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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