BP lying and standing Flashcards
the procedure for doing standing and lying BP
ask patient ot lie down for at least 5 minutes
measure the BP
ask pt to stand up and measure BP after standing in the first minute
measure BP again after standing up for 3 minutes
repeat if BP is still dropping
what is a positive result
A drop in systolic BP of 20mmHg or more (with or without symptoms).
A drop to below 90mmHg on standing even if the drop is less than 20mmHg (with or without
symptoms).
A drop in diastolic BP of 10mmHg with symptoms (although clinically less significant than a
drop in systolic BP).
purpose of lying and standing BP
orthostatic hypotension
increases risk of falls
causes of orthostatic hypotension
impaired homeostatic mechanisms; inadequate hydration, for example, because of anorexia, drowsiness, delirium and dementia; antihypertensive medication; or prolonged bedrest
symptoms of orthostatic hypotension
dizzy, lightheaded and have blurred vision and blackouts
non pharmacological treatment of postural hypotension
- withdraw offending medication
- OT referral
- falls prevention class
- rise slowly from supine to sitting to standing position
- avoid straining, coughing and prolonged standing in hot weather
- cross legs while standing
- squat, stooping forward
- raise head of bed 10-20 degrees
- small meals and coffee in the morning
- elastic waist high stocking
- increase salt and water intake
- exercise ie swimming, recumbent biking and rowing
pharmacological treatment for postural hypotension
fludrocortisone - reduce salt loss
— monitor for fluid overload and electrolyte imbalance
midodrine
- severe orthostatic hypotension due to autonomic dysfunction when corrective factors have been rules out and other forms of treatment are inadequate - alpha receptor agonist
drugs that can cause postural hypotension
nitrates diuretics anticholinergic medications antidepressants beta-blockers L-Dopa ACE inhibitors
SEs of nitrites
headache dizziness NV postural drop tachycardia flushing heartburn rash
