2. Spinal shock: temporary flaccid paralysis and areflexia following a severe injury to the spinal cord.

    1. Pathophysiology: squeezing or shearing of the spinal cord due to fractures or dislocation of vertebrae; interruption of sensory tracts; loss of conscious sensation; interruption of motor tracts; loss of voluntary movement; loss of facilitation; loss of reflex activity; loss of muscle tone; loss of stretch reflexes, leading to bowel and bladder retention. If injury between T-l and L-2, leads to loss of sympathetic tone and decrease in blood pressure. Afferent impulses are unable to ascend from below the injured site to the brain, and efferent impulses are unable to descend to points below the site.

    2. Risk factors:

      1. Automobile/motorcycle accidents.
      2. Athletic accidents, e.g., diving in shallow water.
      3. Gunshot wounds.
    3. Assessment:
      1. Subjective data:
        1. Loss of sensation below level of injury.
        2. Inability to move extremities.
        3. Pain at level of injury.
      2. Objective data:
        1. Neurological exam:
          1. Absent: pinprick, pressure, and vibratory sensations below level of injury; reflexes below level of injury.
          2. Muscles: flaccid.
        2. Vital signs:
          1. BP decreased (loss of vasomotor tone below level of injury).
          2. Bradycardia.
          3. Elevated temperature.
          4. Respirations: may be depressed; possible respiratory failure if diaphragm involved.
        3. Absence of sweating below level of injury.
        4. Urinary retention.
        5. Abdominal distention: retention of feces, paralytic ileus.
        6. Skin: cold, clammy.
    4. Analysis/nursing diagnosis:
      1. Decreased cardiac output related to loss of vasomotor tone below level of injury.
      2. Ineffective breathing pattern related to injuries involving diaphragm.
      3. Improved physical mobility related to loss of voluntary movement of limbs.
      4. Urinary retention related to loss of stretch reflexes.
      5. Fear related to serious physical condition.
      6. Risk for injury related to potential organ damage if shock continues.
    5. Nursing care plan/implementation:
      1. Goal: prevent injury related to shock.
        1. Maintain patent airway: intubation and mechanical ventilation may be necessary with cervical spinal injuries due to involvement of diaphragm.
        2. Monitor vital signs; profound hypotension and bradycardia are most dangerous aspects of spinal shock.
        3. Administer blood/IV fluids as ordered.
        4. Nutrition and hydration:
          1. NPO in acute stage: maintain nutrition by IV infusions as ordered.
          2. When allowed to eat: high-protein, high-calorie, high-vitamin diet.
        5. Maintain proper position to prevent further injury.
          1. Backboard is necessary to transport from place of injury.
          2. Support head in neutral alignment and prevent flexion.
          3. Skeletal traction will be applied once diagnosis is made.
        6. Monitor urinary output qlh; may have Foley catheter while in shock; later intermittent catheterization will be used as needed.
        7. Relieve bowel distention; use lubricant containing anesthetic, as necessary, when checking for or removing impaction.
    6. Evaluation/outcome criteria:
      1. Complications are avoided.
      2. Body functions are maintained.