What are interventions for autonomic dysreflexia?
Autonomic Dysreflexia is a life threatening condition that can cause death. Show The most common causes of Autonomic Dysreflexia are bladder and bowel distension. Signs and SymptomsRaised BP, bradycardia, pounding headache, flushing, sweating or blotching above level of injury; pale, cold, goosebumps below level of injury. If a patient has an episode of Autonomic Dysreflexia:
Autonomic Dysreflexia Reproduced from Ontario Neurotrauma Foundation. Autosomal Dysreflexia. Caring for Persons with Spinal Cord Injury - e-learning
resource for family physicians. A stimulus, such as a distended bowel or bladder that occurs below the level of spinal cord injury (1) sends an afferent signal to the spinal cord (2). The impulses from the noxious stimulus are unable to ascend past the spinal cord lesion and may activate a massive sympathetic reflex (3) causing widespread vasoconstriction of the blood vessels below the level of the injury (4) resulting in hypertension and other signs of sympathetic
stimulation (5). Two vasomotor brainstem reflexes (6)occur to lower BP:
As the spinal cord injury separates the parasympathetic (craniosacral division of ANS) from the sympathetic branch (thoracolumbar chain) the negative feedback loop is affected. The body is unable to restore autonomic equilibrium when presented with noxious stimulus below the level of injury so BP will keep rising until the stimulus is removed.
Autonomic Dysreflexia has many potential causes. It is essential that the specific cause be identified and treated in order to resolve an episode of Autonomic Dysreflexia and to prevent recurrence. Any noxious stimuli below the level of injury may result in Autonomic Dysreflexia. Bladder and bowel problems are the most common causes of Autonomic Dysreflexia.
Sit patient up (keep patient sitting or upright until BP returns to normal) Loosen or remove any tight clothing Monitor BP every 2-5 minutes For patients with catheter:
For patients without catheter:
For faecal mass in rectum:
If bladder and bowel excluded check the above (see table of causes) If systolic BP > 150mmHg instigate immediate pharmacological management:
How is autonomic dysreflexia managed?The most commonly used agents are nifedipine and nitrates (eg, nitroglycerine paste or sublingual nitroglycerine). Nifedipine should be in the immediate-release form; bite and swallow is the preferred method of administering the drug, not sublingual administration.
How can nursing prevent autonomic dysreflexia?Prevention of Autonomic Dysreflexia
Regularly use the bathroom to avoid an overfull bladder or bowels. Always check for any ingrown toenails. Seek immediate medical help if there is any sign of urinary tract infection.
What is the best position for a patient experiencing autonomic dysreflexia?If You Are Experiencing an Episode of Autonomic Dysreflexia
First, you should get into the sitting position or elevate you head as much as possible. This will help to drop your blood pressure. Since bladder issues are the most common cause of AD, you or a caregiver should check your bladder.
What are the intervention for patient with spinal cord injury?You might need traction to stabilize or align your spine. Options include soft neck collars and various braces. Surgery. Often surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine.
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