Spinal Cord Injury – Autonomic Dysreflexia – Flashcards
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autonomic dysreflexia - other name
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autonomic hyperreflexia
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autonomic dysreflexia - define
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a massive uncompensated cardiovascular reaction mediated by the SNS
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autonomic dysreflexia - occurs when
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in response to visceral stimulation once spinal shcok resolved
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return of reflexes after resolution of spinal shock - what does it mean
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patients with an injury level at T6 or higher may develop autonomic dysreflexia
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autonomic dysreflexia - complications
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life threatening
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autonomic dysreflexia - what conditions can occur
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status epilepticus stroke MI death
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autonomic dysreflexia - most common precipitating cause
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distended bladder or rectum
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autonomic dysreflexia - other causes
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sensory stimulation contraction of the bladder/rectum stimulation of skin stimulation of pain receptors
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autonomic dysreflexia - manifestations
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hypertension - up to 300 mmHg systolic throbbing headache marked diphoresis above level of lesion bradycardia (30-40 bpm) piloerection - erection of body hair - pilomotor spams flushing of skin above lol blurred vision or spots nasal congestion anxiety and nausea
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autonomic dysreflexia - when complaining of headache - important to monitor
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blood pressure
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autonomic dysreflexia - patho
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1. stimulation of sensory receptors below lol 2. intact SNS below lol responds to stimulation w/reflex arteriolar vasoconstriction - increases blood pressure 3. PNS unable to counteract this 4. baroreceptors in carotid sinus & aorta sense HTN & stimulate PNS 5. results in decrease in hr, but visceral & peripheral vessels don't dilate - efferent impulses can't pass through cord lesion
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autonomic dysreflexia - nursing interventions
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1. elevate head of bed 45 degrees or sit patient upright 2. notify physician, assess to determine cause
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autonomic dysreflexia - most common cause
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bladder irritation
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autonomic dysreflexia - bladder irritation
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immediate catheterization
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autonomic dysreflexia - catheterization - interventions
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lidocaine jelly instilled in urethra before cath check for kinks or folds if plugged - small volume irrigation or new cath
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autonomic dysreflexia - other cause
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stool impaction
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autonomic dysreflexia - stool impaction - intervention
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digital rectal exam only after application of anesthetic oitment to decrease rectal stimulation & prevent increase in symptoms
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autonomic dysreflexia - other interventions
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1. remove all stimuli - constrictive clothing & tight shoes 2. monitor bp frequently during episode
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autonomic dysreflexia - if symptoms persist after source relieved
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a-adrenergic blocker arteriolar vasodilator (Procardia) administered
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SCI - Home Care - respiratory - high cervical injury
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1. phrenic nerve stimulators 2. electronic diphragmatic pacemakers 3. may improve mobilty greatly 4. used when phrenic nerve intact 5. ventilators - teach patient about ventilator care 6. patients w/o ventilators - taught assisted coughing & regular use of incentive spirometry or deep breathing exercises
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SCI - Home Care - neurogenic bladder - define
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any type of bladder dysfunction r/t abnormal or absent bladder innervation
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SCI - Home Care - neuogenic bladder - who has it
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after spinal cord shock resolves some usually have to some degree
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SCI - Home Care - bladder needs to function properly
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NS coordination urethral & pelvic floor muscles relaxing detrusor muscle contracting
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SCI - Home Care - complication of bladder
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neurogenic bladder may have to reflex detrusor contractions (areflexic, flaccid) may have hyperactive reflex detrusor contractions (hyperreflexic, spastic) or lack of coordination between the two (dyssynergia)
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SCI - Home Care - neurogenic bladder manifestations
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urgency frequency incontinence inability to void high bladder pressures - reflex into kidneys
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Neurogenic bladder classifications
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1. reflex detrusor activity 2. intravesical filling pressure 3. continence function
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When stable & evidence of neurologic reflexes - tests done
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urodynamic testing cultures
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Neurogenic bladder - drainage methods
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bladder reflex retraining - when partial voiding remains indwelling catheter intermittent catheterization external catheter (condom cath)
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Neurogenic bladder - surgical options
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sphincterotomy implantation of a functional electrical stimulation device urinary diversion
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Reflexic bladder w/detrusor & sphincter dyssynergia requires
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interventions to provide low-pressure storage low-pressure voiding adequate empyting
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Neurogenic Bladder - Reflexic bladder - Meds to suppress bladder contraction
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anticholinergics ditropan detrol
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Neurogenic Bladder - reflexic bladder - meds to decrease outflow resistance at bladder neck
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a-adrenergic blockers hytrin cardura
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Neurogenic Bladder - reflexic bladder - meds to decrease spasticity of pelvic floor muscles
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antispasmatics lioresal (Baclofen)
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Neurogenic Bladder - reflexic bladder - drainage options
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intermittent catherization external cath indwelling cath
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Reflexic bladder with hyperreflexia may be treated with
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anticholinergic drugs intravesical capsaicin botulinum A toxin
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Areflexic bladder management
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usually with intermitten cath or indwelling cath
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most commonly recommended method of bladder management
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intermittent cath
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initially intermmitent cath done when
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q 4 hours
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how to assess bladder volume before
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portable bladder ultrasound
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amount of urine - parameter
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500 mL urine, time interval shortened number of caths per day usually 5 or 6
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Neurogenic bladder - surgery when
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repeated UTIs w/renal involvment repeated stone therapeutic intervention unseccessful
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Neurogenic bladder - sugery - describe
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1. bladder neck revision - sphincterotomy 2. bladder augmentation - augmentation cystoplasty 3.penile prosthesis 4. artificial sphincter 5. perineal ureterostomy 6. cystotomy 7. vesicotomy 8. anterior urethral transplantation
