Spinal Cord Injury Progression: Spinal Shock → Neurogenic Shock → Autonomic Dysreflexia
These three SCI complications happen at different times, present with opposite vital sign patterns, and demand completely different interventions. Picking the wrong one — treating autonomic dysreflexia like neurogenic shock by pushing fluids — can kill the patient. The NCLEX expects you to match the timeline to the presentation to the action.
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Spinal Shock
What's happening- Temporary loss of reflexes below injury
Key findings- ★Areflexia, flaccid paralysis below level
- Ends when reflexes return
Nursing focus- Cath for flaccid bladder retention
- Serial neuro checks for reflex return
- Watch for paralytic ileus
Escalate when- ↓ Vital capacity, resp distress
Neurogenic Shock
What's happening- Lost sympathetic tone (T6 and above)
Key findings- ★Hypotension + bradycardia
- Warm, dry skin (not cold)
Nursing focus- IV fluids first, then vasopressors
- Atropine for bradycardia
- Keep flat
Escalate when- BP falling despite IV fluids
Autonomic Dysreflexia
What's happening- Sympathetic surge below lesion
Key findings- ★Sudden severe HTN + bradycardia
- Pounding headache
- Flushed above, pale below lesion
Nursing focus- Sit upright immediately
- Remove trigger: #1 distended bladder
Escalate when- SBP ≥ 150 after trigger removed
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No reflexes = spinal shock; warm and hypotensive = neurogenic; hypertensive crisis with headache = dysreflexia — sit up, find the trigger.
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