Question

A patient with a neck fracture at the C5 level is admitted to the intensive care unit (ICU) following initial treatment in the emergency room. During initial assessment of the patient, the nurse recognizes the presence of spinal shock on finding

a. hypotension, bradycardia, and warm extremities.
b. involuntary, spastic movements of the arms and legs.
c. the presence of hyperactive reflex activity below the level of the injury.
d. flaccid paralysis and lack of sensation below the level of the injury.

Answer 1

The nurse's observation of flaccid paralysis and lack of sensation below the injury indicates the patient is experiencing spinal shock, making option (d) the correct assessment.

Step-by-step explanation:

The correct identification of the symptoms associated with spinal shock after a C5 neck fracture is crucial for proper patient management in the intensive care unit (ICU). Spinal shock is characterized by a sudden loss of reflexes, sensation, and motor function below the level of injury. Immediately following the injury, the patient may display symptoms such as flaccid paralysis and a lack of sensation below the level of the injury, which would make option (d) the most accurate assessment. The body's response to a severe spinal cord injury includes a period of areflexia or hyporeflexia. This condition typically evolves through various phases before potentially transitioning to a state of hyperreflexia or spasticity, if reflexes return.

It is critical to distinguish spinal shock from neurogenic shock, which is a type of vascular shock. Neurogenic shock can occur with cranial or spinal injuries that impact the cardiovascular centers in the medulla oblongata or the nervous fibers stemming from this region. This shock may be demonstrated by hypotension, bradycardia, and warm extremities due to vasodilation, but it is a separate physiological state from spinal shock. Understanding the difference between these conditions is essential for appropriate clinical care.