Hypotension Nursing Diagnosis and Nursing Care Plans

Hypotension Nursing Care Plans Diagnosis and Interventions

Hypotension NCLEX Review and Nursing Care Plans

Hypotension is the medical term for low blood pressure, and it is defined as a measurement of less than 90 millimeters of mercury (mm Hg) for the top number or systolic and 60 mm Hg for the bottom number or diastolic.

Blood pressure is the force of blood pushing against the walls of the arteries. The blood pressure rises and falls in response to daily activities.  Low blood pressure may appear desirable, and it may not create any difficulties for some people.

However, unusually low blood pressure or hypotension can cause dizziness and fainting in many people. Thus, making it life-threatening in severe circumstances. Low blood pressure can be caused by a variety of factors, ranging from dehydration to severe medical conditions. It is important to determine the source of low blood pressure so that it can be treated.

Causes of Hypotension

Hypotension can be caused by a variety of medical disorders, including:

  • Pregnancy. Blood pressure is likely to decline during pregnancy due to the rapid expansion of the circulatory system. This is normal, and once given birth, and the blood pressure should recover to its pre-pregnancy level.
  • Heart Problems. Extremely low heart rate (bradycardia), heart valve problems, heart attack, and heart failure are all disorders that can cause hypotension.
  • Endocrine problems. Hypotension can be caused by thyroid disease, adrenal insufficiency (Addison’s disease), low blood sugar (hypoglycemia), and, in some situations, diabetes.
  • Dehydration. Weakness, dizziness, and fatigue can occur when the body loses more water than it takes in. Fever, vomiting, severe diarrhea, overuse of diuretics, and extreme exercise can all lead to dehydration which may cause a drop in blood pressure.
  • Severe infection or septicemia. When an infection in the body reaches the bloodstream, it can cause a life-threatening drop in blood pressure called septic shock.
  • Severe allergic reaction or anaphylaxis. Foods, certain drugs, insect venoms, and latex are all common triggers for this severe and life-threatening reaction. Symptoms of anaphylaxis include breathing difficulties, hives, itching, a swollen throat, and a severe drop in blood pressure.

Risk Factors to Hypotension

  • Age. Adults over the age of 65 are more likely to have drops in blood pressure after standing or eating. Children and young adults are most affected by neurally mediated hypotension.
  • Medications. People who take particular drugs, such as alpha-blockers for high blood pressure, are more likely to develop low blood pressure.
  • Other diseases. Low blood pressure is more common in people with Parkinson’s disease, diabetes, and other heart conditions.

Signs and Symptoms of Hypotension

Symptoms of hypotension may include:

  • Fatigue
  • Lightheadedness
  • Dizziness or a sense of being off-balance.
  • Nausea
  • Clammy skin
  • Depression
  • Loss of consciousness
  • Blurry vision

Types of Hypotension

There are several types of hypotension. It is classified based on when it occurs and what causes it:

  • Orthostatic Hypotension. The drop in blood pressure that occurs when there is a change from sitting or lying down to standing is known as orthostatic hypotension, also known as postural hypotension. The person may feel dizzy or lightheaded while the body adjusts to the new position or when waking up; it is described by some people as “seeing stars.” The most prevalent type of low blood pressure is orthostatic hypotension. It can affect persons of all ages, but it is more frequent among the elderly. Blood pressure drops can also be a result of aging and pregnancy.
  • Postprandial Hypotension. A decrease in blood pressure that occurs after eating is known as postprandial hypotension. Low blood pressure after eating is more likely to happen in older adults and people with autonomic dysfunction.
  • Neurally-mediated Hypotension. Blood pressure is a balancing act between the nervous system and other bodily systems like hormones and organs. This type of hypotension happens when there is an abnormal interaction between the heart and the brain. Causes of neurally mediated hypotension may include standing in one position for a long time and a strong emotional response, such as feeling shocked or scared. This happens most commonly in children than adults.
  • Severe Hypotension. Shock can cause a severe reduction in blood pressure, and this can occur as a result of a catastrophic accident or infection. The organs don’t obtain the blood and oxygen needed to function correctly when there is a shock. If severe hypotension is not treated immediately, it can be life-threatening.
  • Nervous system damage (multiple system atrophy with orthostatic hypotension). Nervous system damage causes low blood pressure (multiple system atrophy with orthostatic hypotension). This rare disorder, also known as Shy-Drager syndrome, exhibits several symptoms that are similar to Parkinson’s disease. The autonomic nerve system, which regulates involuntary functions, including blood pressure, heart rate, respiration, and digestion, is progressively damaged. It is associated with having very high blood pressure while lying down.

Diagnosis of Hypotension

The purpose of testing for low blood pressure is to determine the cause.  In addition to taking the medical history, performing a physical exam, and checking the blood pressure, the healthcare provider may suggest the following:

  • Blood Tests. These can provide information about the overall health, as well as if there is a presence of low blood sugar or hypoglycemia, high blood sugar or hyperglycemia or diabetes, and a low red blood cell count or anemia, which all can result in a blood pressure that is lower than normal.
  • Electrocardiogram (ECG). This procedure is done by placing some soft, sticky patches or electrodes on the skin of the chest, arms, and legs during this painless, noninvasive test. The patches monitor electrical signals from the heart, which are then recorded on graph paper or displayed on a screen by a machine. It detects irregularities in the heart rhythm, structural problems, and problems with the supply of blood and oxygen to the heart muscle. It can also tell if there is a current or past heart attack.
  • Tilt Table Test. This test can determine how the body reacts to changes in position. It will identify if there is a low blood pressure when standing or due to incorrect brain signals or neurally mediated hypotension. During the test, the patient will lie down on a table that is slanted to lift the upper body, simulating the transition from a horizontal to a standing position.

Treatment for Hypotension

Low blood pressure that is either asymptomatic or has very minor symptoms seldom required treatment. The treatment for hypotension will be determined by its cause; for example, when a medicine produces low blood pressure, the treatment usually focuses on changing, stopping, or reducing the dose of the medication.

However, If the cause of low blood pressure is unknown or no treatment is available. The goal is to raise the blood pressure and reduce the signs and symptoms. Depending on the age, health, and type of low blood pressure that is present, this can be achieved in a variety of ways, including:

  1. Increased sodium intake. Because sodium can significantly raise blood pressure, experts usually advise minimizing salt in the diet. However, more salt can be beneficial for people with low blood pressure.
  2. Increased fluid intake. Fluids particularly water can help to increase blood volume and avoid dehydration, which are both important in the treatment of hypotension.
  3. Use of compression stockings. Elastic stockings, which are often used to relieve the pain and swelling of varicose veins, can help in reducing blood pooling in the legs.
  4. Medications. Low blood pressure that happens when standing up or orthostatic hypotension can be treated with a variety of medications that increase blood volume and elevate the blood pressure by reducing the ability of the blood vessels to expand.

Prevention of Hypotension

Here are some home remedies and lifestyle modification recommendations to help decrease or prevent symptoms of hypotension, depending on its cause:

  • Drink more water and less alcohol. Alcohol dehydrates the body and lowers the blood pressure. Water, on the other hand, helps to prevent dehydration by increasing blood volume.
  • Observe proper positioning. Gradually raise the body from a prone or squatting position to a standing position. Sitting with the legs crossed is not a good idea. If symptoms are felt while standing, it is advised to cross the thighs in a scissors pattern and squeeze, or to lean as far forward as tolerated on a ledge or chair. These exercises help to circulate blood from the legs to the heart.
  • Eat small, low-carb meals. Eat small portions several times a day to help avoid blood pressure from dropping abruptly after meals and minimize the intake of high-carbohydrate foods like potatoes, rice, pasta, and bread. Drinking one or two strong cups of caffeinated coffee or tea with breakfast may also be recommended. Caffeine should not be consumed throughout the day because it may result in less sensitivity in caffeine and it can induce dehydration.
  • Exercise regularly. Aim for 30 to 60 minutes of heart rate raising exercise every day, including strength training for two or three times per week. However, doing exercise in hot, humid weather is not recommended.

Nursing Diagnosis for Hypotension

Hypotension Nursing Care Plan 1

Risk for falls

Nursing Diagnosis: Risk for Falls related to age, unsafe workplace, lower body weakness and altered level of alertness secondary to hypotension

Desired Outcomes:

  • The patient will not sustain a fall.
  • The patient will be able to verbalize the willingness to utilize safety measures to prevent falls.
  • The patient is able to demonstrate selective preventative measures.
  • The patient and caregivers will be able to implement effective measures to improve home safety and prevent falls at home.
Hypotension Nursing InterventionsRationale
Assess the patient’s history of fall.      Patients who have had one or more falls in the previous six months are more likely to fall again. According to a study that identified the characteristics predictive of repeat fall associated outcomes, the elderly population is at increased risk of readmission (Prabhakaran et al., 2020).
Assess the patient for changes in the mental status.  Patients who are disoriented or have impaired awareness may not know what is happening around or how to help themselves. The patients may wander from one place to another, putting safety at risk. Additionally, the patient’s chances of falling are increased by confusion and impaired judgment.
Assess the patient’s age-related physical changes.    The patient’s ability to defend themselves from falls is influenced by characteristics such as age and development. Muscle weakness makes older patients more likely to fall than those who retain muscle strength, flexibility, and endurance. Reduced visual function, impaired color perception, a shift in center of gravity, unsteady gait, diminished muscle strength, decreased endurance, and delayed response are all examples of these alterations. Increased visual impairment was linked to an increased risk of falls and other injuries in older patients with age-related macular degeneration.
Assess the patient’s balance and gait.Falling is more likely to happen in older patients who have poor balance or difficulties walking. These issues could be caused by a lack of activity, a neurological ailment, arthritis, or other medical illnesses such as hypotension.
Educate the patient about the benefits of using glasses and hearing aids. Encourage the patient to have eyes checkup and hearing test on a regular basis.If the patient uses suitable aids to increase visual and auditory orientation to the environment, the risk can be reduced. Visual impairment greatly contributes to falls.
Ensure that the patient is wearing appropriate footwear.  Advise the patient to wear nonskid socks when standing to keep the feet from sliding. Encourage patients to walk in proper, well-fitting shoes rather than non skid socks to avoid slipping.
Provide reality orientation if the patient is experiencing a new beginning of confusion or delirium. To maintain orientation, have family members bring along familiar items such as clocks and watches from home.For the patients with delirium, reality orientation can help in preventing or reducing the confusion that raises the risk of falling.  

Hypotension Nursing Care Plan 2

Nausea

Nursing Diagnosis: Nausea related to motion sickness, dizziness, overeating and fatigue secondary to hypotension, as evidenced by the patient reporting nausea, gagging sensation, increased swallowing and salivation.

Desired Outcome: The patient will be able to report decreased severity or total relief of nausea.

Hypotension Nursing InterventionsRationale
Determine the source of nausea for the patient, ask the patient to describe what triggers the nausea.  The choice of management for the patient will be determined from the assessment of the trigger factors. If the stimulus is removed, treatment may not be required.
Determine and record the track of patient’s hydration status, weight, blood pressure, intake and output, and skin turgor.Nausea is frequently associated with vomiting and low blood pressure, which can result in a change of patient’s hydration status or dehydration due to fluid loss.
Ensure that the patient’s room is well ventilated with adequate lightning and eliminate strong odors from the surrounding such as perfumes, dressings and emesisAssist the patient in getting some fresh air if at all possible. Breathing becomes easier in a well-ventilated and well-lit area or with a fan nearby. Strong and unpleasant odors can contribute to nausea.
Educate the patient about the benefits of maintaining good dental hygiene and how to do it properly.Anorexia and excessive salivation are linked to this condition. Oral hygiene helps in the treatment of the condition and facilitates comfort.
Educate the patient on how to use non pharmaceutical management methods including relaxation, guided visualization, music therapy, distraction, or deep breathing exercises.These techniques will help the patient in managing the symptoms of nausea, but these techniques must be used before the symptoms develop.  
Educate the patient or caregiver about appropriate fluid and dietary options for nausea.By noting dietary factors to consider while nauseated, patients and caregivers can support proper hydration and nutritional status.
Advice the patient to maintain an upright position while eating and for 1 to 2 hours post-meal.This can be helpful in reducing the risk of nausea.
Educate the patient about the importance of moving slowly when changing positions from lying down to standing position.Abrupt change in position may cause orthostatic hypotension which may trigger nausea.

Hypotension Nursing Care Plan 3

Risk for Injury

Nursing Diagnosis: Risk for Injury related to changes in cognitive function, sensory-perceptual impairment, lack of knowledge regarding environmental hazards and altered nutritional status secondary to hypotension

Desired Outcomes:

  • The patient will be able to determine the factors that increase the risk for injury.
  • The patient will be able to demonstrate effective methods to avoid injury.
  • The patient will remain free from injuries.
Hypotension Nursing InterventionsRationale
Assess the patient’s sensory-perceptual impairment.  The loss or impairment of the patient’s senses such as vision, taste, hearing, smell, and touch, might contribute to how they react to external cues, putting them at risk for injuries and falls. A patient with poor vision may be more likely to slip or fall.
Assess the patient’s changes in health status and cognitive awareness.  The patient’s risk of injury may increase as the health status changes. A patient with low blood pressure for example, may experience dizziness or a feeling of fainting and a postoperative patient, may have confusion, disorientation, and memory loss, placing the patient at danger of falling or injuring themselves.
Educate the patient and significant others to examine the home environment for any threat to the patient’s safety.        Patients with decreased mobility, vision acuity, and neurological dysfunction, such as dementia and other cognitive functioning abnormalities, are vulnerable to common dangers. Slips, stumbles, and falls in the home by older people with a history of falls or functional disability are often linked to household hazards.
Assist the patient in becoming familiar with the surroundings and educate the patient about safety at home, including using safety measures such as grab bars in the bathroom, use of nonslip, well-fitting footwear, and encourage patients to request help from family members.To prevent accidents, the patient should be familiar with the layout of the environment. Home safety should be evaluated, addressed with patient and family members, and considered frequently when making decisions about the patient’s future care towards maximizing the health outcomes. In order to promote functional and independent living as well as injury prevention, it is important to educate the patient and family about how to modify the home environment.
Keep the patient oriented especially when talking with a patient who has recently developed confusion or delirium. To keep orientation, advise the family member or significant other to bring along familiar things like clocks, and watches from home.    When a patient becomes agitated, reality orientation can help limit or reduce the confusion that increases the risk for injury. Validation therapy is an effective strategy and mode of communication for patients with mild to moderate dementia. It lowers the patient’s stress levels and reduces behavioral disturbances.
Advice to have family or significant others accompany the patient at all times.This is to keep the patient from injuring themselves and avoid the risk of falling.

Hypotension Nursing Care Plan 4

Activity Intolerance

Nursing Diagnosis: Activity Intolerance related to altered nutritional status, impaired sleeping pattern and immobility secondary to hypotension, as evidenced by dehydration, malnutrition, insomnia, fatigue and difficulty in performing activities of daily living.

Desired Outcomes:

  • The patient will be able to have an optimal nutritional status
  • The patient will be able to determine methods on how to conserve energy.
  • The patient will be able to perform daily activities independently.
Hypotension Nursing InterventionsRationale
Determine the patient’s understanding of the causes of activity intolerance.    Causative factors might be physical or psychological and can be transitory or permanent. Identifying the cause will assist the nurse in guiding the nursing intervention.
Determine the patient’s nutritional status and needs.During physical exertion, adequate energy reserves are required. Adequate hydration is needed.
Observe and track the patient’s sleep pattern, as well as the amount of sleep in the past several days.Sleep deprivation and sleep issues can impair a patient’s activity level; these must be addressed before successful activity progression can be achieved.
Assess the patient’s need for additional assistance at home.    When it comes to helping the patient in conserving energy, coordinated efforts from significant others are more meaningful and effective.
Advice the patient to do the activity at a slower pace, for a longer period of time, with more rest or pauses, or with assistance if needed.This method helps in the development of activity tolerance.  
Educate the patient to gradually raise the activity level by doing active range-of-motion exercises in bed, then moving on to sitting and finally standing.Overexertion is avoided by gradually increasing the intensity of the exercise.    
Advise the patient to dangle the legs from the bedside from 10 to 15 minutes in sitting position before standing up from lying down position.Prevents orthostatic hypotension from occurring.    
Educate the patient about some ways of conserving energy, such as sitting down to complete tasks, working at a steady pace, keeping frequently used objects close at hand and organizing a work-rest-work timetable.These methods lower oxygen consumption, allowing for longer periods of activity.    

Hypotension Nursing Care Plan 5

Knowledge Deficit

Nursing Diagnosis: Knowledge Deficit related to unawareness of information or resources due to a lack of exposure secondary to hypotension, as evidenced by statements of concern, request for additional information, inability to follow instructions, agitated and apathetic behavior.

Desired Outcomes:

●      The patient will be able to verbalize understanding of the treatment plan.

●      The patient will be able to participate in the home remedies and lifestyle modification plan.

●      The patient will be able to verbalize a full understanding of the therapeutic regimen.

Nursing Stat Facts
Nursing Stat Facts

●     The patient will be able to perform the necessary treatment methods and explain the actions correctly.

Hypotension Nursing InterventionsRationale
Assess the patient’s capacity to learn the required health-care services.Cognitive deficits must be identified before a proper teaching strategy can be devised.
Examine the patient’s drive and readiness to cooperate in the lifestyle modification plan.Learning takes a lot of effort. Patients must see a reason or need to learn.
Determine the importance of the patient’s learning needs in the context of the overall care plan.  This is to determine what has to be stated, particularly if the patient has prior knowledge of the situation. Knowing what to prioritize will assist the nurse to avoid valuable time.
Provide the patient with a calm and relaxing environment that is free from any stressor.The patient can concentrate and focus more fully on a tranquil setting away from any distractions.
Include the patient in the development of the nutritional plan, beginning with the establishment of learning objectives and goals at the start of the session.Setting goals allows the patient to anticipate what will be discussed and what they can expect throughout the session.
6. Educate the patient and significant other on how to properly take and record the blood pressure at home and to report signs of hypotension.Proper and daily monitoring can easily identify alterations in the blood pressure that may require immediate medical attention.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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