a critical cue pointing away from hypovolemic shock and towards neurogenic shock.

Question ID

QCleThQ_y6emwo7zSEHNv

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 100-102