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Assessing for orthostatic hypotension

RUSHING, JILL RN, MSN

CLINICAL DO'S & DON'TS
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ORTHOSTATIC HYPOTENSION is a drop of at least 20 mm Hg systolic or 10 mm Hg diastolic in blood pressure (BP) when someone stands quietly for a few minutes after rising from a reclining position. The most common causes are volume depletion and autonomic dysfunction.

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DO

  • Assess your patient's history, signs and symptoms, and current medications.
  • Lower the head of the bed and place the bed in a low position so she can stand easily later in the examination.
  • Ask her to lie on her back and remain supine for 5 to 10 minutes. Then take and record initial BP and pulse readings while she remains supine. If her medical record doesn't contain previous readings on both arms, take her BP in both arms and record the higher reading.
  • Figure

    Figure

    Figure

    Figure

  • Throughout the procedure, assess her for signs and symptoms of hypotension, including dizziness, light-headedness, pallor, diaphoresis, or syncope (or arrhythmias if she's attached to a cardiac monitor). Immediately return her to a supine position if she develops symptoms of hypotension before you complete the test.
  • When recording your patient's BP and pulse rates, include her position when you took the readings and any signs or symptoms she developed with postural changes.
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DON'T

  • Don't leave the patient unassisted during position changes if she develops dizziness or light-headedness.
  • Don't have her stand if she develops signs and symptoms of hypotension, such as dizziness, light-headedness, or pallor while sitting.

Jill Rushing is a nursing instructor at Amarillo (Tex.) College. Richard L. Pullen, Jr., RN, EdD, coordinates Clinical Do's & Don'ts, which illustrates key clinical points for a common nursing procedure. Because of space constraints, it's not comprehensive.

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SELECTED REFERENCES

Smeltzer S, Bare B. Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 10th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2003.
    Smith S, et al. (eds). Clinical Nursing Skills: Basic to Advanced Skills, 6th edition. Upper Saddle River, N.J., Prentice-Hall, Inc., 2004.
      Timby B. Fundamental Nursing Skills and Concepts, 8th edition. Philadelphia, Pa., Lippincott Williams & Wilkins, 2004.
        © 2005 Lippincott Williams & Wilkins, Inc.