Orthostatic hypotension (OH) is a form of low blood pressure that occurs when standing up from a sitting or lying position. This condition can lead to dizziness, fainting, and falls, making it a significant concern in nursing care. This comprehensive guide focuses on the nursing diagnosis, assessment, and care planning for patients with orthostatic hypotension.
Causes (Related to)
Orthostatic hypotension can develop due to various factors affecting blood pressure regulation:
- Medications including:
- Antihypertensives
- Diuretics
- Antidepressants
- Parkinson’s medications
- Vasodilators
- Medical conditions such as:
- Diabetes
- Parkinson’s disease
- Heart conditions
- Dehydration
- Anemia
- Neurological disorders
- Age-related factors:
- Decreased baroreceptor sensitivity
- Reduced vascular compliance
- Impaired autonomic function
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Dizziness upon standing
- Lightheadedness
- Blurred vision
- Weakness
- Fatigue
- Neck and shoulder pain
- Syncope or near-syncope episodes
Objective: (Nurse assesses)
- Drop in systolic BP ≥20 mmHg upon standing
- Drop in diastolic BP ≥10 mmHg upon standing
- Increased heart rate
- Pallor
- Unsteady gait
- Delayed capillary refill
- Changes in mental status
Expected Outcomes
- The patient will maintain stable blood pressure during position changes
- The patient will demonstrate proper position change techniques
- The patient will report decreased episodes of dizziness
- The patient will maintain safety during activities
- The patient will identify and avoid triggers
- The patient will adhere to the prescribed medication regimen
- The patient will maintain adequate hydration status
Nursing Assessment
Monitor Vital Signs
- Check orthostatic blood pressure readings
- Assess heart rate and rhythm
- Monitor respiratory rate
- Document temperature
- Track postural changes
Evaluate Risk Factors
- Review medication history
- Assess chronic conditions
- Document cardiac history
- Check neurological status
- Review hydration status
Assess Functional Status
- Evaluate mobility
- Check balance
- Assess gait
- Document activity tolerance
- Monitor independence level
Check for Complications
- Monitor for falls
- Assess for injuries
- Check for syncopal episodes
- Evaluate cognitive status
- Document any trauma
Nursing Care Plans
Nursing Care Plan 1: Risk for Falls
Nursing Diagnosis Statement:
Risk for Falls related to orthostatic hypotension as evidenced by decreased blood pressure upon position changes and reported dizziness.
Related Factors:
- Orthostatic blood pressure changes
- Impaired balance
- Medications affecting blood pressure
- Age-related changes
- Environmental hazards
Nursing Interventions and Rationales:
- Implement fall precautions
Rationale: Prevents injury from potential falls - Teach proper position change techniques
Rationale: Minimizes orthostatic blood pressure drops - Ensure adequate lighting and clear pathways
Rationale: Reduces environmental fall risks
Desired Outcomes:
- The patient will remain free from falls
- The patient will demonstrate proper positioning techniques
- The patient will maintain a safe environment
Nursing Care Plan 2: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to orthostatic hypotension as evidenced by unsteady gait and fear of falling.
Related Factors:
- Postural blood pressure changes
- Muscle weakness
- Decreased balance
- Fear of falling
- Fatigue
Nursing Interventions and Rationales:
- Assist with gradual mobility progression
Rationale: Builds confidence and strength safely - Provide assistive devices as needed
Rationale: Supports independent mobility - Monitor activity tolerance
Rationale: Prevents overexertion
Desired Outcomes:
- The patient will demonstrate improved mobility
- The patient will use assistive devices correctly
- The patient will maintain safety during activities
Nursing Care Plan 3: Risk for Ineffective Cerebral Tissue Perfusion
Nursing Diagnosis Statement:
Risk for Ineffective Cerebral Tissue Perfusion related to orthostatic hypotension as evidenced by dizziness and altered consciousness upon standing.
Related Factors:
- Decreased blood pressure
- Altered cardiovascular function
- Medication effects
- Dehydration
- Autonomic dysfunction
Nursing Interventions and Rationales:
- Monitor neurological status
Rationale: Identifies changes in cerebral perfusion - Maintain adequate hydration
Rationale: Supports blood pressure stability - Teach compensatory techniques
Rationale: Improves cerebral blood flow
Desired Outcomes:
- The patient will maintain adequate cerebral perfusion
- The patient will report decreased dizziness
- The patient will demonstrate a stable neurological status
Nursing Care Plan 4: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to orthostatic hypotension management as evidenced by incorrect position changes and medication non-compliance.
Related Factors:
- Lack of exposure to information
- Misinterpretation of information
- Cognitive limitations
- Language barriers
- Cultural influences
Nursing Interventions and Rationales:
- Provide education about the condition
Rationale: Increases understanding and compliance - Demonstrate proper techniques
Rationale: Enhances learning through observation - Verify understanding
Rationale: Ensures effective education
Desired Outcomes:
- The patient will verbalize understanding of the condition
- The patient will demonstrate proper management techniques
- The patient will adhere to the treatment plan
Nursing Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety related to fear of falling and activity limitations as evidenced by expressed concerns and restricted movement.
Related Factors:
- Fear of injury
- Activity restrictions
- Previous falls
- Loss of independence
- Uncertain prognosis
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety and builds confidence - Teach coping strategies
Rationale: Helps manage fear and anxiety - Encourage gradual activity progression
Rationale: Builds confidence through successful experiences
Desired Outcomes:
- The patient will report decreased anxiety
- The patient will demonstrate effective coping strategies
- The patient will participate in activities confidently
References
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- Krassioukov A, Eng JJ, Warburton DE, Teasell R; Spinal Cord Injury Rehabilitation Evidence Research Team. A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil. 2009 May;90(5):876-85. doi: 10.1016/j.apmr.2009.01.009. PMID: 19406310; PMCID: PMC3104993.
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