While in nursing school, I worked part-time as a home health aide to get some experience. One of my patients was quadriplegic, and the very first thing he asked me to do was learn about autonomic dysreflexia.
Autonomic dysreflexia (AR) is a side effect of spinal cord injury (SCI) at or above the T6 level. The higher the level of the SCI, the greater the risk of the patient developing AR. The more complete the injury, the greater the risk of developing AR.
When a stimulus occurs below the level of injury (for example, bladder distention from a blocked drainage catheter, urinary tract infection, constipation, or pain from not changing position for a long time), blood pressure increases reflexively. Theoretically, it can increase by up to 40 mmHg and 20 mmHg of baseline systolic and diastolic blood pressures, respectively, but I have seen blood pressures of 180/100 and above.
Up to 90% of patients with cervical or high thoracic SCI are susceptible to AR, and it is unlikely to develop in SCIs below the T10 level.
Due to their sensory deficits from the SCI, patients usually do not feel pain or the need to urinate or have a bowel movement, so they may not verbalize any discomfort and go on to develop AR. The only symptom of AR may be a bad, throbbing headache. Other symptoms may include a slow heart rate, facial flushing, sweating, pallor, and cold skin.
Good nursing practice is to check the patient’s blood pressure as soon as they complain of a headache. Although AR is a condition with a high potential for severe and deadly complications like hemorrhagic stroke, heart attack, kidney failure, and pulmonary edema, it is also one of the most straightforward conditions to treat.
The best treatment is quick correction of the cause of reflexive high blood pressure. For instance, if a blocked drainage catheter causes the bladder to distend, which causes high blood pressure, promptly flushing the catheter and ensuring good drainage will bring down the blood pressure.
Good nursing practice also includes adopting preventive measures such as monitoring urinary output regularly, adhering to a good bowel regimen, and frequently repositioning the patient. Having all the required supplies ready, putting together an emergency kit for travel, and educating the entire care staff are also essential.
My quadriplegic patient never developed AR when I cared for him. I used the knowledge I gained from caring for him to educate my fellow nurses, mentioning it during shift handoffs, and educating other patients with SCI who were unaware of it.
Please reach out to me if your client has complications from untreated autonomic dysreflexia, and I will be able to pinpoint areas of negligence.
Disclaimer: I wrote this content, using sources like NIH for research and AI for checking grammar. Please contact me for permission if you would like to use this article in any way.
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