A nurse in the emergency department is monitoring a client who has a cervical spinal cord injury from a fall. The nurse should monitor the client for which of the following complications? (Select all that apply)

Choice A rationale Bradycardia is a common complication of cervical spinal cord injury, particularly in injuries at or above the T6 level. This occurs due to disruption of the sympathetic nervous system pathways that originate in the thoracic spinal cord, leading to unopposed parasympathetic (vagal) tone. The vagus nerve, which originates from the brainstem, then slows the heart rate significantly. Choice B rationale Hypotension, often referred to as neurogenic shock, is a significant complication of cervical spinal cord injury. Damage to the sympathetic pathways interrupts sympathetic outflow to the peripheral vasculature, leading to widespread vasodilation and pooling of blood in the extremities. This results in a decrease in systemic vascular resistance and subsequently, a profound drop in blood pressure. Choice C rationale Hyperthermia is less common immediately after a spinal cord injury compared to poikilothermia or hypothermia, where the body's temperature fluctuates with the ambient temperature due to impaired thermoregulation. The sympathetic nervous system, responsible for vasoconstriction and sweating, is disrupted, leading to an inability to regulate body temperature effectively. While hyperthermia can occur, it's not the primary immediate concern; rather, impaired thermoregulation generally manifests as difficulty maintaining a stable core temperature. Choice D rationale A weakened gag reflex is a critical complication of a high cervical spinal cord injury. Injuries affecting the brainstem or the cranial nerves that control swallowing (glossopharyngeal and vagus nerves) can impair the gag reflex and the ability to protect the airway. This increases the risk of aspiration, necessitating careful assessment of swallowing ability and potential airway protection. Choice E rationale Polyuria, meaning excessive urination, is not a typical immediate complication of cervical spinal cord injury. While neurogenic bladder can occur later, leading to issues with bladder emptying or incontinence, polyuria is not directly caused by the acute neurological injury. It could be a sign of diabetes insipidus, which is a rare complication of severe head trauma impacting the pituitary gland, not primarily spinal cord injury.