👤 By the CinnaRN Clinical Content Team🕐 Updated 2026-08-23🏷️ Physiological Adaptation🔖 Free to read, print, and share
Also known as: AD · autonomic hyperreflexia · dysreflexia
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Use this quick-reference guide to spot, treat, and prevent Autonomic Dysreflexia on the NCLEX. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Mechanism
SCI at/above T6 → reflex storm
Noxious stimulus below injury
Trigger: full bladder #1 cause
🩺 Signs
Sudden severe HTN, pounding HA
Bradycardia, flushing above injury
Sweating, nasal congestion
✅ Do
Sit patient UP FIRST
Find/remove cause: kink, stool
Check catheter, antihypertensive
🚩 Report
Untreated → stroke, seizure, death
Medical EMERGENCY
📚 Autonomic Dysreflexia — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what must be reported, and what to teach.
Autonomic dysreflexia is a life-threatening emergency in patients with spinal cord injury at or above T6, triggered by a noxious stimulus below the level of injury (most commonly a distended bladder or bowel). The stimulus causes massive uncontrolled sympathetic discharge leading to severe, sudden hypertension. If not relieved quickly it can cause seizures, stroke, or death. The first action is to sit the patient upright and find and remove the trigger.
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Key points
Understand these first
Occurs in spinal cord injuries at or above T6 from a stimulus below the injury level.
The most common trigger is a distended bladder (blocked or kinked catheter); fecal impaction is the next most common.
Hallmark is a sudden, severe pounding headache with dangerously high blood pressure.
Above the injury: flushing, sweating, and nasal congestion; below the injury: pale, cool skin with goosebumps.
Bradycardia and blurred vision often accompany the hypertensive episode.
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Nursing priorities
What to do, in order
Raise the head of the bed/sit the patient upright immediately to lower blood pressure by orthostasis.
Identify and remove the noxious stimulus: first check the bladder/catheter for kinks and ensure drainage.
Check for and relieve fecal impaction (use anesthetic ointment first) and remove tight clothing or pressure.
Monitor blood pressure frequently (every few minutes) throughout the episode.
Administer prescribed rapid-acting antihypertensive if blood pressure remains dangerously high after removing the trigger.
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Red flags — report now
Escalate immediately
Severe pounding headache with sudden hypertension in a T6-or-above SCI patient is an emergency, act immediately.
Persistently elevated blood pressure despite removing the trigger can cause stroke or seizure, give antihypertensive and notify the provider.
Never leave the patient flat; lowering the head worsens the hypertension.
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Patient teaching
What patients must know
Prevent triggers by keeping a regular bladder and bowel routine and ensuring the catheter drains freely.
Recognize early signs (pounding headache, sweating, flushing) and sit upright and remove the cause immediately.
Wear a medical alert bracelet and seek emergency care if blood pressure cannot be controlled.
❓ Autonomic Dysreflexia: NCLEX FAQs
What are the priority nursing interventions for Autonomic Dysreflexia?
Raise the head of the bed/sit the patient upright immediately to lower blood pressure by orthostasis. Identify and remove the noxious stimulus: first check the bladder/catheter for kinks and ensure drainage. Check for and relieve fecal impaction (use anesthetic ointment first) and remove tight clothing or pressure. Monitor blood pressure frequently (every few minutes) throughout the episode.
What are the warning signs of Autonomic Dysreflexia a nurse must report?
Severe pounding headache with sudden hypertension in a T6-or-above SCI patient is an emergency, act immediately. Persistently elevated blood pressure despite removing the trigger can cause stroke or seizure, give antihypertensive and notify the provider. Never leave the patient flat; lowering the head worsens the hypertension.
What do I need to know about Autonomic Dysreflexia for the NCLEX?
Occurs in spinal cord injuries at or above T6 from a stimulus below the injury level. The most common trigger is a distended bladder (blocked or kinked catheter); fecal impaction is the next most common. Hallmark is a sudden, severe pounding headache with dangerously high blood pressure. Above the injury: flushing, sweating, and nasal congestion; below the injury: pale, cool skin with goosebumps.
What patient teaching is important for Autonomic Dysreflexia?
Prevent triggers by keeping a regular bladder and bowel routine and ensuring the catheter drains freely. Recognize early signs (pounding headache, sweating, flushing) and sit upright and remove the cause immediately. Wear a medical alert bracelet and seek emergency care if blood pressure cannot be controlled.
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Quick Tip
Occurs in spinal cord injuries at or above T6 from a stimulus below the injury level.