Neurogenic Shock: Management (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Let's look at the management of neurogenic shock.

    00:03 Now, we know this is a spinal cord injury.

    00:05 But we're still in that Layer 3, right? We're focusing in on those types of decisions that we make in that third layer of the clinical judgment measurement model.

    00:14 We know our job in any patient with shock is to correct the underlying cause.

    00:19 This patient's underlying cause is a spinal cord injury.

    00:22 So, we're going to stabilize them, right? Cervical stabilization, and we'll put a C-collar on them like you see in the picture.

    00:30 Now, what are our target goals to maintain for our patient? You want a arterial oxygen of 92 to 95%, whether you have to give that externally or intubate you want to do what you have to do to keep their sat at 92 to 95%.

    00:46 Now, that hypotension and bradycardia, you're gonna have to stay right on top of.

    00:51 This could become life threatening to the patient.

    00:53 So you'll need to treat that.

    00:55 Now, the hypotension, you'll probably use a vasopressor to help with that.

    00:59 And bradycardia, you may use the drug atropine.

    01:02 Okay, so low blood pressure, we give them vasopressors.

    01:05 Things are constricted down.

    01:07 And bradycardia, we're going to give extra pain, which is going to bring that heart rate up.

    01:13 Although our goal is to restore fluid loss, I want you to be very careful, because this isn't hypovolemia.

    01:19 Remember, we had so much volume to replace.

    01:21 This patient has just lost the sympathetic nervous system tone.

    01:25 So we're going to infuse fluids, cautiously, alright.

    01:30 Because the low blood pressure is not due to low intravascular volume.

    01:35 Now, you're probably use something like an IV crystalline normal saline. But I cannot stress enough Don't overload these patients with IV fluids.

    01:44 That won't fix the problem, right? That's what the vasopressors and the atropine are hopefully going to help us do.

    01:50 So one of the key points about nursing care for patients in neurogenic shock after a spinal cord injury.

    01:57 While we may also put the SPO2 sensor on their forehead of their client to give us an accurate reading.

    02:02 We're going to monitor them closely for hypothermia.

    02:05 Now, we take every patient's temperature on a regular basis, but we're going to know to watch for the cues of signs of hypothermia.

    02:13 Now, why would someone in neurogenic shock have that? Well, they have this hypothalamic dysfunction.

    02:18 They're not able to really manage their temperature like they would if they had not had the spinal cord injury.

    02:24 So keep an extra close eye on their temperature.

    02:27 Okay, so those are the things that are different in neurogenic shock.

    02:32 Now, if we look at cardiac output, it's decreased. Why? Remember, they are vasodilated because they don't have any sympathetic tone.

    02:40 Heart rate, yeah, they're gonna have low heart rate or bradycardia.

    02:44 Now, the CVP may remain unchanged.

    02:48 But the wedge pressure, the SVR, and the O2 sat will all three be decreased.

    02:55 Remember, that volume is staying out in the periphery instead of coming back to the heart.

    03:01 Join us for the rest of our video series on the different types of shock.

    About the Lecture

    The lecture Neurogenic Shock: Management (Nursing) by Rhonda Lawes, PhD, RN is from the course Shock (Nursing).

    Included Quiz Questions

    1. Normal saline IV at 1000mL/hour throughout the shift for fluid resuscitation
    2. Phenylephrine IV to treat hypotension
    3. Atropine IV to treat bradycardia
    4. Oxygen via non-rebreather mask to keep oxygen saturation above 92%
    1. Applying a cervical collar around the client’s neck and ensuring it fits properly
    2. Administering oxygen via venturi mask to keep saturation above 92%
    3. Administering prescribed atropine to reverse bradycardia
    4. Applying falls precautions to prevent further injury

    Author of lecture Neurogenic Shock: Management (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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