Spinal Cord Injury and Autonomic Dysreflexia on the NCLEX

Level predicts function

C3-C5 innervates the diaphragm, so injuries at C4 and above threaten breathing and usually mean ventilator support. C6 allows wrist extension and independence with adaptive equipment. T1 and below spares the arms. The higher the lesion, the more autonomic instability.

Neurogenic shock (early)

Injuries at T6 or above knock out sympathetic tone. The giveaway pairing: hypotension WITH bradycardia plus warm, dry skin. Hypovolemic shock is hypotension with tachycardia. Treat with fluids, vasopressors, atropine for symptomatic bradycardia.

Autonomic dysreflexia (late)

Occurs with lesions at T6 or above, after spinal shock resolves. A noxious stimulus below the injury fires an uncontrolled sympathetic surge. Findings: sudden severe hypertension, pounding headache, bradycardia, flushing and diaphoresis above the level, pale cool skin and goosebumps below. Untreated, it can cause stroke or seizure.

The sequence the NCLEX wants

1. Sit the patient upright (raise HOB to 90). Orthostatic pooling lowers BP immediately.
2. Loosen anything tight: clothing, straps, hose.
3. Find the cause. Bladder first, because a distended bladder is the most common trigger. Check the catheter for kinks, scan, catheterize if needed.
4. Then bowel (impaction), then skin (pressure injury, ingrown toenail).
5. Antihypertensive per order if BP stays critical. Removing the trigger usually fixes it.