POSTURAL/ORTHOSTATIC HYPOTENSION

Introduction

Blood Pressure – it is the force exerted on the walls of an artery created by the pulsing blood
under pressure from the heart.
The heart’s contraction ejects blood under high pressure into the aorta. The peak of maximum
pressure when ejection occurs is the systolic blood pressure. When the heart relaxes, the blood
remaining in the arteries exerts minimum or diastolic pressure. Diastolic pressure is the lowest
pressure exerted against the arterial walls at all times. The standard unit of measuring blood
pressure is millimeters of mercury (mm Hg)
Pulse pressure – the difference between systolic and diastolic pressure is pulse pressure.

Orthostatic hypotension

Definition
Orthostatic hypotension, also referred to as postural hypotension, occurs when a client with a
normal blood pressure develops symptoms and low blood pressure when rising to an upright
position.

Cause
When healthy person changes from a lying, to sitting, to standing position the peripheral blood
vessels in the legs constrict, preventing the pooling of blood in legs caused by gravity.
Orthostatic hypotension occurs when the peripheral blood vessels in the legs are already
constricted or are unable to constrict in response to a change in position.

Measuring Orthostatic Blood Pressure

Equipment
A Big tray containing
Stethoscope
BP Apparatus(Sphygmomanometer)
Spirit swab
Kidney and Paper Bag

Procedure
1) Obtaining orthostatic blood pressure measurements require critical thinking and ongoing
nursing judgements and is not delegated to assistive personnel.
2) Obtain supine clients blood pressure in each arm .select arm with highest systolic reading
for subsequent measurements.
3) Leaving blood pressure cuff in place ,assist client to sitting position .After 1-3 minutes
with client in sitting position ,obtain blood pressure . if orthostatic symptoms occur such
as dizziness ,weakness ,lightheadedness ,feeling faint or sudden pallor ,terminate blood
pressure measurement and assist client to supine position.
4) Leaving blood pressure cuff in place, assist client to standing position .After 1-3 minutes
with client is standing position ,obtain blood pressure . If orthostatic symptoms occur
 ,terminate blood pressure measurement and assist client to supine position . In most cases
you will detect orthostatic hypotension within one minute of standing.
5) Record clients blood pressure in each position ,e.g.
140/80 supine
132/72 sitting
108/60 standing
6) Report findings of orthostatic hypotension or orthostatic symptoms to physician or nurse
incharge .Intruct client to obtain assistance when getting out of bed if orthostatic
hypotension is present or orthostatic symptoms occur.

General instructions for taking blood pressure

1. Provide comfortable position.
2. Select appropriate size of the cuff according to the age of the client.

Age Size of cuff

Under one year 2.5 – 3
1 – 4 years 5 – 6 cm
4 – 8 years 8 – 9 cm
≥ 8 years 12 – 18 cm

3. Deflate the cuff slowly. There should be no noise in the environment. View the meniscus
from above the eye level (Mercury sphygmomanometer)
4. Inflate the cuff 20-30 mm of Hg above the disappearance of the pulse.
5. Ensure that the tubing is not cracked or kinked.
6. Place the bell on the direct area of the artery.
7. Before measuring blood pressure consider the factors which cause variation in a normal
condition.
8. Do not take blood pressure more than three times in succession at the same time.

Procedure of taking Blood presssure

Preparation of patient
- Identify the patient to select appropriate cuff size
- Provide a comfortable position
- Explain the procedure to the patient.
- Assess the arm on which the blood pressure is to be taken. Do not take blood pressure
from the arm which has :-
I/V infusion, injury, shunt or fistula for renal dialysis and female patients with radical
mastectomy.

Equipments used for Measuring Orthostatic hypotension

A tray containing: -
Articles Rationale

Sphygmomanometer with cuff of an To record blood pressure

appropriate size
Stethoscope To record systolic and diastolic blood pressure

Spirit swabs in a container To clean ear piece and diaphragm to prevent

transmission of infection.

A paper bag To discard used spirit swabs

TPR sheet and nurses’ record To record the findings at the same time.

Steps of procedure

1. Explain procedure to the patient.

2. Wash hands
3. Use spirit swab to clean ear pieces and diaphragm.
4. Select the arm by removing constrictive clothings.
5. Palpate brachial artery and position cuff 2.5 cms above brachial pulsation. Mercury
sphygmomanometer should be placed at eye level .If aneroid type of sphygmomanometer
is used ,dial should be facing upwards.
6. Wrap cuff evenly and snugly around the upper arm.
7. Palpate radial artery with finger tips of one hand ,30 mm of Hg above the point of pulse
disappearance and close the valve.
8. Place the stethoscope ear piece in the ear and diaphragm on the brachial artery.
9. Slow release the valve and allow the mercury to fall at the rate of 2-3 mm of Hg /second.
10. Note the point of manometer when the first clear sound is heard and continue its deflate
gradually, noting the point at which the sound disappears or changes.
11. Deflate the cuff rapidly and completely and remove the cuff.
12. Record blood pressure in nurses note.
13. Inform the client blood pressure reading .it helps to reduce anxiety.
14. Make the patient comfortable and wash hands.

Aftercare of Articles:-
1) Make the patient comfortable.
2) Remove the cuff, roll it and replace in the box and close it.
3) Keep sphygmomanometer and stethoscope in the duty room /cupboard.
4) Report any deviation from normal.