Prepared by: Madi, krister

Salvador, Ma. Grace

BSN-4A
DEFINITION:
• Neurogenic shock is a life-
threatening condition caused by
irregular blood circulation in the
body.
• Trauma or injury to the spine can
cause this disruption. It can occur
after damage to the central nervous
system such as spinal cord injury.
• Sympathetic nervous system loses
the ability to stimulate nerve
impulses that leads to hemodynamic
changes due to massive vasodilation.
• Vessels are relax and wide and leads
to decreased tissue perfusion that
the amount of oxygen that goes to
the cells that make up tissue and
organs are very limited.
INCIDENCE:
• National Spinal Cord Injury Database:
 MVA
 Falls
 Violence
 Sports
 55% case occur in 16-30 years of
age.
RISK FACTORS:
• Conditions that result in
Neurologic impairment (Neurogenic bladder)
• trauma to the brain or spinal cord
• CVA
• Diabetic neuropathy (R/T metabolic derangements)
Altered mobility
• Severe arthritis
Cognitive impairment
• Dementia
Immunologic impairment or infection
• AIDS
CAUSES:
 Spinal cord injury (above T6,
cervical)
 Spinal anesthesia
 Nervous system damage
 Drugs (depressant action of
medications)
 Glucose deficiency
Neurogenic shock is caused by SNS
disruption resulting from:
 physical injury to the central nervous system,
especially high thoracic spinal injury (T6 level
or higher) or damage to the brainstem’s
vasomotor center
 emotional trauma, in which high levels of fear,
anxiety, and stress cause sudden loss of
autonomic nervous system (ANS) control,
leading to massive vasodilation
 vagus nerve stimulation, which may override
the ANS, causing parasympathetic tone to
dominate and resulting in vasodilation.
 Autonomic Nervous System
Controls:
• Heart rate
• Blood pressure
• Salivation
• Perspiration
• Digestion
• Respiratory rate
• Urination
• Pupillary response
• sexual arousal.
 Autonomic
Nervous System

Parasynpathetic
Sympathetic –
– “rest and
“fight or flight”
digest system”
• Afterload: the amount of resistance that the
ventricle must overcome to open the aortic
valve to get the blood out of the heart.
• Preload: the amount the ventricles stretch
once they have filled at the end of diastole.
PATHOPHYSIOLOGY:
SNS lose ability to stimulate
nerve impulses

Hemodynamic changes
PATHOPHYSIOLOGY:
 SIGNS & SYMPTOMS:
 Warm, dry skin (from vasodilation)
 Hypotension
 Bradycardia, or slower heart rhythm
 Organ dysfunction
 SIGNS & SYMPTOMS:
• Emergency signs and symptoms
Extreme back pain
Weakness, incoordination or paralysis
below the spinal injury level.
Loss of bladder or bowel control
Difficulty with balance and walking
Impaired breathing after injury
Others symptoms….
 Dizziness
 Nausea
 Vomiting
 Blank stares
 Fainting
 Increased sweating
 Anxiety
 Pale skin
In more severe cases of neurogenic
shock, you may experience:

 Difficulty breathing
 Flushed appearance
 Chest pain
 Weakness from irregular blood circulation
 Faint pulse
 Cyanosis, or discolored lips and fingers
 Hypothermia, or decreased body
temperature
Other findings may include:
• absence of jugular vein distention (from vasodilation
and pooling of blood in the peripheral circulation)
• reduced central venous, right arterial, and
pulmonary artery wedge pressures
blood pH shifting toward the acidic range, from tissue
hypoperfusion or low cardiac output and buildup of
byproducts of anaerobic cellular respiration
• altered mental status, if the patient’s cerebral
perfusion pressure is altered
• hypoactive or absent bowel sounds (from shunting
of blood away from nonessential abdominal organs to
compensate for shock symptoms).
DIAGNOSTIC
EVALUATION:
 Physical examination
 X-rays
 CT scan
 MRI scan
PREVENTION:
Following this advice nay reduce
the risk of a spinal cord injury:
 Drive safely
 Check water depth before diving
 Prevent falls
 Take precautions when playing sports
 Don’t drink and drive
COMPLICATIONS:
• Paralysis
• Autonomic dysreflexia
• Spinal shock
• Contractures
• Pressure ulcers
• Stool impaction
• Death
NURSING MANAGEMENT:
Besides performing frequent physical
assessments, other key nursing interventions
include:
 Be alert for changes in blood pressure and
heart rate and monitor oxygenation.
 Assess hemodynamic and neurologic
parameters, including motor, sensation and
reflexes.
 Monitor intake and output.
 Assess skin temperature and integrity.
CONTI…
 Assess for coping skills and watch for signs
of anxiety and depression.
 Assessing for bladder distention
 Managing the patient’s airway.
 Implementing coughing and deep-breathing
exercises.
 Performing passive range-of-motion
exercises.
 Implementing deep-vein thrombosis
prophylaxis
CONTI…
 Monitor results of X-rays, CT scans, MRI
and any lab studies, cultures, activated
partial thromboplastin time, white
blood cell count, and differentiates
blood count. Report any abnormal
results to the physicians.
 Be sure to provide psychosocial support
and education to the patient and family.
 Successful management of
neurogenic shock hinges on early
diagnosis and treatment of acute signs
and symptoms to limit the effects of
hypotension and bradycardia on the
rate of secondary neurologic injury.
The treatment goal is to restore
adequate oxygenation to vital tissues
and limit cellular damage.
 Because autonomic function loss
leads to changes in blood pressure,
heart rate, respiratory rate, and body
temperature, patients should be
placed where they’ll receive close
observation, as in an intermediate or
intensive care unit. During the acute
period, vital signs and fluid intake and
output must be monitored at least
hourly.
MEDICAL MANAGEMENT:
Early (acute) stages of treatment:
In the emergency room, focus on:
Maintain the ability to breath
Prevent shock
Immobilizing neck to prevent further spinal
cord damage
Avoiding possible complications, such as
stool or urine retention, respiratory or
cardiovascular difficulty, and formation of
deep vein blood clots in the extremities
CONTI…
 Immobilization. To need traction to
stabilize the spine, to bring the spine
into proper alignment or both.
 Surgery. Surgery is necessary to
remove fragments of bones, foreign
objects, herniated disks or fractured
vertebrae that appear to be
compressing the spine. Surgery may
also be needed to stabilize the spine
to prevent future pain or deformity.
CONTI…
Neurogenic shock treatment includes:
• IV fluids
• Vasopressors
• Atropine
• IV fluids are the primary treatment for low
blood pressure. They replenish fluid levels
in the veins to help stabilize blood
pressure.
• If IV fluids prove ineffective, vasopressors
 help tighten blood vessels and increase
blood pressure. The most common
vasopressors to treat neurogenic shock
are norepinephrine, phenylephrine, and
dopamine.
• If your heart rate is low, your doctor will likely
prescribe atropine.  It helps activate the fight or
flight response in your body to increase heart
rate.
• By focusing on restoring heart rate and blood
pressure to normal levels, all other symptoms of
neurogenic shock should start to get resolved.
• Blood will no longer pool in your veins if your
blood vessels tighten and an increased heart
rate will elevate blood pressure, which keeps
blood circulating throughout the body.
New technologies:
 Modern wheelchairs
 Computer adaptations
 Electronic aids to daily living
 Electrical stimulation devices
 Robotic gait training