Autonomic dysreflexia

[Sapple]

What is the nurse first action in a pt who has AD.....assess for bladder or bowel impaction or elevate the head of the bed?

[iheartNICU89]

Elevate the head of the bed. I believe I have read that somewhere

[Indian_rn2b]

As we know most common causes of autonomic dysreflexia is bladder distention so the very first thing we would do is assess for bladder distention and check catheter but it really depends on a question if patient is having sever signs and symptoms of AD like sudden onset of sever throbbing headache

sever hypertension

nasal stuffiness

sweating

flushing above the level of the lesion

dilated pupils or blurred vision

then its an emergency situation the first thing to do is to raise the head of the bed to a high fowler's position (90 degree)and loosen tight clothing and then assess for bladder distention and prepare for Catheterization

So I think It really depends on a questions what they are looking for..Do they want us to assess or to do intervention ?

[PRNketamine7, BSN, RN]

It's elevate the hob, next would be what the poster above said. You are worried about hight Bp so definitely sit them up first.