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Pathophysiology of autonomic dysreflexia, potential complications, and nursing interventions

Pathophysiology of autonomic dysreflexia, potential complications, and nursing interventions.





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Pathophysiology of autonomic dysreflexia, potential complications, and nursing interventions.

Autonomic dysreflexia is defined by the development of unusually high blood pressure with little or no preparation. Accidental spinal cord injury, particularly one that affects the thoracic nerves of the spine, is an extremely common event. The development of autonomic dysreflexia is a possibility when sensory receptors positioned below the level of the cord lesion are activated in a persistent and unrelieved way. It most usually occurs during the first year after a T6 or higher spinal cord injury, although it may occur at any time after that.

Autonomic dysreflexia is produced by the separation of the spinal sympathetic nervous system from the supraspinal nervous system, which is a hereditary predisposition. The presence of SCI inhibits descending inhibitory signals from reaching sympathetic neurons, resulting in an increase in sympathetic response and significant vasoconstriction in the lower limbs, as well as pallor and coolness in the lower limbs and a lack of sweating in those areas. According to Jackson and Acland (2011), there are multiple frequent reasons of autonomic dysreflexia, including bladder and bowel distention, wearing tight clothes, getting hurt by a sharp item, participating in sexual activity, and having a painful menstrual period, among others.

The use of a Foley catheter or intermittent catheterization to correctly care for one's bladder and intestines may help to prevent the development of autonomic dysreflexia (i.e., preventing fecal impaction and bladder distention). Morgan, S. (2020) strongly urge that you have a frequent urologic follow-up to guarantee proper fecal movement and prevent constipation. It is also vital to keep a regular bowel pattern in order to avoid constipation. Aside from that, boosting the consumption of high-fiber meals is necessary in order to enhance digestive function and nutritional maintenance. In order to reduce pressure injuries and skin infections, it is important to examine and monitor the client's bed for foreign objects and wrinkles. This is an effective technique for lowering the risk of pressure injuries and skin infections.

Patients with autonomic dysreflexia should be elevated 45 degrees on their bed or persuaded to sit up straight, and any unpleasant stimuli (kinked urinary catheter, fecal impaction, tight clothing, etc.) should be looked for and removed as quickly as possible from the patient's surroundings. In addition, the nurse should keep a constant eye on the patient's blood pressure, which should be checked every 5 minutes by the doctor. There are many indications of SCI, including excessive sweating over the SCI level as well as bradycardia and paleness in the lower body. Another is having blood pressure that is more than 200/100mmHg.

When a patient is in a wheelchair, the nursing interventions to prevent and manage pressure injury include: lifting the patient and shifting weight every 15-30 minutes; if in a bed, a regular turning schedule every 2 hours; using an air mattress and wheelchair cushion, and using a pillow to protect bony prominences when in a bed; as well as monitoring skin condition. Wounds would also be prevented by following conventional wound care management procedures and monitoring nutritional status by checking for weight increase or loss, ensuring enough protein intake, and monitoring nutritional status. In most cases when autonomic dysreflexia is not recognized or left untreated it may result in retinal hemorrhage and seizures, as well as myocardial infarction, renal failure, cerebral hemorrhage, and, in rare cases, death. These complications arise directly as a consequence of long-term, severe peripheral arterial hypertension (Morgan 2020). 

There is a critical role for nursing intervention in reducing spinal cord compression, preventing additional damage, and examining a patient by listening to his or her lung for pulmonary complications that may be induced by immobility. Additionally, you should palpate and percussion the bladder to determine the degree of distention since the loss of autonomic and reflex control to alleviate urine retention are all instances of nursing actions that may help to avoid future issues from developing. According to Andrade et al (2013), in addition to establishing baseline function, monitoring bowel movements, including frequency, consistency, shape, volume, and color, is also carried out as part of the procedure. It is important to allow for numerous spins on a therapeutic mattress that is suitable in order to prevent breaking cervical traction while maintaining the spine in an ideal posture. To avoid thrombosis and contractures, practice passive or aggressive range of motion exercises while wearing devices to protect the feet from lowering. ABGs should be monitored, pulse oximetry should be used, and movement should be encouraged by utilizing a logroll to turn left or right to keep an eye on things. The neck should be protected by wearing a stiff collar and optimizing respiratory functions since prolonged laying down might result in pneumonia: record the patient's ventilation and oxygenation status. Determine the presence of respiratory issues such as hypoventilation.

After everything is said and done, there are a few ways that may be employed to help spinal cord injury patients in adapting to their situation. As a consequence of the grieving and mourning process, individual and group therapy as well as support groups are easily accessible to those in need. People often endure feelings such as denial, disbelief, despair, and even rage before they are able to come to terms with a loss. Handrails and grab rails, ramps for wheelchair access, stairlifts, and intercom systems, to mention a few examples of home modifications, are available. People with disabilities may benefit from the installation of fall and movement sensors or alarms on their doors, which will make them more accessible and diet-friendly.

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Andrade, L. T. D., Araújo, E. G. D., Andrade, K. D. R. P., Souza, D. R. P. D., Garcia, T. R., & Chianca, T. C. M. (2013). Autonomic dysreflexia and nursing interventions for patients with spinal cord injury. Revista da Escola de Enfermagem da USP, 47, 93-100.

Jackson, C. R., & Acland, R. (2011). Knowledge of autonomic dysreflexia in the emergency department. Emergency Medicine Journal, 28(10), 866-869.

Morgan, S. (2020). Management of autonomic dysreflexia in the community. British Journal of Community Nursing, 25(10), 496-501.