Page 309 - Critical Care Nursing Demystified

294 CRITICAL CARE NURSING DeMYSTIFIED

Autonomic Nervous Syndromes That Occur with SCI
Autonomic nervous syndromes can occur during SCI or the recovery phase.
Common syndromes include spinal and neurogenic shock, orthostatic hypoten-
sion, and autonomic dysreflexia.
Spinal shock – A condition that occurs immediately after a traumatic spinal
cord injury. Flaccid paralysis and a complete loss of all normal reflex activity
below the level of injury is evident, including the loss of motor, reflex, sensory,
and autonomic function. Bowel and bladder retention also occur. This condition
can last for several weeks after injury, and its severity is determined by the level
of injury. Spinal shock ends when spastic paralysis replaces flaccid paralysis.
Neurogenic shock – Known as a second shock state that can occur after spi-
nal cord injury above the T6 level. Sympathetic nerve fibers are disrupted
and the parasympathetic system becomes dominant, resulting in vasodilata-
tion and a decreased heart rate. Blood pressure will also be decreased as a
result of decreased venous return. The classic signs of neurogenic shock are
hypotension, hypothermia, and bradycardia.

Orthostatic hypotension – This type of syndrome might occur after a spinal
cord injury because the patient cannot compensate for position changes. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Messages from the medulla are unable to reach the blood vessels, instructing
them to vasoconstrict, and the result is an extreme hypotension as the pa-
tient’s position changes from lying to sitting or standing.
Autonomic dysreflexia – Also known as autonomic hyperreflexia, this is a
life-threatening complication of a spinal cord injury. It is caused by a massive
nervous sympathetic response to stimuli such as a full urinary bladder, fecal
impactions, kinked urinary catheter tubing, or excessive pressure on lower
extremities, feet, and toes. Symptoms are bradycardia, hypertension, facial
flushing, and extreme headache caused by vasoconstriction. The hyperten-
sion can be greater than 200 mm Hg systolic, with a diastolic reading of
130 mm Hg or greater. Immediate recognition of this problem along with
immediate intervention is critical to the patient’s survival. Recognize the cause;
sit the patient up; and loosen tight clothing. Blood-pressure-reducing medica-
tions are needed to vasodilate the vessels if the symptoms continue and remain
uncorrected, for example, nitroglycerin, nifedipine, and hydralazine.

Prognosis
The type of disability associated with SCI varies according to the location,
amount of injury, and severity of the injured section of the cord. Many regain