In a patient with a spinal cord injury, which complication should the nurse be vigilant for due to autonomic dysreflexia risk?

• A. Pneumonia
• B. Autonomic dysreflexia
• C. Deep vein thrombosis
• D. Seizures

Answer: (B)

Focusing on the risk for autonomic dysreflexia in a patient with spinal cord injury highlights a life-threatening response that can occur when the injury is above T6. A noxious stimulus below the level of injury—such as bladder distension or bowel impaction—triggers an exaggerated sympathetic reflex. This causes a sudden, dangerous rise in blood pressure, often with a pounding headache, sweating or flushing above the level of injury, nasal congestion, and sometimes a slow or irregular heart rate. Because the hypertension can progress quickly to stroke or other serious complications, recognizing and acting on these signs promptly is essential.

In practice, if autonomic dysreflexia is suspected, place the patient upright or raise the head of the bed to help lower blood pressure, and immediately identify and remove the triggering stimulus (for example, check for a full or kinked catheter or bowel impaction, and remove tight clothing). Monitor blood pressure frequently and notify the healthcare provider if the blood pressure remains elevated after removing triggers or if symptoms persist. While pneumonia, deep vein thrombosis, and seizures are certainly concerns for someone with spinal cord injury due to immobility and neurological changes, autonomic dysreflexia is the specific, urgent complication that requires rapid recognition and intervention to prevent serious outcomes.