Editing Medical-Surgical Nursing (section)

=== Spinal Cord Injury ===

Immediately after injury, spinal shock produces flaccid paralysis, loss of reflexes, and loss of sensation below the level of injury. Injuries at or above C4 threaten diaphragm function and may require ventilatory support.

Nursing application: autonomic dysreflexia is an emergency in patients with injury at or above the sixth thoracic vertebra. A noxious stimulus below the injury level, most commonly a distended bladder or impacted bowel, triggers severe hypertension with a pounding headache, bradycardia, flushing and sweating above the injury, and pallor and coolness below it. Act in this order: place the patient in a sitting position immediately to lower blood pressure, loosen constrictive clothing, then find and remove the stimulus by checking for kinked catheter tubing or bladder distention and then for impaction, and notify the provider. Untreated, it causes stroke, seizure, or death.