GF16: Neuro Autonomic Dysreflexia

Question 1

What is Autonomic Dysreflexia?

Answer 1

A life threatening hyper-SNS reaction that causes extremely high blood pressure in a pt that has a SCI at or above T6

Question 2

What is the patho of autonomic dysreflexia?

Answer 2

• Stimuli below the level of CSI initatiates a sympathetic response resulting in vasoconstriction and increased BP
• PNS attempts to compensate by sending signals to lower HR resulting in bradycardia

Question 3

What are the s/s autonomic dysreflexia above injury level?

Answer 3

• Extreme and rapid onset of HTN (systolic can reach 300)
• Throbbing (HTN) HA and blurred vision
• Facial flushing/Distended neck veins
• Nasal congestion
• Piloerection/goosebumps
• Decreased HR (bradycardia)
• Diaphoresis (above injury, not below)

Question 4

What are the s/s of autonomic dysreflexia below injury level?

Answer 4

• Pale
• Cool
• Dry (no sweating)

Question 5

What unique temperature reaction occurs with autonomic dysreflexia?

Answer 5

• PNS response causes vasodilation above injury level causing warmer temps and flushed skin
• PNS response does not reach below injury level leaving them pale in comparison

Question 6

Extreme BP can lead to _____ and ____.

Answer 6

Stroke and seizures

Question 7

What are some stimuli trigger an autonomic dysreflexia attack?

Answer 7

• Triggered from below injury level
• Bladder: Full bladder or UTI
• Breakdown of skin: Pressure areas/injuries
• Bowel: Fecal impaction
• Restrictive clothing
• Pain

Question 8

What are some ways to prevent autonomic dysreflexia?

Answer 8

• Do not let bladder become too full
• Prevent UTIs
• Practice proper bowel care to avoid stool impaction
• Practice proper skin care to avoid bedsores and skin infections
• Pain needs to be controlled

Question 9

What are the interventions for managing autonomic dysreflexia?

Answer 9

• Place pt in high fowlers w/ legs slightly lowered to help blood drain from head
• Notify HCP
• Assess for cause first then treat cause
• Check room temp
• Monitor BP q10-15mins

Question 10

What are some examples of things to assess at onset of autonomic dysreflexia?

Answer 10

• Check for catheter kinks
• Assess for bladder distention
• Assess for fecal impaction
• Inquire as to sexual activity

Question 11

What medication tx can be done for autonomic dysreflexia?

Answer 11

Antihypertensives:

• Phentolamine (Regitine)
• Nitrates (Nitroglycerin)
• Hydralazine (Apresoline)
• Nifedipine (Procardia)

Question 12

What meds may be given to prevent chronic episodes of autonomic dysreflexia?

Answer 12

• Prazosin (minipress) helps with vasodilation
• Clonidine (catapres) helps reduce CNS outflow to decrease peripheral resistance

Question 13

What is the relation of neurogenic shock and autonomic dysreflexia to the SNS?

Answer 13

• Neurogenic shock is reduced sympathetic response
• Autonomic dysreflexia is an increased sympathetic response

Question 14

A pt presents at the ED w/ a cervical spine injury, throbbing headache, nausea & elevated blood pressure. What is the first assessment?

Answer 14

Palpate the bladder (treat the cause, the autonomic dysreflexia goes away)

Question 15

_____ first, _____ second.

Answer 15

• Assess first
• Treat second

Question 16

Priority interventions for a pt w/ T-1 spinal cord injury with flushing, diaphoresis & pulse of 58?

(select all that apply)

• Assess for bladder distention
• Remove tight clothing
• Measure BP
• High Folwers position
• Semi-fowlers position

Answer 16

• Assess for bladder distention
• Remove tight clothing
• Measure BP
• High Folwers position