STUDY - Technical - New Dacian's Medicine
Orthostatic
hypotension (Classical / Allopathic Medicine)
With
orthostatic hypotension, also known as postural
hypotension, the patient's blood pressure drops 15 to 20
mm Hg or more - with or without an increase in the heart
rate of at least 20 beats/minute - when he rises from a
supine position to a sitting or standing position. (Blood
pressure should be measured 5 minutes after the patient
has changed his position.) This common sign indicates
failure of compensatory vasomotor responses to adjust to
position changes. It's typically associated with
light-headedness, syncope, or blurred vision, and it may
occur in hypotensive, normotensive, or hypertensive
patients. Although frequently a nonpathologic sign in
elderly people, orthostatic hypotension may result from
prolonged bed rest, fluid and electrolyte imbalance, an
endocrine or systemic disorder, or the effects of certain
drugs.
To
detect orthostatic hypotension, take and compare blood
pressure readings with the patient in supine, sitting, and
standing positions.
ALERT:
If you detect orthostatic hypotension:
- quickly check for tachycardia, altered level of consciousness, and pale, clammy skin (If these signs are present, suspect hypovolemic shock.)
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
If you detect orthostatic hypotension:
- quickly check for tachycardia, altered level of consciousness, and pale, clammy skin (If these signs are present, suspect hypovolemic shock.)
- institute emergency measures, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient whether he frequently experiences dizziness, weakness, or fainting when he changes position.
Ask the patient about associated signs and symptoms, particularly fatigue, orthopnea, impotence, nausea, headache, abdominal or chest discomfort, and GI bleeding.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient whether he frequently experiences dizziness, weakness, or fainting when he changes position.
Ask the patient about associated signs and symptoms, particularly fatigue, orthopnea, impotence, nausea, headache, abdominal or chest discomfort, and GI bleeding.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Check the patient's skin turgor.
Palpate peripheral pulses, and auscultate the heart and lungs.
Test muscle strength, and observe the patient's gait for unsteadiness.
Check the patient's skin turgor.
Palpate peripheral pulses, and auscultate the heart and lungs.
Test muscle strength, and observe the patient's gait for unsteadiness.
SPECIAL
CONSIDERATIONS:
Always keep the patient's safety in mind. Never leave him unattended while he's sitting or walking; evaluate his need for assistive devices, such as a cane or walker.
Always keep the patient's safety in mind. Never leave him unattended while he's sitting or walking; evaluate his need for assistive devices, such as a cane or walker.
PEDIATRIC
POINTERS:
Because normal blood pressure is lower in children than in adults, familiarize yourself with normal age-specific values to detect orthostatic hypotension. From birth to age 3 months, normal systolic pressure is 40 to 80 mm Hg; from ages 3 months to 1 year, 80 to 100 mm Hg; and from ages 1 to 12, 100 mm Hg plus 2 mm Hg for every year over age 1. Diastolic blood pressure is first heard at about age 4; it's normally 60 mm Hg at this age and gradually increases to 70 mm Hg by age 12.
The causes of orthostatic hypotension in children are the same as those in adults.
Because normal blood pressure is lower in children than in adults, familiarize yourself with normal age-specific values to detect orthostatic hypotension. From birth to age 3 months, normal systolic pressure is 40 to 80 mm Hg; from ages 3 months to 1 year, 80 to 100 mm Hg; and from ages 1 to 12, 100 mm Hg plus 2 mm Hg for every year over age 1. Diastolic blood pressure is first heard at about age 4; it's normally 60 mm Hg at this age and gradually increases to 70 mm Hg by age 12.
The causes of orthostatic hypotension in children are the same as those in adults.
AGING
ISSUES:
Elderly patients commonly experience autonomic dysfunction, which can present as orthostatic hypotension. Postprandial hypotension occurs 45 to 60 minutes after a meal and has been documented in up to one-third of nursing home residents.
Elderly patients commonly experience autonomic dysfunction, which can present as orthostatic hypotension. Postprandial hypotension occurs 45 to 60 minutes after a meal and has been documented in up to one-third of nursing home residents.
PATIENT
COUNSELING:
Patients with conditions that can lead to autonomic dysfunction (such as diabetes mellitus) should be made aware of the acute drop in blood pressure that can occur with positional changes. Such patients need to avoid volume depletion and perform positional changes gradually instead of suddenly.
Patients with conditions that can lead to autonomic dysfunction (such as diabetes mellitus) should be made aware of the acute drop in blood pressure that can occur with positional changes. Such patients need to avoid volume depletion and perform positional changes gradually instead of suddenly.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.