Autonomic Dysreflexia in Nursing

Autonomic Dysreflexia

• Occurs when the sympathetic nervous system is stimulated, but the parasympathetic system doesn't adequately respond.
• Lesions below T6 prevent dysreflexia as the parasympathetic system counteracts the sympathetic response.
• Triggers are usually stimuli from below the lesion's dermatome level.
• Symptoms include:
  • Extreme hypertension
  • Severe headache
  • Pallor below the spinal cord lesion's dermatome
  • Blurred vision
  • Diaphoresis (sweating)
  • Restlessness
  • Nausea
  • Piloerection (goosebumps)
• Parasympathetic response:
  • Bradycardia
  • Flushing above the spinal cord lesion's dermatome (e.g., face, neck)
  • Nasal stuffiness

Nursing Actions

• Position: Sit the client upright to reduce blood pressure from postural hypotension.
• Notification: Alert the healthcare provider immediately.
• Cause Identification & Treatment: Determine and address the underlying cause.
• Distended Bladder: Common cause, address by:
  • Inserting a catheter (using anesthetics)
  • Checking for kinks/blockages in the catheter
  • Irrigation if needed
• Fecal Impaction: Address by removing the impaction (using anesthetics).
• Environment: Adjust room temperature and block drafts. Remove tight clothing. Assess for injuries (e.g., fractures, infections).
• Monitoring: Continuous monitoring of vital signs for high blood pressure and bradycardia.
• Medication: Antihypertensives (e.g., nitrates, hydralazine) may be administered.

Client Education

• Understanding and preventing potential causes (e.g., blocked catheter, constipation) is key.
• Spreading fluid intake throughout the day is important if intake is increased, rather than drinking it all at once.
• Develop a personal action plan for episodes of dysreflexia.