Patho Patho #64

Question

What is the pathophysiology of neurogenic shock?

Answers

  1. Dangerous hypertension caused by excessive vasodilation.
    • Rationale:

      This answer choice is not correct because neurogenic shock results in dangerous hypotension as opposed to hypertension. Autonomic dysreflexia causes hypertension when a trigger is present following a previous high level spinal injury.

  2. Bradycardia and hypotension due to loss of sympathetic outflow.
    • Rationale:

      This answer is correct because neurogenic shock causes significant hypotension and bradycardia due to the loss of sympathetic nervous system stimulation.

  3. Loss of all sensation below the level of a spinal injury.
    • Rationale:

      This answer choice is not correct because the loss of sensation below the level of the spinal injury is spinal shock; not neurogenic shock.

  4. Impaired reflexes caused by overstimulation of the parasympathetic nervous system.
    • Rationale:

      This answer choice is not correct as neurogenic shock is the result of loss of the sympathetic nervous system stimulation causing bradycardia and hypotension.

Overview

The focus of this question is asking the nurse to identify the underlying pathophysiology of neurogenic shock. Neurogenic shock occurs following a high level spinal cord injury. With high level spinal cord damage, there is a loss in sympathetic nervous stimulation leading to vasodilation, hypotension and bradycardia.

Explanation

Learning Outcomes

Neurogenic shock is a unique type of shock that usually follows a high level spinal cord injury. With loss of sympathetic nervous system outflow, stimulation by the catecholamines epinephrine and norepinephrine is lost. With the loss of stimulation from epinephrine, significant bradycardia results. Loss of stimulation by norepinephrine leads to massive vasodilation and resultant hypotension.

Test Taking Tip

Neurogenic shock differs from most other forms of shock in that there is bradycardia as opposed to the typical presentation of shock which includes tachycardia.

Video Rationale