Autonomic Dysreflexia Clinical Procedure



Canberra Hospital and Health ServicesClinical ProcedureAutonomic DysreflexiaContents TOC \h \z \t "Heading 1,1" Contents PAGEREF _Toc441833425 \h 1Purpose PAGEREF _Toc441833426 \h 2Alerts PAGEREF _Toc441833427 \h 2Scope PAGEREF _Toc441833428 \h 2Section 1 – Recognition of Autonomic Dysreflexia PAGEREF _Toc441833429 \h 2Section 2 – Treatment of Autonomic Dysreflexia PAGEREF _Toc441833430 \h 4Implementation PAGEREF _Toc441833431 \h 4Related Policies, Procedures, Guidelines and Legislation PAGEREF _Toc441833432 \h 5References PAGEREF _Toc441833433 \h 5Search Terms PAGEREF _Toc441833434 \h 5Attachments PAGEREF _Toc441833435 \h 6PurposeThis procedure provides information, direction and a clinical algorithm for the recognition and management of an episode of autonomic dysreflexia in spinal cord injured patients. This Standard Operating Procedure (SOP) describes for staff the process to ScopeAlertsAn episode of autonomic dysreflexia is always considered a medical emergency and requires immediate intervention. ScopeThis procedure applies to nursing and medical staff who provide clinical care to spinal cord injured patients. Nursing and medical staff providing clinical care to spinal cord injured patients must have current theoretical and clinical knowledge in the recognition and management of autonomic dysreflexia. Section 1 – Recognition of Autonomic DysreflexiaEssential clinical information Autonomic dysreflexia, also known as hyperreflexia, can occur in people with a spinal cord injury at or above the T6 level. It is an exaggerated and potentially dangerous response of the autonomic nervous system to a painful or noxious stimulus below the level of the injury. It is very unpredictable. Some spinal injured people may experience regular episodes whereas other people, even at the same level of injury, may never have an episode. Autonomic Dysreflexia is a complex syndrome, resulting in rapid and unresolved hypertension (high blood pressure) caused by the interaction of many different responses in the body. During autonomic dysreflexia the blood pressure will continue to rise until the cause is identified and removed. In the worst case scenario the high blood pressure can lead to stroke.It is always caused by an irritating/painful/noxious stimulus below the level of the injury. For example this could be a very full bladder, a pressure area or an ingrown toe nail. In some cases it may be due to a visceral issue such as appendicitis or impacted bowel. Signs and symptomsOne or more of the following signs and symptoms will be present:Sudden throbbing or pounding headacheSudden sweating above the level of the injurySudden appearance of red/pink rash above the level of the injurySudden pale skin below the level of the injurySudden stuffy noseApprehension or anxietyHypertension Bradycardia Headache is often the first sign that most spinal injured people are aware of. It is important to note that this is not the type of headache that starts slowly and gets worse over a number of hours. It is a sudden pounding headache which rapidly increases in pain and intensity. Most people with a spinal cord injury easily recognise this type of headache once they have experienced it once. Common causesBladder issues (most common cause of autonomic dysreflexia) - distended bladder, kidney or bladder stones, urinary tract infection, blocked catheter, defective drainage system, high pressure voiding, insertion of a catheter, catheter tubing which is kinked.Bowel issues - constipation, faecal impaction, rectal irritation (e.g. enema or manual evacuation), haemorrhoids.Skin problems - ingrown toenail, pressure ulcer, contact burns, scalds or sunburn, tight clothing.Other - any irritating/noxious stimulus including: fracture, epididymo-orchitis, distended stomach, deep vein thrombosis and labour or severe menstrual cramping.Patients with a spinal cord injury at or above the T6 level should:Have an appropriate management plan for bladder and bowel careHave a current medication order for administration of medication as per treatment algorithm (see attachment)Be educated in identifying causative factors, prevention strategies and early management of autonomic dysreflexia.Patients in the communityPatients in the community with a spinal cord injury at or above the T6 level are to consult with their General Practitioner to obtain ongoing prescriptions and ensure that the medication is available in their home during catheter changes attended to by community nurses. The community nurse will leave an emergency catheter pack in the house containing a catheter, lubricant containing local anaesthetic, sterile gloves. Back to Table of Contents Section 2 – Treatment of Autonomic DysreflexiaFirst line treatment of autonomic dysreflexia Sit the person as upright as possibleRemove or loosen all tight clothing – including binders, TED stockings, beltsCommence treatment as per algorithm (see attachment - Treatment Algorithm for Autonomic Dysreflexia (Hypertensive Crises) In Spinal Cord Injury, New South Wales Department of Health) Note: Blood pressure for spinal cord injured patients is typically low e.g. 90-100/60mmg.If you are unable to take blood pressure or do not have access to this equipment follow the algorithm omitting the blood pressure section.Note: Autonomic dysreflexia is always considered a medical emergency and can be life threatening. For patients in the community: Call 000 for ACT Ambulance Service if additional support is required.Follow up careFollowing an episode of autonomic dysreflexia explain to the patient:They may experience a residual headache up to one week post the dysreflexic episode (this is not the same intensity headache as in a dysreflexic episode).Try to avoid procedures that triggered the episode for at least 48 hours e.g. rectal stimulation/catheter manipulation.There is a possibility of increased susceptibility to further episodes over the following few days and it is important to remain vigilant with self care. Back to Table of Contents Implementation This procedure is available on the ACT Policy Register for all munity nurses are educated in the recognition and management of autonomic dysreflexia by the Nurse Practitioner Rehabilitation and Continence CNC.Nurses in the hospital are educated by the ward CDNs.Back to Table of ContentsRelated Policies, Procedures, Guidelines and LegislationPoliciesNursing and Midwifery Continuing Competence PolicyProceduresCHHS Bowel Assessment and Management Clinical ProcedureCHHS Urology - catheter management and bladder irrigation Clinical ProcedureBack to Table of ContentsReferencesTreatment Algorithm for Autonomic Dysreflexia (Hypertensive Crises) In Spinal Cord Injury, New South Wales Department of Health: Safety Notice 014/10 (2006 amended 2010).Middleton J (2010) NSW State Spinal Cord Injury Service: Treatment of Autonomic Dysreflexia for adults and adolescents with spinal cord injuries. A medical emergency. The Complete Drug Reference Copyright 2009 Pharmaceutical Press. (Captopril).Krassioukov, A. Warburton, D. Teasell, R. A Systematic Review of the Management of Autonomic Dysreflexia Following Spinal Cord Injury. Arch Pphys Rehabil. 2009: 90(4): 682-695. 2009Sweetman SC (2009). Martindale: The Complete Drug Reference (36th edition ed.). London: Pharmaceutical Press.Sublingual captopril - a pharmacokinetic and pharmacodynamic evaluation. Al-Furaih TA, McElnay JC, Elborn JS, Rusk R, Scott MG, McMahon J, Nicholls DP. Eur J Clin Pharmacology 1991 40: 393-398.Evaluation of Captopril for the Management of Hypertension in Autonomic Dysreflexia: A Pilot Study. Esmail Z, Shalansky KF, Sunderrji R, Anton H, Chambers K, Fish W. Archives of Physical Medicine & Rehabilitation 2002, Vol 83, 604-608.Back to Table of ContentsSearch Terms Autonomic dysreflexia, Dysreflexia, Hyperreflexia, Spinal cord injury, Dysreflexic, Autonomic nervous system, Catheter, BowelBack to Table of ContentsAttachmentsAttachment 1: Treatment Algorithm for Autonomic Dysreflexia (Hypertensive Crises) In Spinal Cord Injury, New South Wales Department of HealthDisclaimer: This document has been developed by ACT Health, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.Date AmendedSection AmendedApproved ByEg: 17 August 2014Section 1ED/CHHSPC ChairAttachment 1: Treatment Algorithm for Autonomic Dysreflexia (Hypertensive Crises) In Spinal Cord Injury, New South Wales Department of Health ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download