Neurogenic Shock: Management (Nursing)

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.