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Autonomic Dysreflexia

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a guide for nurses

Published in: Health & Medicine
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Autonomic Dysreflexia

  1. 1. Autonomic Dysreflexia A guide to acute nursing care prevention, and education
  2. 2. Objectives After this presentation you should be able to: <ul><li>Understand what AD is
  3. 3. Know how to manage acute AD crisis
  4. 4. Know some ways to prevent AD
  5. 5. Effectively educate patients on the management and prevention of AD </li></ul>
  6. 6. What is Autonomic Dysreflexia? <ul><li>An abnormal response to painful stimuli below the level of Spinal Cord Injury (SCI) </li></ul><ul><li>Mediated by the Autonomic Nervous System (ANS) </li></ul><ul><li>SCI above T6 </li></ul><ul><li>Causes dangerous high blood pressure </li></ul><ul><li>Emergency! </li></ul>
  7. 7. Pathopysiology http://emedicine.medscape.com/article/322809-overview
  8. 8. Pathophysiology <ul><li>Painful/noxious stimuli occurs below SCI </li></ul><ul><li>Signal is blocked at site of SCI so patient is not aware of pain and cannot correct it </li></ul><ul><li>Autonomic Nervous Stystem responds: </li></ul>(ANS) ---> vasoconstriction below SCI. Sudden rise in blood pressure.
  9. 9. Pathophysiology ANS detects high BP above SCI and attempts to correct it: <ul><li>Bradycardia (vagal nerve)
  10. 10. Vasodilation in head and chest to absorb increased blood flow to upper body </li></ul><ul><li>Negative feedback loop is interrupted by the SCI. </li></ul>Cycle continues until stimulus is removed
  11. 11. Causes #1 cause is a full bladder #2 cause is a full bowel
  12. 12. Causes <ul><li>bladder or kidney infection
  13. 13. gastric ulcers, gallstones, other GI disturbances
  14. 14. tight clothing, leg braces, shoes
  15. 15. patient lying or sitting on hard object
  16. 16. pressure ulcer
  17. 17. ingrown toenail
  18. 18. insect bites and other minor injuries
  19. 19. DVT </li></ul>
  20. 20. Causes <ul><li>sexual activity
  21. 21. menstruation
  22. 22. pregnancy
  23. 23. vaginal infections
  24. 24. extreme temperatures
  25. 25. rapid changes in temperature
  26. 26. positioning problem, lack of circulation to limb
  27. 27. drug stimulants </li></ul>
  28. 28. Signs and Symptoms Systemic <ul><li>Rapid rise in systolic and diastolic blood pressure 20-40 mmHg above patient's baseline.
  29. 29. Bradycardia
  30. 30. Cardiac arrhythmias, A-fib, PVC, AV conduction abnormalities </li></ul>
  31. 31. Observable Signs Above SCI site <ul><li>Profuse diaphoresis
  32. 32. Piloerection
  33. 33. Flusing of skin, especially face, neck, shoulders </li></ul>
  34. 34. Symptoms Patient reports: <ul><li>severe headache
  35. 35. blurred vision
  36. 36. spots in visual fields
  37. 37. nasal congestion
  38. 38. anxiety, sense of impending doom </li></ul>* slient AD does not have symptoms despite signficant elevation in BP
  39. 39. Acute Care Nursing Plan Goals Locate and remove stimuli Lower blood pressure Administer prescribed meds Notify doctor
  40. 40. Step-by-Step Care 1. Sit the patient up
  41. 41. Step-by-Step Care 2. Loosen restrictive clothing
  42. 42. Step-by-Step Care 3. Closely monitor BP
  43. 43. Step-by-Step Care 4. Check the Bladder
  44. 44. Step-by-Step Care 5. Check the bowels
  45. 45. Step-by-Step Care 6. Check for other noxious stimuli <ul><li>toes up </li></ul>
  46. 46. “The Four B's” B ed Up B ladder B owels B ody
  47. 47. Medication Systolic BP > 150mmHg <ul><li>Procardia (nefidipine) </li><ul><li>immediate release tablets, bite and swallow </li></ul><li>Nitrates </li><ul><li>nitroglycerin paste </li></ul><li>Others: mecamylamine, diazoxide, and phenoxybenzamine. </li></ul>
  48. 48. If Unresolved If noxious stimuli not identified and crisis unable to be resolved, <ul><li>In-patient: call doctor
  49. 49. Home Health: consider admitting
  50. 50. Teach patient: call 911 or go to ED </li></ul>
  51. 51. Prevention Prevention is the key to preventing an autonomic crisis! <ul><li>Regular bladder and bowel care
  52. 52. Prevent pressure ulcers
  53. 53. Inspect patient bed often for foreign objects
  54. 54. Check records for past crisis and causes
  55. 55. Avoid tight fitting clothes, changes in temp. </li></ul>
  56. 56. Surgical/Outpatient Testing Prevent Autonomic Dysreflexia <ul><li>hypothermia
  57. 57. positioning
  58. 58. vein/artery access procedures </li></ul>Continuously monitor BP for signs of AD!
  59. 59. Patient Teaching <ul><li>AD kit
  60. 60. cath/bowel care
  61. 61. educate family
  62. 62. card with plan of care
  63. 63. medical bracelet </li></ul>
  64. 64. References Paralyzed Veterans of America/Consortium for Spinal Cord Medicine. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health-care facilities. Washington (DC): Paralyzed Veterans of America (PVA); 2001 Jul. 29 p. Autonomic Dysreflexia in Spinal Cord Injury: Treatment & Medication Author: Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers Glynis Collis Pellat, British Journal of Neuroscience Nursing, Aug/Sept 2010, Vol 6, Number 6, PP 271-275 Autonomic Dysreflexia: What You Should Know, Consortium for Spinal Cord Management. www.pva.org

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