shock, medical surgical, med surg
Hi friends in today's video. We're going to talk about neurogenic shock. And if you liked this video, make sure to give it a thumbs up and subscribe to the channel. I make educational content for nurses and nursing students to help you guys pass nursing school and paths and clacks. Also make sure to check out the link below.
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neurogenic shock is due to vasodilation. That occurs as a result of the loss of a balance between the parasympathetic and sympathetic nervous system. It's caused by a sudden loss of signals from the sympathetic nervous system, which maintains the normal muscle tone and blood vessels. So the pathophysiology is first the sympathetic stimulation.
In our body causes vascular smooth muscles to constrict and parasympathetic stimulation causes vascular smooth muscles to relax or dilate when the patient experiences a predominantly parasympathetic stimulation. This causes vasodilation blasting for an extended period of time. That leads to a hypovolemic state.
So hypertension. Occurs because blood volume, although is it is adequate because of the vasodilation of our blood vessels. It causes our blood pressure to drop and leads to a hypotensive state. Then there's cardiovascular changes. So because the overriding parasympathetic stimulation is occurring with neurogenic shock, it causes a drastic decrease in the patient's systemic vascular resistance and also bradycardia.
This leads to in sufficient perfusion because inadequate blood pressure results in the, or being insufficient perfusion of tissues and cells that is common with all types of shock. So the causes of neurogenic shock include spinal cord injury, which causes hypotension and bradycardia. Spinal anesthesia, which is an injection of an anesthetic into the space surrounding the spinal cord or severance of the cord, which results in a fall in blood pressure because of the dilation of the blood vessels in the lower position of the body and a resultant diminishing of venous returned to the heart.
And a depressant action of medication. So depression action of medication and lack of glucose can also cause neurogenic shock. So clinical manifestations that we may see as a sign of the parasympathetic stimulation is dry, warm skin. So instead of cool and moist skin, the patient experiences, a dry, warm skin due to the vasodilation and inability to vasoconstrict.
You're also going to see some hypotension which occurs due to sudden massive dilation, the bradycardia. I see, instead of getting tachycardic, the patient experiences bradycardia. And again, because we have that parasympathetic stimulation, we also might see diaphragmatic breathing. If the injury is below the fifth, cervical vertebrae, the patient will exhibit this type of breathing due to the loss of nervous control of the intercostal muscles, which are required for thoracic breathing.
And we may see respiratory arrest. If the injury is above the third cervical vertebrae, and they will go into respiratory arrest immediately following the injury due to loss of nervous control of the diaphragm. So just different assessment and diagnostic findings. So we may use a computerized tomography or a CT scan, which can provide a better look at abnormalities.
Seen on an x-ray can use an x-ray for people who are suspected of having a spinal cord injury after trauma, or we might do at magnetic. imaging or an MRI, which uses a strong magnetic fields and radio waves to produce a computer generated image. So as different medical management that we may use in patients with neurogenic shock, which involves restoring sympathetic tone, it would be either through the stabilization of the spinal cord injury or in the instance of spinal anesthesia by positioning the patient appropriate.
We may use immobilization. If the patient has a suspected case of a spinal cord injury, a traction may be needed to stabilize the spine to bring it into proper alignment. And we may use IV fluids to stabilize the patient's blood pressure. There's different pharmacological therapies we can use to help patients who are undergoing neurogenic shock, which include.
Inotropic agents such as dopamine for which can be used for fluid resuscitation. Atropine is given by IV to manage severe bradycardia steroids may be used which will be given by in high doses, within eight hours of the commencement of neurogenic shock. And heparin may be administered or low molecular weight heparin as prescribed to prevent thrombus formation.
So nursing management includes airway, breathing, circulation assessment. You should follow basic. Airway breathing and circulation approaches to the trauma patient while protecting the spine from extra movement and neurological assessments and identify neurological deficits in a general level of which abnormalities began and can help to identify when these abnormalities started.
So nursing diagnoses. These are just some examples, but we could say respire impaired breathing pattern related to impairment of innervation of the diaphragm risk of trauma related to temporary weakness, instability of spinal cord impaired physical mobility related to neuro muscular pain. Disturbed sensory perception related to destruction of sensory tracks with altered century reception, transmission and integration and acute pain related to pooling up blood secondary to thrombus formation.
So nursing care plans and goals are to maintain adequate ventilation as evidenced by the absence of respiratory distress and ABGs within acceptable limits demonstrate appropriate behaviors to support respiratory effort, maintain proper alignment of the spine without further damage, maintain positioning of function as evidenced by the absence of foot drop or contractures, increased strength of unaffected or compensatory body parts, demonstrate techniques and behaviors that enable resumption of activity recognized. Sensory impairments, identify behaviors to compensate for deficits and verbalize awareness of sensory needs and potential for deprivation and overload.
So different nurse nursing interventions that we can use with these types of patients with neurogenic shock it should be geared towards supporting cardiovascular and neurologic functioning. This can include elevating the head of the bed. So elevation of the head helps prevent the spread of anesthetic agent up the spinal cord. When a patient receives spinal or epidural anesthesia, we can also do some lower extremity interventions, such as applying an anti embolism, stocking and elevating the foot of the bed, which may help to minimize the pooling of blood in the legs and prevent thrombus formation.
We can also encourage exercise their passive range of motion of the immobile extremity to help promote circulation. We can support airway patency by maintaining a patent airway, keeping the head in the neutral position, elevate the head of the bed slightly. If tolerated and use airway adjuncts.
As indicated we can support the patient using oxygen using nasal prongs, a mask intubation, or a vent. We can support activities so we can plan activities to provide uninterrupted, rest periods and income, encourage involvement within the individual tolerance and ability of the patient. We can look at blood pressure monitoring by measuring and monitoring the blood pressure before and after activities in acute phases or until stable we can reduce anxiety by helping the patient to recognize and their anxiety. And we can also compensate for alterations in mental status. Our evaluation can include all types of different things, but here's just some examples. So maintained adequate ventilation demonstrated appropriate behaviors to support respiratory efforts, maintain proper alignment of the spine without further spinal cord damage maintained position of function, increased strength of unaffected and compensatory body parts demonstrated techniques, behaviors that enable.
Resumption of activity recognized sensory impairments, identified behaviors to compensate for deficits and verbalized awareness of sensory needs and potential for a deprivation and overload. So our documentation guidelines should include a relevant history of the problem, the different respiratory patterns that we see, the breath sounds.
Any accessory muscle use laboratory values. Past in recent history of injury, awareness of safety needs, use of safety equipment, or procedures, environmental concerns, or safety issues, level of functioning ability to participate in specific or desired activities. The client's description of pain, specifics about the pain, different pain management, and was this acceptable.
Prior medication use plan of care, specific interventions who's involved in the planning, teaching plan, the patient's responses to the interventions, what actions were performed, what is the treatment regimen? Attainment a progress towards desired outcomes and modifications to the plan of care. All right.
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