Neurogenic shock is a condition of the body that causes irregular blood circulation due to damage to the nervous system after an injury to the spinal cord.
Spinal cord injury may stop the blood vessels to constrict. When the blood vessel constricts slowing of the blood flow may happen.
Neurogenic shock usually lasts 1 to 6 weeks after the spinal cord injury. Neurogenic shock may cause a sudden decrease in blood pressure, heart rate, and temperature that may leave permanent damage to the body tissues that can be fatal if left untreated. Severe decrease in blood pressure and decrease in heart rate may usually occur.
Based on recent studies, people with spinal cord injury can acquire neurogenic shock. The neurogenic shock will affect the sympathetic nervous system that regulates the tone of the muscles in the walls of the blood vessels.
The sympathetic nervous system connects the organs of the brain thru spinal nerves. The sympathetic nervous system is included in the two-division of the autonomic nervous system (ANS) as well as the parasympathetic nervous system.
The sympathetic nervous system consists of neurons in the peripheral nervous system that can maintain homeostasis.
Signs and Symptoms of Neurogenic Shock
The main symptom of neurogenic shock is a decrease in blood pressure. Hypotension is due to the loss of muscle activity in the blood vessel that may lead to organ damage. If the blood cannot carry oxygen to the body, the organs will experience oxygen starvation and cause the tissues to die. However, a decrease in blood pressure or hypotension may lead to other symptoms such as:
- brady arrhythmia or slow heart rhythm – this happens when the heartbeat is slower than normal and the rhythm is irregular. The normal range of the heart is 60- 100 beats per minute.
- dizziness or feeling of lightheadedness and loss of balance – may be caused by the sudden drop in blood pressure.
- nausea or a sensation of wanting to vomit accompanied by stomach discomfort
- vomiting – may result from a decrease in blood pressure that may cause dehydration if untreated immediately.
- anxiety – the body’s usual response to stress due to a medical emergency caused by irregular blood circulation.
- skin pallor – determines the amount of blood that flows to the skin and is a manifestation of a decreased number of red blood cells.
- excessive sweating may be caused by a medical condition and neurologic disease
- fainting, and altered mental status due to loss of circulation to the brain which results in impaired nutrient and tissue oxygen delivery. Fainting is also known as “passing out” and usually lasts a few seconds to minutes. Fainting and altered mental status usually calls for concern because can be caused by a serious medical problem.
- decreased body temperature – happens when the body temperature drops too low because of the interruption of the sympathetic nervous system.
In addition to these, severe cases of neurogenic shock may manifest through the following symptoms:
- difficulty in breathing – respiratory difficulty is one of the causes of death and complications in patients with acute and chronic phases after an injury. difficulty in breathing can develop gradually or suddenly. breathing problems may show symptoms such as faster breathing rate, wheezes, blue fingernails, and nasal flaring.
- chest pain may occur due to a lack of oxygen to the heart. chest pain may vary in quality, intensity, duration, and location. chest pain may indicate a common heart problem.
- body weakness due to irregular circulation of the blood. the body’s circulation system acts to send blood, oxygen, and nutrients to the body. Reduced blood flow to body parts may cause poor circulation to the extremities and cause weakness of the legs and arms.
Neurogenic shock can cause damage to the tissues and death. The death may occur because of cardiogenic and hypovolemic shock.
Cause of Neurogenic Shock
Neurogenic shock is often caused by trauma or spinal cord injury which results in the loss of body functioning and stimulation of the sympathetic nervous system.
The sympathetic nervous system enables the body to use energy and functions during physical activity and helps the body respond to dangerous and stressful situations.
The sympathetic nervous system helps in strengthening the beat of the heart, increases blood pressure, and improves breathing.
Other causes and risk factors of neurogenic shock may include:
- Trauma to the spine from a sports injury
- Gunshot wounds that hit the spine
- The usage of medications that affect the autonomic nervous system
- Spinal anesthesia injection into the space surrounding the spinal cord that causes a decrease in blood pressure
- Depressant action of prescribed medications may also cause neurogenic shock
- Stroke occurs when blood vessels that bring oxygen to the brain are blocked.
- Guillain-Barre syndrome happens when the immune system affects the body’s nerves.
- Transverse myelitis – a condition that involves the inflammation of the spinal cord.
Diagnosis of Neurogenic Shock
To diagnose neurogenic shock the physician will perform a physical examination and check for the blood pressure and other symptoms. Tests may also be done to detect the severity of the injury because of neurogenic shock. These diagnostic tools may include:
- Computed tomography. A CT scan is a series of X-ray images from different angles of the body and uses computer processing to make cross-sectional images of blood vessels, bones, and soft tissues. CT scan helps the physician to detect diseases and injuries by providing detailed pictures of the skull, brain, paranasal sinuses, and ventricles. CT scan is painless and also a non-invasive procedure for diagnosing a condition. During the CT scan, the patient will lie on a bed and the patient may be injected with a contrast dye intravenously.
- Magnetic resonance imaging. An MRI Scan helps in diagnosing conditions of the chest, abdomen, and pelvis using a magnetic field and computer-generated radio waves of the body. It may also help in detecting any irregularities of the spinal column and may help the physician to diagnose back pain and the source of neurogenic shock.
Before having MRI, the nurse should check if the patient has any of the following:
- heart pacemaker/defibrillator
- implanted devices such as brain stimulators, vague nerve stimulators, bladder stimulators, spine stimulators, or implanted electrodes
- stents
- metals in the body or eye
- claustrophobia
Treatment for Neurogenic shock
Neurogenic shock causes severe damage if not quickly treated. The goals of treatment for neurogenic shock should focus on the prevention of hypoxia and optimizing perfusion of the central nervous system and the critical organs. Treatment will help prevent any additional injury and damage.
- Hospitalization. The patient is strongly recommended to be admitted in the hospital for medical treatment. The physician will treat the decrease in blood pressure with intravenous fluids and treat the decrease in heart rhythm.
- Medication. Vasopressors are medicines that help to increase the contractility of the heart and constrict the narrow blood vessels that may cause an increase in blood pressure. Vasopressors stimulate the function of the nerve cell receptors. If the blood pressure is too low, the physician may give medication such as vasopressors or medications such as steroid and inotropic agents that help the blood vessels tighten, thus increasing blood pressure.
- Catheterization. A urinary catheter is used to measure the volume of the urine. Spinal injuries may cause incontinence and the patient may be unable to urinate on their own, by checking the urine physicians may detect signs of infection. Urinary catheterization uses a flexible tube to drain urine from the bladder to relieve urinary retention and provide irrigation for the patient.
- Immobilization. Immobilization may also help in the treatment of neurogenic shock in patients with spinal injury by using traction to help for the proper alignment of the spine. Immobilization limits motion that will allow the injury to heal the infected part and will help to lessen the pain and swelling as well as the muscle spasm. The physician may also put a collar or brace on the neck which prevents the injury from getting worse.
Prevention of Neurogenic Shock
There are no ways to prevent Neurogenic shock from happening but avoiding severe injuries that may cause damage to the nervous system is important. Using safety precautions is always advised for spinal cord injury prevention to decrease the risk of neurogenic shock. To prevent spinal cord injury, an individual should:
- Make sure to drive safely.
- Practice the use of a seat belt all the time when driving.
- Avoid diving into water when swimming.
- Using protective gear when playing sports.
- Immobilization of the spine to avoid injury to the spinal cord.
Nursing Diagnosis for Neurogenic shock
Nursing Care Plan for Neurogenic Shock 1
Nursing Diagnosis: Risk for Impaired Breathing Pattern related to innervation diaphragm secondary to Neurogenic shock
Desired Outcomes:
- The patient will maintain sufficient ventilation as evidenced by a normal respiratory rate.
- The patient’s Arterial blood gases will be regulated to their normal level.
- The patient will Exhibit appropriate actions to sustain the respiratory effort.
Neurogenic Shock Nursing Interventions
Check for the respiratory functioning of the patient by instructing the patient to breathe deeply. Check for the patient’s spontaneous effort and respiration quality. Neurogenic shock may cause complete loss of respiratory function depending on the phrenic nerve and diaphragmatic function involvement that generally cause decreased vital capacity and inspiratory effort.C-1 to C-3, and C-4 or C5 injuries can cause loss of respiratory function.
Check for the patient’s breath sounds for the absence of and decreased breath sounds. Checking the patient’s breath sounds helps the nurse assess for the presence of adventitious breath sounds.
Instruct the patient to cough, its strength, and effectiveness. Coughing may help to determine the function of the intercostal muscle of the patient through his/her ability to cough.
Arterial blood gas levels should also be checked for any abnormal findings. Regulating the normal level of arterial blood gases (ABG) should also be observed during neurogenic shock. Arterial blood gases are taken to check for measurement of the balance of oxygen and carbon dioxide.
Note for changes in skin color or the presence of cyanosis. Discoloration of the skin may indicate a lack of oxygen supply to the arterial blood. The tongue and lips that became cyanotic are caused by desaturation of the central arterial blood that may result from a cardiac and respiratory disorder.
Position the patient properly and limit positioning the patient to a prone position. Positioning increases ventilation of the lung segments, and secretion mobilization, and reduces the risk of complications.
Nursing Care Plan for Neurogenic Shock 2
Risk for Trauma
Nursing Diagnosis: Risk for Trauma related to temporary weakness and/or instability of spinal column secondary to neurogenic shock.
Desired Outcomes:
- The patient’s spine alignment will be maintained without further damage to the spinal cord.
- The patient will adapt to immobilization activities which aid healing.
- The patient will verbalize that his/her body weakness will be lessened.
Neurogenic Shock Nursing Interventions
Establish patient comfort by maintaining bed rest and providing immobilization devices. Providing immobilization devices such as sandbags, traction, halo, cervical collars and braces is important to maintain spine stabilization. Providing comfort will also help in the mobilization of the patient.
Position the patient with the head of the traction bed frame elevated. Secure the frames of the traction and the pulleys should always be aligned. Positioning the patient properly provides a safe and effective counterbalance. Weight should also be checked because weight pull depends on the size and amount of reduction needed to provide vertebral alignment.
Assist the patient to a position comfortable to the patient by using a sheet blanket, pillows, and foam wedges. The nurse may ask for help from other staff members when turning and repositioning the patient. The patient’s relatives and family may also be instructed on ways to properly turn and position the patient, without causing further trauma. Improper ways of repositioning and turning will cause additional injury to the patient. Proper ways of positioning and turning may reduce the risk of trauma.
Help the patient maintain skeletal tractions via tongs, calipers, and vests as indicated. Skeletal tractions will decrease fracture and dislocation. Skeletal traction is used to treat broken bones where the combination of pulleys, pins, and weights is used to heal fractured bones.
Explain the indication for internal stabilization surgery if indicated and as advised by the physician. Spinal stabilization and decompression of the cord may need surgery. Spinal stabilization helps in strengthening the back and muscles of the abdomen.
Nursing Care Plan for Neurogenic Shock 3
Nursing Diagnosis: Impaired Physical Mobility related to neuromuscular impairment secondary to neurogenic shock as evidenced by the inability to move.
Desired Outcomes:
- The patient’s strength will be increased and will utilize the unaffected body parts.
- The patient will show techniques and behaviors that will help in doing activities.
- The patient will verbalize comfort after the rest period of the activities.
Neurogenic Shock Nursing Interventions
Evaluate the motor function of the patient by asking the patient to do actions such as moving shoulders, spreading fingers, and squeezing the examiner’s hands. Evaluating the patient’s status is done to detect the level of injury and may help to formulate actions and goals for the patient’s interventions.
Educate the patient about the exercises that can be used for the extremities and the joints
by using gentle movements and assisting the patient in doing ROM movements. Organize activities to provide rest periods after the activities. This intervention will help to promote circulation and will help maintain muscle tone and mobility of the joints. Gentle movements will prevent deterioration of the muscles. Regular rest periods may decrease the occurrence of fatigue and will help encourage the patient to participate in the activities.
Place the patient’s arm at a 90-degree angle and the ankles at 90-degrees with a footboard. Positioning of arms and ankles at intervals will avoid frozen shoulders and will prevent foot drop and rotation of the hips.
Place the lower extremities in an elevated position if necessary and check for the presence of edema of the feet and ankles. Hypotension and thrombus formation may occur because of the loss of muscle action that causes the pooling of blood in the lower extremities.
Inspect the patient’s skin daily for possible pressure sores and provide skincare. Pressure sore may be present due to altered circulation and paralysis. Regularly changing the position of the patient will also help prevent pressure sores.
Nursing Care Plan for Neurogenic Shock 4
Nursing Diagnosis: Disturbed Sensory Perception related to the destruction of sensory tracts with altered sensory reception, transmission, and integration secondary to neurogenic shock as evidenced by anxiety, disorientation, and increased emotional response.
Desired Outcomes:
- The patient will identify physical impairments.
- The patient will recognize behaviors that will help in improving perception.
- The patient’s anxiety and emotional response will be decreased.
Neurogenic Shock Nursing Interventions
Examine the sensory function of the patient by touching and pin pricking and ask the patient to identify familiar objects. Inform the patient about the procedures that will be done during interventions Changes in sensory function may occur during neurogenic shock. Examination of sensory function will evaluate pain, position sense, vibration as well as the discriminative sensation of the patient.
Protect the patient from bodily harm such as burns, the position of the arm, and falls. Changes in sensory function may affect the patient’s sense of pain and the patient may not be aware of his position. The Nurse should always check the patient from time to time.
Allow the patient to do diversional activities that will help in reducing anxiety such as television, radio, and music. Orient the patient by using clocks, calendars, pictures, and bulletins. Orientation of the time, date, and pictures provides a sense of normality. Orientation will evaluate the patient’s mental status.
Allow the patient to have enough time to rest and sleep without interruptions. Sleeping patterns should always be established to reduce sensory overload and may promote orientation and increase coping abilities. Sleeping is needed by the patient to recharge the mind and the body.
Assess for the presence of an increase in emotional responses, and altered mental processes such as disorientation and unusual thinking. Altered thoughts may indicate sensory tracts and stress. Altered thoughts and mental processes may require further management.
Nursing Care Plan for Neurogenic Shock 5
Nursing Diagnosis: Acute Pain related to the pooling of blood due to thrombus formation secondary to neurogenic shock as evidenced by muscle spasms and burning below the level of injury.
Desired Outcomes:
- The patient will report pain relief and effective pain control.
- The patient will recognize pain management ways.
- The patient will use relaxation exercises and diversional activities to alleviate pain.
Neurogenic Shock Nursing Interventions
Assess the patient by asking about the quality of pain, location, type, and intensity (using a pain scale of 0 to 10 with 10 being the worst pain and 0 being no pain). Allow the patient to verbalize the level of pain, and advise the patient to report muscle spasms, burning, and the presence of radical pain related to injury and peripheral nerves.
Check for increased irritability, tension of muscles, increased restlessness, and unusual changes in the result of vital signs. The patient’s non-verbal body responses may indicate pain and may require interventions. The result of vital signs may increase when the patient is experiencing pain.
Place or turn the patient to a position that the patient is comfortable. Assist the patient when changing the patient’s position and apply warm or cold packs to the affected area as needed. Pain interventions help to decrease the need for taking pain medications. Non-pharmacological management such as positioning will help to decrease and alleviate pain. The nurse may ask for help or assistance from the patient’s family when changing the position and turning the patient.
Teach the patient relaxation techniques and use of diversional activities by using television, radio, and television, and allow visitors. Diverting the patient’s attention will help promote the patient’s control of pain and boost coping abilities. Diversional activities are provided to the patient to switch the focus of the patient to something else.
Offer and administer pain remedies such as muscle relaxants and analgesics and anti-anxiety medications, as prescribed by the physician. The physician may prescribe pain remedies to patients. Examine the patient’s previously taken medications and check for possible allergies.
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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