Which of the following conditions indicates that spinal shock is resolving in a client with C7 quadriplegia?
A. Absence of pain sensation in chest
B. Spasticity
C. Spontaneous respirations
D. Urinary continence
Correct Answer: B. Spasticity
Spasticity, the return of reflexes, is a sign of resolving shock. Spinal or neurogenic shock is characterized by hypotension, bradycardia, dry skin, flaccid paralysis, or the absence of reflexes below the level of injury. Spinal shock is a result of severe spinal cord injury. It usually requires high-impact, direct trauma that leads to spinal cord injury and spinal shock. The initial encounter with a patient that has spinal shock is usually under a trauma scenario.
Option A: The absence of pain sensation in the chest doesn’t apply to spinal shock. With high cervical injuries, the diaphragmatic function will be compromised, and these patients will necessitate early tracheotomy since they will be ventilator dependent. Deep vein thrombosis is excessively high in these patients.
Option C: Spinal shock descends from the injury, and respiratory difficulties occur at C4 and above. In spinal shock, there is a transient increase in blood pressure due to the release of catecholamines. This is followed by a state of hypotension, flaccid paralysis, urinary retention, and fecal incontinence. The symptoms of spinal shock may last a few hours to several days/weeks.
Option D: The full spinal examination should include motor, sensory reflexes including bulbocavernosus reflex and anal wink reflex. Motor activity and strength decrease not only in the skeletal muscles but the motor activity of internal organs like bowel and bladder. This decrease leads to constipation and urinary retention.
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