Hypotension, bradycardia and warm, dry skin are the classic signs of neurogenic shock. Careful monitoring will detect a drop in blood pressure and heart rate that may not manifest initially. Neurogenic shock can be diagnosed only after ruling out other causes of hypotension and must also be differentiated from spinal shock.
In assessing the trauma patient:
- 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.
- Assess for coping skills and watch for signs of anxiety and depression.
- Monitor results of X-rays, CT scans, MRIs and any lab studies, including INR, cultures, activated partial thromboplastin time, white blood cell count, and differentiated blood count. Report any abnormal results to the physician.
Planning and Implementation
Patients who have experienced a spinal cord injury may be placed in a specialty bed and stabilized with a cervical collar and backboard to reduce the risk of secondary injury, which can progress to neurogenic shock. In caring for a patient with neurogenic shock, it is important to:
- Ensure a patent airway.
- Administer crystalloid infusions; vasopressors, such as vasopressin; and positive inotropic medications, such as dopamine, as prescribed. For patients who have primary hemostasis, heparin may be administered, if prescribed.
- Administer chemoprophylaxis for deep venous thromboembolism (DVT), as ordered.
- Apply elastic stockings to prevent DVT or an abdominal binder to minimize orthostatic hypotension, if ordered.
- Prepare the patient for insertion of a pulmonary artery (PA) catheter, if ordered.
- Maintain spinal immobilization until spinal clearance is obtained.
- Prepare the patient for spinal surgery, if required, and implement appropriate preoperative and postoperative care.
- Provide appropriate warming measures to maintain normothermia.
- Perform hand hygiene to minimize the risk of healthcare-associated or nosocomial infection.
- Provide emotional support to address the patient’s anxiety, depression, or coping difficulties and facilitate referrals to appropriate resources.
To prepare the patient for discharge:
- Arrange for adequate management of mobility and any respiratory, gastrointestinal and genitourinary issues.
- Arrange for physical and occupational therapy, as ordered.
- Provide information about support groups to patients and family members.
Before the patient is discharged, ensure that the patient has:
- optimal tissue perfusion.
- well maintained normothermia.
- no evidence of infection, skin breakdown or DVT.
- maximal mobility and optimal nutrition.
- optimal bowel and bladder elimination.
- positive coping strategies.
For more information on managing neurogenic shock, see Evidence-based Nursing Monographs: Neurogenic Shock in Mosby’s Nursing Consult.