Neurogenic shock is a life-threatening condition resulting from damage to the sympathetic nervous system, typically due to spinal cord injury. This nursing diagnosis focuses on identifying symptoms, preventing complications, and providing comprehensive care to patients experiencing neurogenic shock.
Causes (Related to)
Neurogenic shock can occur due to various factors affecting the autonomic nervous system:
- Spinal cord injury (particularly above T6)
- Trauma to the central nervous system
- Surgical complications
- Medical conditions include:
- Multiple sclerosis
- Guillain-Barré syndrome
- Transverse myelitis
- Iatrogenic causes such as:
- Spinal anesthesia
- Epidural complications
- Certain medications
Signs and Symptoms (As evidenced by)
Neurogenic shock presents distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Dizziness or lightheadedness
- Weakness
- Anxiety
- Nausea
- Visual disturbances
- Numbness or tingling below the injury level
Objective: (Nurse assesses)
- Hypotension
- Bradycardia
- Warm, dry skin below injury level
- Decreased muscle tone
- Flaccid paralysis
- Loss of reflexes
- Temperature dysregulation
- Priapism in male patients
Expected Outcomes
The following outcomes indicate successful management of neurogenic shock:
- The patient will maintain stable blood pressure
- The patient will maintain adequate tissue perfusion
- The patient will demonstrate improved cardiovascular stability
- The patient will maintain a normal body temperature
- The patient will avoid complications
- The patient will show improved neurological status
- The patient will maintain skin integrity
Nursing Assessment
Monitor Vital Signs
- Check blood pressure, heart rate, and temperature frequently
- Monitor cardiac rhythm
- Assess for orthostatic hypotension
- Document hemodynamic trends
Assess Neurological Status
- Monitor consciousness level
- Check pupillary responses
- Assess motor and sensory function
- Document reflexes
- Evaluate pain levels
Evaluate Cardiovascular Status
- Monitor peripheral perfusion
- Check capillary refill
- Assess skin temperature and color
- Monitor cardiac output
- Document fluid balance
Monitor for Complications
- Assess for autonomic dysreflexia
- Check for pressure injuries
- Monitor respiratory status
- Evaluate bowel and bladder function
- Watch for deep vein thrombosis
Review Risk Factors
- Document the mechanism of injury
- Assess comorbidities
- Review medication history
- Evaluate support systems
- Check for contraindications to treatments
Nursing Care Plans
Nursing Care Plan 1: Decreased Cardiac Output
Nursing Diagnosis Statement:
Decreased Cardiac Output related to autonomic nervous system disruption as evidenced by hypotension, bradycardia, and decreased peripheral perfusion.
Related Factors:
- Sympathetic nervous system disruption
- Vasodilation
- Decreased venous return
- Altered heart rate and contractility
Nursing Interventions and Rationales:
- Monitor vital signs q15min or as ordered
Rationale: Allows early detection of cardiovascular deterioration - Administer prescribed vasopressors
Rationale: Improves blood pressure and tissue perfusion - Maintain a supine position with legs elevated
Rationale: Enhances venous return
Desired Outcomes:
- The patient will maintain MAP >65 mmHg
- The patient will demonstrate adequate tissue perfusion
- The patient will maintain a heart rate within the normal range
Nursing Care Plan 2: Risk for Ineffective Thermoregulation
Nursing Diagnosis Statement:
Risk for Ineffective Thermoregulation related to autonomic nervous system dysfunction as evidenced by temperature instability and poikilothermia.
Related Factors:
- Sympathetic nervous system disruption
- Impaired vasomotor control
- Environmental exposure
- Altered metabolic state
Nursing Interventions and Rationales:
- Monitor core temperature continuously
Rationale: Enables prompt intervention for temperature fluctuations - Implement temperature management protocols
Rationale: Maintains normothermia - Adjust the environmental temperature as needed
Rationale: Supports temperature regulation
Desired Outcomes:
- The patient will maintain a core temperature between 36.5-37.5°C
- The patient will demonstrate stable temperature readings
- The patient will remain free from complications of temperature dysregulation
Nursing Care Plan 3: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to immobility and altered sensation as evidenced by risk for pressure injuries.
Related Factors:
- Immobility
- Decreased sensation
- Altered circulation
- Moisture
Nursing Interventions and Rationales:
- Perform frequent skin assessments
Rationale: Enables early detection of skin breakdown - Implement turning schedule q2h
Rationale: Reduces pressure on susceptible areas - Use pressure-relieving devices
Rationale: Distributes pressure evenly
Desired Outcomes:
- The patient will maintain intact skin integrity
- The patient will remain free from pressure injuries
- The patient will demonstrate improved tissue perfusion
Nursing Care Plan 4: Risk for Autonomic Dysreflexia
Nursing Diagnosis Statement:
Risk for Autonomic Dysreflexia related to spinal cord injury above T6 as evidenced by the potential for severe hypertension and bradycardia.
Related Factors:
- Spinal cord injury above T6
- Bladder distention
- Bowel impaction
- Skin irritation
Nursing Interventions and Rationales:
- Monitor for signs of autonomic dysreflexia
Rationale: Enables rapid intervention - Maintain bowel and bladder programs
Rationale: Prevents triggering factors - Educate patient and family about symptoms
Rationale: Promotes early recognition and intervention
Desired Outcomes:
- The patient will remain free from autonomic dysreflexia episodes
- The patient will demonstrate knowledge of prevention strategies
- The patient will maintain stable vital signs
Nursing Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety related to an acute medical condition and uncertain prognosis as evidenced by expressed concerns and physiological symptoms.
Related Factors:
- Life-threatening condition
- Uncertain prognosis
- Change in health status
- Loss of independence
Nursing Interventions and Rationales:
- Provide emotional support and reassurance
Rationale: Reduces anxiety and promotes coping - Explain procedures and treatments
Rationale: Increases understanding and reduces fear - Facilitate family involvement
Rationale: Enhances support system
Desired Outcomes:
- The patient will demonstrate decreased anxiety levels
- The patient will utilize effective coping strategies
- The patient will verbalize understanding of condition and treatment
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Dave S, Dahlstrom JJ, Weisbrod LJ. Neurogenic Shock. [Updated 2023 Oct 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459361/
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- McKinley W, McNamee S, Meade M, Kandra K, Abdul N. Incidence, etiology, and risk factors for fever following acute spinal cord injury. J Spinal Cord Med. 2006;29(5):501-6. doi: 10.1080/10790268.2006.11753899. PMID: 17274488; PMCID: PMC1949035.
- Savage KE, Oleson CV, Schroeder GD, Sidhu GS, Vaccaro AR. Neurogenic Fever after Acute Traumatic Spinal Cord Injury: A Qualitative Systematic Review. Global Spine J. 2016 Sep;6(6):607-14. doi: 10.1055/s-0035-1570751. Epub 2016 Jan 30. PMID: 27556002; PMCID: PMC4993608.
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