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Lecture on Autonomic Dysreflexia
Jul 1, 2024
Lecture on Autonomic Dysreflexia
Introduction
Autonomic Dysreflexia (AD)
: Also known as autonomic hyperreflexia.
Definition
: An exaggerated reflex response by the autonomic nervous system, particularly the sympathetic nervous system (fight or flight).
Important to prevent, detect, and manage as it is a medical emergency.
Causes and Risk Factors
Irritating stimulus below the site of spinal cord injury
.
Highest Risk
: Patients with T6 or higher spinal cord injuries.
Common Causes
: Referred to as the three big B's:
Bladder issues
: Urinary tract infections, full distended bladder.
Bowel problems
: Impacted stool in the rectum.
Breakdown of skin
: Pressure injuries, cuts, infections, ingrown toenails.
Miscellaneous Causes
: Menstruation, childbirth, sexual intercourse.
Pathophysiology
Autonomic Nervous System
: Divided into sympathetic (fight or flight) and parasympathetic (rest and digest).
Sympathetic Response
:
Vasoconstriction, leading to high blood pressure.
Increased heart rate, dilated pupils, bronchodilation, sweating.
Parasympathetic Response
:
Vasodilation, leading to lowered blood pressure.
Decreased heart rate, bronchoconstriction, increased salivation, pupil constriction.
In AD, sympathetic response is unopposed due to impaired parasympathetic response from spinal cord injury.
Impact of Separation
: Leads to excessive sympathetic response causing severe hypertension, potential stroke/seizures.
Symptoms
Headache
: Often throbbing/pounding.
Hypertension
: Systolic blood pressure 20-40 mmHg above baseline.
Skin Changes
:
Above site of injury: Flushed and warm.
Below site of injury: Pale, cool, and clammy.
Bradycardia
: Heart rate less than 60 BPM.
Other Symptoms
: Sweating, goosebumps, dilated pupils, stuffy nose, anxiety.
Nursing Interventions
Prevention, Detection, Action (PDA)
:
Prevention
:
Manage bladder issues: Ensure bladder is emptied, check urine output (>30 cc/hr), prevent UTIs.
Manage bowel issues: Monitor bowel sounds, check for impaction.
Manage skin integrity: Remove binding devices, reposition every 2 hours, assess skin.
Detection
:
Monitor blood pressure regularly, especially for patients with T6 or higher injuries.
Look for symptoms of AD (headache, skin changes).
Action
:
Call for rapid response in hospital.
Position patient at 90 degrees (legs lowered).
Remove binding devices or clothing.
Investigate and address causes: bladder, bowel, skin.
Use medications if necessary (e.g., nitropaste, nifedipine).
Conclusion
AD is a critical condition requiring prompt identification and management.
Nurses play an essential role in preventing, detecting, and managing AD.
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