A nurse is caring for a client with a C4 spinal cord injury with an indwelling urinary catheter who exhibits signs of autonomic dysreflexia, including a severe headache and hypertension. What should the nurse do first?

Autonomic dysreflexia is a potentially life-threatening syndrome seen in clients with spinal cord injuries at T6 or above (including C4). It is triggered by a noxious stimulus below the level of injury, with bladder distension being the most common cause. The resulting uncontrolled sympathetic response produces severe hypertension, pounding headache, bradycardia, flushing above the level of injury, and pallor below it. The immediate priority is to identify and remove the triggering stimulus. Because a urinary catheter is in place, the first action is to check the catheter for kinks, obstructions, or a full drainage bag that could be causing bladder distension. Relieving the obstruction often rapidly resolves the episode. Performing digital rectal stimulation could worsen the dysreflexia by providing an additional noxious stimulus and is not the first action. Administering antihypertensive medication may eventually be necessary if the causative stimulus cannot be quickly removed, but it is a secondary measure and does not address the underlying cause. Placing the client in a supine position is contraindicated — the client should be placed in a sitting (upright) position to use orthostatic hypotension to help lower blood pressure while the trigger is identified. Always address the root cause first before turning to pharmacological intervention.