Which assessment findings alert the nurse that the client who has a spinal cord injury is developing autonomic hyperreflexia (autonomic dysreflexia)?

• A. Hypertension and bradycardia
• B. Flaccid paralysis and numbness
• C. Absence of sweating and pyrexia
• D. Escalating tachycardia and shock

Answer: (A)

Autonomic dysreflexia happens when a noxious stimulus below a spinal cord injury (usually above T6) triggers an unregulated sympathetic response. The blood vessels below the injury constrict, causing a sudden, dangerous rise in blood pressure. Because signals can’t reach or be modulated by the brain, the body tries to compensate, and the heart rate often slows down in response, producing bradycardia. So the key clue is a pattern of very high blood pressure with a relatively slow heart rate.

The other descriptions don’t fit this syndrome. Flaccid paralysis and numbness align more with the acute injury or spinal shock rather than the reflex hypertension. Absence of sweating and fever doesn’t reflect the typical autonomic changes above the injury (sweating may occur above the level of injury). Escalating tachycardia and shock suggest a different hemodynamic state (shock often implies hypotension or a different crisis), not the classic hypertensive, bradycardic pattern of autonomic dysreflexia.

Recognizing hypertension with bradycardia alerts you to rapidly identify and remove triggering stimuli and position the patient to help lower BP, preventing serious complications.