Which of the following clients on the rehab unit is most likely to develop autonomic dysreflexia?
A. A client with a brain injury.
B. A client with a herniated nucleus pulposus.
C. A client with a high cervical spine injury.
D. A client with a stroke.
Correct Answer: C. A client with a high cervical spine injury.
Autonomic dysreflexia refers to uninhibited sympathetic outflow in clients with spinal cord injuries about the level of T10. The other clients aren’t prone to dysreflexia. The etiology is a spinal cord injury, usually above the T6 level. It is unlikely to occur if the level is below T10. The higher the injury level, the greater the severity of the cardiovascular dysfunction. The severity and frequency of autonomic dysreflexia episodes are also associated with the completeness of the spinal cord injury.
Option A: The American Journal of Psychiatry published a study in 2015 that showed the prevalence of comorbidity of disorders among soldiers classified at T2 (3 months post-deployment) as experiencing a major depressive episode, PTSD, generalized anxiety disorder, or suicidality in the past 30 days went up from 12.9% to 16.8% at T3 (9 months post-deployment).
Option B: Complications associated with nucleus pulposus herniation can result from the compression effect on the nerve root in severe cases resulting in motor deficit, in the cervical and thoracic spine there is also a risk of spinal cord compression in severe cases. These complications are relatively uncommon but should be considered and properly treated to avoid a permanent neurological deficit.
Option D: Stroke complications can also impact a patient’s prognosis. Common complications include pneumonia, deep vein thrombosis, urinary tract infections, and pulmonary embolism. However, patients who do not experience any complications within the first week tend to experience steady neurological improvement. The majority of patients experience the most improvement during the first 3 to 6 months after a stroke.
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