Neurological Disorders Q 92

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The nurse is planning care for the client in spinal shock. Which of the following actions would be least helpful in minimizing the effects of vasodilation below the level of the injury?

  

     A. Monitoring vital signs before and during position changes.

     B. Using vasopressor medications as prescribed.

     C. Moving the client quickly as one unit.

     D. Applying Teds or compression stockings.

    

    

Correct Answer: C. Moving the client quickly as one unit.

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Reflex vasodilation below the level of the spinal cord injury places the client at risk for orthostatic hypotension, which may be profound. Immobilize the patient. A sandbag and tape are not sufficient. Spinal immobilization in patients with penetrating trauma is not recommended. Patients with spinal cord injury need to be evaluated in a timely fashion to minimize secondary injuries. Preferably, these patients should be evaluated at level one trauma centers due to the extent of injuries.

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Option A: Measures to minimize this include measuring vital signs before and during position changes, use of a tilt-table with early mobilization, and changing the client’s position slowly. Oxygenation should be maintained and bradycardia managed with atropine. A Foley should be inserted and the output monitored. Some patients may benefit from low-dose dopamine.

Option B: Vasopressor medications are administered per protocol. The cause of hypotension has to be treated. Hemorrhage may be due to injury in the chest or abdomen. Fluid resuscitation is vital. Crystalloid is often used to reverse the hypotension. The goal should be to bring the blood pressure at 90-100 mm Hg systolic.

Option D: Venous pooling can be reduced by using Teds (compression stockings) or pneumatic boots. Deep vein thrombosis is excessively high in these patients. Prophylaxis should be initiated as soon as possible within days of the injury. Long-term management of spinal shock injury patients always requires multidisciplinary team treatment between different services. Approximately 60% of these patients will require spine stabilization with surgical intervention, and neurosurgery or orthopedic professionals should be consulted early.

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