The nurse is caring for a client experiencing autonomic dysreflexia. Which of the following does the nurse recognize as the source of symptoms?
A.
Autonomic nervous system.
B.
Central nervous system.
C.
Sympathetic nervous system.
D.
Peripheral nervous system.
The Correct Answer and Explanation is:
The correct answer is A. Autonomic nervous system.
Explanation:
Autonomic dysreflexia (AD) is a potentially life-threatening condition often observed in individuals with spinal cord injuries above the T6 level. It is characterized by an abnormal overactivity of the autonomic nervous system (ANS), which leads to a sudden and severe increase in blood pressure and other symptoms. Understanding the source of these symptoms involves a deep dive into the role of the ANS and its impact on the body.
Autonomic Nervous System (ANS): The ANS is a division of the peripheral nervous system that controls involuntary physiological functions, including heart rate, blood pressure, digestion, and temperature regulation. It operates below the level of conscious control and consists of two primary branches: the sympathetic and parasympathetic nervous systems.
In the context of autonomic dysreflexia, the source of the symptoms is indeed the ANS. This condition occurs due to a disruption in the normal function of the ANS, primarily affecting the sympathetic branch. When an individual with a spinal cord injury experiences a noxious stimulus below the level of injury (such as a full bladder, bowel impaction, or skin irritation), the sympathetic nervous system responds with a reflexive increase in blood pressure and other systemic symptoms. However, because the spinal cord injury blocks the descending inhibitory pathways from the brain, this sympathetic response is exaggerated and uncontrolled.
Pathophysiology: During AD, the sympathetic nervous system becomes hyperactive below the level of the injury, causing vasoconstriction and a dramatic rise in blood pressure. This increase in blood pressure triggers a compensatory parasympathetic response above the injury level (such as bradycardia), but this response is often insufficient or ineffective in counteracting the hypertensive episode. Symptoms of AD include severe headache, sweating, flushed skin, and nasal congestion.
Clinical Management: Immediate treatment involves identifying and removing the offending stimulus (e.g., emptying the bladder, addressing bowel impaction) and managing blood pressure to prevent complications like stroke or cardiovascular events.
Understanding that autonomic dysreflexia stems from an overreaction of the autonomic nervous system is crucial in providing appropriate care and preventing potentially serious complications.