› Orthostatic Hypotension

The Nursing Skill Of Assessing
Orthostatic Hypotension

Usually when there is any change in the body position, there are autonomic responses to maintain homeostasis (maintain a balance of all things in the body). With this condition, it doesn’t occur. There can be various causes, some of which can be managed by a nurse.

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When a patient complains of dizziness when moving from lying to sitting or from sitting to standing, checking their blood pressure is a good nursing intervention. Sometimes the symptoms are more severe and can lead to LOC (loss of consciousness) and falls resulting in injuries.

It also may be a physician’s order for the nurse to take orthostatic readings for evaluation.

The procedure is to simply have the patient lie down for approximately five minutes while you take the blood pressure. Then ask the patient to sit up and measure the blood pressure within one to three minutes of this change in position. Note if there are any complaints of dizziness or lightheadedness.   Ask the patient to move from sitting to standing and again check the blood pressure.

These readings are then recorded along with any c/o (complaints offered) by the patient and all is reported to the physician. 

A change in the systolic blood pressure reading of > (greater than) 20 mm/HG (millimeters of mercury which is 20 points of the top number of the blood pressure or >10 mm/HG of the diastolic blood pressure (bottom number of the blood pressure) is considered to be orthostatic hypotension.

Taking a blood pressure does NOT require a doctor’s order so if you feel it appropriate to assess for any reason this is well within your nursing scope of practice.

woman fainted from orthostatic hypotension

Causes of Orthostatic Hypotension

Can be as simple as dehydration from lack of adequate fluid intake. Encouraging fluids if there is no dietary restrictions from the physician is appropriate.

If the patient is on antihypertensive medication, it is possible an adjustment in medication by the physician may be warranted. However, one set of readings does not a trend make. 

You may want to report the readings to the doc but keep in mind that additional readings confirming the problem would be best before you request a change in medication. You don’t want the BP to bounce sky high if the medication is reduced too soon. 

Prolonged bed rest can temporarily cause orthostatic hypotension until the patient begins to increase activity and changes in position. If this is the case, careful increase in activity with standby assist to prevent falls may eliminate the problem.

Terminology

  • Orthostatic: (how to pronounce) Caused by standing up
  • Hypotension: Low blood pressure
  • c/o: complaints of
  • LOC: Loss of consciousness

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