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.
The lecture Neurogenic Shock: Management (Nursing) by Rhonda Lawes, PhD, RN is from the course Shock (Nursing).
The nurse is caring for a client with neurogenic shock. Which prescriber order would the nurse question for this client?
Which nursing intervention for the client with neurogenic shock is aimed at treating the underlying cause of the shock?
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