Orthostatic Hypotension
Drop in blood pressure on standing, a fall risk
Definition
Orthostatic hypotension (postural hypotension) is a sustained reduction of systolic BP of at least 20 mmHg or diastolic BP of at least 10 mmHg within 3 minutes of standing or being placed upright.
Causes
- Dehydration, hypovolemia
- Medications: antihypertensives, diuretics, tricyclic antidepressants, alpha-blockers, opioids
- Prolonged bed rest
- Autonomic dysfunction (Parkinson's, diabetes)
- Adrenal insufficiency
- Anemia
Signs and Symptoms
Dizziness, lightheadedness, blurred vision, weakness, syncope, falls.
Assessment Technique
Measure BP and HR supine, sitting, and standing at 1 and 3 minutes. Record and compare values.
Nursing Interventions
- Teach 'dangle' before standing (sit on edge of bed 1 to 2 minutes)
- Encourage slow position changes
- Adequate hydration (2 L/day unless restricted)
- Compression stockings
- Review and adjust medications
- Fall precautions
NCLEX Relevance
Dangle before standing. Safety teaching for elderly and medicated patients.