Neurological Disorders Q 98

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The nurse is evaluating neurological signs of the male client in spinal shock following spinal cord injury. Which of the following observations by the nurse indicates that spinal shock persists?

  

     A. Positive reflexes

     B. Hyperreflexia

     C. Inability to elicit a Babinski’s reflex.

     D. Reflex emptying of the bladder.

    

    

Correct Answer: C. Inability to elicit a Babinski’s reflex.

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Resolution of spinal shock is occurring when there is a return of reflexes (especially flexors to noxious cutaneous stimuli), a state of hyperreflexia rather than flaccidity, reflex emptying of the bladder, and a positive Babinski’s reflex. It is more appropriate to use the trauma activation code announced when a patient with spinal shock arrives at the emergency department, that way the trauma team can complete a full workup for the patient. The full spinal examination should include motor, sensory reflexes including bulbocavernosus reflex and anal wink reflex.

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Option A: Often it is observed that the patient starts losing neurologic function above the level of injury, which brings anxiety to an inexperienced provider prompting more imaging of the patient’s spinal cord. Loss of function that happens several days post-injury above the level of the injury is mostly due to spinal cord pathways rearrangement.

Option B: Once this process abates, the function above the injury returns to normal, although the exact time needed for this process is not precisely defined and could last from weeks to months. If a patient survives the initial injury but remains immobile, the area fills with gliotic tissue.

Option D: 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. It is of utmost importance to record an American Spinal Injury Association (ASIA) score as prognostic long-term expectations can be made with fair accuracy before any discussion with family and the patient. While evaluating the patient, assume their spine is unstable and take all the necessary precautions to keep it stable until final imaging is obtained and stability is established.

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