Neurogenic Shock: Definition, Causes, Signs & symptoms, Nursing management, Complications of Neurogenic Shock

 

Neurogenic Shock

 

Contents:

1.     Definition

2.   Causes of neurogenic shock

3.   Signs & symptoms of neurogenic shock

4.  Nursing management of neurogenic shock

5.   Complications of neurogenic shock

 

Definition of Neurogenic Shock:

Neurogenic shock is a devastating consequence of spinal cord injury, also known as vasogenic shock. Injury to the spinal cord results in a sudden loss of sympathetic tone, which leads to the autonomic instability that is manifested in hypotension, bradyarrhythmia & temperature dis-regulation.

 

 

Causes of neurogenic shock:

 

1.     Injury or trauma to the spinal cord or which may be caused by a dislocation, rotation and over extension or flexion of the cord. Trauma to the spinal cord may also occur as a result of sport injuries, vehicular accidents, falls and accidents, stab wound and gunshot wound.

2.   Neurogenic shock may also occur as a result of regional anesthesia that is improperly administered.

3.   Drugs and medications that can affect the autonomic nervous system may also result in neurogenic shock.

4.  Improper administration of regional anesthesia can also cause neurogenic shock.

 

Sign & symptoms of neurogenic shock:

 

A. Primary manifestation may include:

1.     Hypotension.

2.   Bradycardia.

3.   Hypothermia.

 

B. Other symptoms of shock include the following:

1.     A rapid & deep shallow breathing.

2.   Difficulty breathing.

3.   Cold & clammy skin.

4.  Pale skin appearance.

5.   Nausea & vomiting.

6.  Dizziness.

7.   Fainting.

8.  Rapid & weak pulse.

9.  Weakness is experienced as a result of insufficiency in the blood supply.

 

C. In severe state of neurogenic shock the symptoms may also be accompanied with the following symptoms:

1.     Blank stares or the eyes staring at nothing.

2.   Anxiety.

3.   Change in mental state or confusion and disorientation.

4.  Unresponsive to stimuli.

5.   Bluish discoloration of the lips and fingers which signify which signify a deprivation of oxygen in the body.

6.  Low urine output or urine may cease.

7.   Excessive sweating.

8.  Unconsciousness.

 

Nursing management of neurogenic shock:

 

1.     The patent is examined carefully and his/her general condition is assessed thoroughly. Special attention is given to the patient & circulation.

 

2.   It is important to immobilize the patient, especially the spinal region to prevent any further damage to the spinal cord.

 

3.   Administration of I/V fluids is done to stabilize the patient’s blood pressure.

 

4.  Inotropic agents such as dopamine may be infused for fluid resuscitation, if needed.

 

5.   Atropine is given intravenously to manage severe bradycardia.

 

6.  Patient with obvious neurological deficit can be given I/V steroids, such as methyl –prednisolone in high dose, within 8 hours of commencement of neurogenic shock.

 

7.   In spinal cord injury, general measures to promote spinal stability are initially used.

 

8.  Definitive treatment of the hypotension and bradycardia involves the use of vasopressors & atropine respectively.

 

9.  The role of the nurse in neurogenic shock involves:

                                            i)          Monitoring the patient’s ongoing physical & emotional status to detect changes in the patient’s condition.

                                         ii)          Planning & implementing nursing interventions and therapy.

                                      iii)          Evaluating the patient’s response to therapy.

                                       iv)          Providing emotional support to the patient and family

                                          v)          Collaborating with other members of the health team.

 

10.    Neurologic status, introducing orientation & level of consciousness should be assessed every hour or more often.

 

11.  Heart rate / rhythm , BP , central venous pressure & PA pressures including continuous cardiac , output should be assessed at least every 15 minutes and PAWP every 1 to 2 hours.

 

12.     Hourly urine output measurements assess the adequacy of renal perfusion and a urine output of less than 0.5 mm/kg/hr may indicate inadequate kidney perfusion.

 

13.     If a nasogastric tube is inserted, drainage should be checked for occult blood as should stools.

 

14.    Oral care for the patient in shock is essential and passive range of motion should be performed three or four times per day.

 

Complications of Neurogenic Shock:

 

1.     Brain damage.

2.   Acute renal failure.

3.   Nerve damage.

4.  Multiple organ dysfunction.

5.   Disseminated intravascular coagulation.

6.  Acute respiratory distress.

7.    Hepatic failure.                

 

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