1 / 31

Autonomic Dysreflexia

Autonomic Dysreflexia. Anne Seaman Lead Nurse Duke of Cornwall Spinal Treatment Centre . What is Autonomic Dysreflexia?. Can occur quickly Is a life threatening medical emergency. Dysreflexia. First described in 1917,

elina
Download Presentation

Autonomic Dysreflexia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Autonomic Dysreflexia Anne Seaman Lead Nurse Duke of Cornwall Spinal Treatment Centre

  2. What is Autonomic Dysreflexia? Can occur quickly Is a life threatening medical emergency

  3. Dysreflexia • First described in 1917, • It is a protective mechanism that tells the person that something is wrong • Important to view it as a positive warning sign • Also known as autonomic hyperreflexia,

  4. Who is at risk? • Occurs in 83-85% of tetraplegic and high level paraplegic persons injured (T6 and above) • If is going to occur, it usually begins within the first few months following spinal shock

  5. What happens • SCI results in the nerve pathways to the brain are interrupted. • When there is pain or discomfort below the level of your SCI it triggers a nervous system reflex response • This begins a rapid increase in your blood pressure • This will continue until the cause is found and treated

  6. Possible Consequences of AD • Retinal haemorrhage in the eye • Apnoea - breath holding • Stroke • Renal (Kidney) failure • Subarachnoid (Brain) haemorrhage • Seizures (Fits) • Cardiac dysrhythmias (Heart changes) • Cardiac arrest • Death All are rare

  7. Prevention of AD • Good personal care • Careful bladder and bowel management • Good education • Expert Patient - in control

  8. Most Common Causes? Research shows that the most common causes are: 1over distended bladder 2 over distended bowel (Ceron & Rakowski-Reinhardt 1991, Dunn 1991, Finocchiaro & Herzfeld 1990, McGuire & Kumar 1986 cited Adsit & Bishop 1995)

  9. Most Common Triggers • Distended bladder • Distended bowel • Skin breakdown • UTI • Other causes of pain or discomfort

  10. Ingrown toenails External temperature extremes Clothing or shoes too tight Digital stimulation of the bowel Bladder spasm and stones Spasticity Sphincter bladder dyssynergia Appendicitis Orgasm Burns and Sunburn SIC Enemas Fractures Ovarian cyst DVT & PE Perforated gastric ulcer Heterotrophic Ossification Orthastic hypotension Oesophageal reflux Other Possible Triggers

  11. Response to Raised BP • The body does try to reduce the BP, • only able to do so above the level of injury, • which produces the well recognised symptoms of autonomic dysreflexia

  12. Signs and Symptoms • Headache - sudden & thumping • Flushed face – vasodilitation • Blotching of the skin – erythema • Goose bumps below the level of the lesion • Pallor below the level of the lesion • Increased blood pressure • Bradycardia • Profuse sweating • Nasal stuffiness • Fear

  13. Patient Specific Symptoms Some patients may not experience the common symptoms, particularly the thumping headache May complain of a ‘tight chest’ instead

  14. Other Signs and Symptoms • Increased spasm and spasticity • Nausea • Respiratory difficulties • Heart beat changes • Impending sense of doom • Vision changes • Metallic taste in the mouth

  15. Treatment Are you at risk of AD? • Level of SCI ? T6 or above • Extent of SCI ?complete/?incomplete • Previous episodes • Usual cause • Post SCI new normal BP

  16. Treatment • Carers or you need to act quickly & calmly, • Enlist help if needed • Sit upright if in bed (helps to lower BP) • BP monitored every 3-5 mins in hospital • Loosen tight clothing & binders • Assess for cause – bladder & bowel first • Prepare for catheter change or bowel care

  17. Find Cause: Bladder • Check urine in drainage bag • Full, empty and monitor • Empty, ?when last emptied • Check for kinks in tubing • Check for signs if catheter is dislodged • Any sign of haematurea? • Catheter blocked? Change it

  18. Find Cause: Bowel • Last bowel care, ? Result – good/small • Lie on left side (head raised) • PR check • If full will need manual evacuation • Local anaesthetic gel (3 mins) • Gentle Manual Evacuation (ME) • Let AD resolve and then perform usual bowel care

  19. Other Cause? • ?Ingrown toe nail • ?Pressure ulcer • Give analgesia • ? Give Nifedipine • Call GP, will need treatment and possibly Nifedipine SR

  20. Treatment • Administer • Nifedipine 5mg crush and swallow • Or GTN 300Micrograms/nasal spray (Only if diastolic BP is greater than 100mmHg) Patient should have a supply • If this is unsuccessful and cause is not found inform a Dr/GP/go to ED as Phentolamine 5-10mg IV may be required • Time will be running out

  21. Patient Information • Alert card • Carry medication • Care manual

  22. Rehabilitation Process • Assessment • Education • Patient, Family, Friends, Carers, • Lesson Plan • Skills development • Skills assessment • Independence • Teaching others

  23. Rehabilitation Process • Developing skills • Recognition • Self assessment – find cause • When to take medication • Change catheter • Bowel care • Skin inspection • Monitoring • Care plan • Diary

  24. AD Diary • This diary is intended for you to use and keep as a record of your episodes autonomic dysreflexia. The intention is not for you to keep records indefinitely, but until you feel confident in your ability to recognise your symptoms together with any trends in the causes to help you to prevent further episodes. • Name: • Level of SCI …………………. Complete Incomplete Date of SCI …………… • Normal BP…………/…………….

  25. Date of Autonomic Dysreflexia episode ……………………….. Symptoms: Put an ‘X’ in the box of all the symptoms you experienced.  Pounding headache  Heavy sweating  Blurred vision  Tight chest  Blotchy/flushed skin above SCI  Goose bumps  Anxiety/fear  Difficulty breathing  Other:

  26. Cause: Comments:…………………………..………………….. • Did you need medication? Yes No • What did you take? ………... Dose(s) ………………. • Did you have any difficulties managing the episode?  Yes  No • Comments: …………………….………………………..

  27. AD Kit It is advisable to carry suitable equipment • going out • on holiday If you out and unable to find a suitable place to manage an episode of AD call 999 for help. In your local area HAVE A PLAN.

  28. Catheter Supplies • Hand wipes or gel • Syringe to remove catheter if using an indwelling catheter • Spare catheter correct size • Bladder syringe • Insertion supplies including hand wipes and gloves • Sterile syringe to put water into the balloon, sterile water • Disposal bag • Spare clothing if you usually bipass the catheter/leak

  29. Bowel Care Supplies • Latex gloves • Polyethylene gloves • Anaesthetic lubricating gel • Wet wipes (baby wipes), tissues • Disposal bag • Spare clothing

  30. Don’t Forget • your medication - Nefidepine • check when it expires • keep your alert card with you. • Paracetamol for ongoing headache • Radar key for access to Disabled Toilets

More Related