Orthostatic Hypotension Nursing Care Plans Diagnosis and Interventions
Orthostatic Hypotension NCLEX Review and Nursing Care Plans
Orthostatic hypotension, also known as postural hypotension, is a medical condition in which the blood pressure drops suddenly after rising from a sitting or lying position.
“Orthostatic hypotension” is derived from the Greek word “orthostasis”, which means “to stand up,” and “hypotension” is the medical term for low blood pressure.
It is more of a symptom of an underlying medical condition rather than a disease in and of itself. Symptoms are frequently mild, and episodes are brief.
Prolonged symptoms, on the other hand, may indicate a more serious condition.
Signs and Symptoms of Orthostatic Hypotension
In the mornings, orthostatic hypotension occurs more frequently and with more serious symptoms. This is due to the fact that blood pressure is lowest in the morning.
Common signs and symptoms are usually mild and usually go away when sitting or lying down, these include:
- Lightheadedness and dizziness when standing
- fatigue
- confusion
- loss of consciousness
Other and less common symptoms of orthostatic hypotension include:
- chest pain
- shoulder pain
- neck pain
- blurred vision
- nausea
- muscle tremors
- shortness of breath
- palpitations
Causes of Orthostatic Hypotension
When a change in position causes the body to experience a drop in the blood pressure level, orthostatic hypotension occurs. Orthostatic hypotension can be caused by a variety of conditions, including:
- Dehydration. Dehydration occurs when the body loses too much fluid, resulting in a reduced blood volume. Dehydration can be caused by vomiting, fever, excessive exercise, and not drinking enough water.
- Heart conditions. Some heart conditions prevent the body from pumping blood faster when standing, resulting in low blood pressure. These conditions include heart valve disease, bradycardia (low heart rate), heart failure, and heart attack.
- Blood loss. Anemia and other medical conditions that can result in a low red blood cell count are also potential causes. Dizziness and light-headedness can occur when there are decreases in red blood cells that will carry oxygen in the bloodstream.
- Drug therapy. Orthostatic hypotension can be caused by certain medications. These include vasodilators, which are used to treat high blood pressure, heart failure, and chest pain. Some antipsychotics, antidepressants, and chemotherapy medications. Diuretics and other drugs that promote urination may cause a decrease in blood volume.
- A disease of the nervous system. Such as Parkinson’s disease, multiple system atrophy, amyloidosis, dementia, and neuropathy.
- A disease of the Endocrine gland. These include thyroid gland conditions, Addison’s disease, and diabetes.
- Postprandial hypotension. It is a condition in which the blood pressure drops after eating meals. This is more frequent among older people.
- Excessive venous pooling. Because of a decrease in the amount of blood returning to the heart. This occurs for a variety of reasons, including recumbency, quickly rising after a long period of sitting or lying down, and prolonged motionless standing.
- Fever. Orthostatic hypotension is common in febrile patients, particularly children. Because the body loses a lot of fluid when someone has a fever.
Risk Factors to Orthostatic Hypotension
- Age. Orthostatic hypotension is common in people over the age of 65. Special cells (baroreceptors) that help regulate blood pressure are situated close to the heart and neck arteries and can slow down with age. An aging heart may also find it more difficult to speed up to compensate for blood pressure drops. It is also necessary to rule out neurogenic reasons in the elderly, as well as hypovolemia caused by diuretics, loss of blood, vomiting, and pharmacological treatments. It is critical to rule out other causative factors of syncope, such as seizure and neurocardiogenic syncope.
- Gender. Although both sexes have the same prevalence of Orthostatic hypotension, the following are the main various risk factors related to gender. Only in women was a systolic blood pressure of 140 mm Hg associated with an increased risk of Orthostatic hypotension, whereas BMI was a protective factor for both men and women.
- Digestion. The intestines receive an increase in blood supply when a person eats and then digests food. Orthostatic hypotension is more common between 15 and 45 minutes after eating (this is known as postprandial hypotension).
- Heat exposure. Heat-induced sweating and dehydration can lower blood pressure and cause orthostatic hypotension.
- Bed rest. Lying in bed for an extended period of time due to illness or injury can result in weakness. This may result in orthostatic hypotension.
- Alcohol. Alcohol consumption can raise the risk of orthostatic hypotension.
- Diabetes. Diabetes patients may be more likely than non-diabetics to develop orthostatic hypertension.
Complications of Orthostatic Hypotension
Orthostatic hypotension, if left untreated for an extended period of time, can result in severe complications, particularly in the elderly. Here are a few examples:
- Fall. Patients suffering from orthostatic hypotension frequently experience fainting and subsequent falls.
- Bone fractures. In orthostatic hypotension patients, there is a risk of broken bones or trauma. because of falls caused by dizziness or loss of consciousness
- Stroke. Blood pressure fluctuations caused by orthostatic hypotension may become a risk factor for stroke due to the reduction in blood supply to the brain.
- Cardiovascular diseases. In people with orthostatic hypotension, hypoperfusion of major organs increases the risk of life-threatening health problems such as heart attack or heart failure, a heart rhythm abnormality known as atrial fibrillation, stroke, or chronic kidney failure.
- Organ Failure. If blood pressure remains too low and is not treated immediately, the patient risks organ failure.
- Uncontrolled blood pressure. Orthostatic hypotension frequently coexists with uncontrolled hypertension, especially in older patients. Some guidelines now provide specific recommendations for measuring standing blood pressure to monitor for orthostatic hypotension in older patients with hypertension, including in patients with a higher likelihood of autonomic dysfunction, like those with diabetes and kidney disease.
- Dementia. The researchers discovered that orthostatic hypotension was linked to an increased possibility of dementia, including Alzheimer’s disease. Moreover, the risk was heightened when orthostatic blood pressure losses were not compensated for by an adequate increase in cardiac output.
Diagnosis of Orthostatic Hypotension
To help diagnose the condition, the doctor may also perform one or more of the following:
- Patient’s assessment. To help diagnose the condition, the healthcare team may review the patient’s medical history, medication list, and symptoms, as well as perform a physical examination.
- Monitoring of blood pressure. Orthostatic hypotension is defined as a decrease of 20 millimeters of mercury (mm Hg) in the top figures (systolic blood pressure) within 2 to 5 minutes of standing. A drop in the bottom number (diastolic blood pressure) of 10 mm Hg within 2 to 5 minutes of standing implies orthostatic hypotension.
- Blood tests. It can also give information regarding the patient’s overall health condition, such as hypoglycemia (low blood sugar) or low red blood cell levels (anemia). Both can result in low blood pressure.
- Electrocardiogram. An ECG can detect changes in heart rhythm or structure, as well as problems with the supply of blood and oxygen to the heart muscle.
- Holter monitor. An ECG may not be able to detect minor changes in the heart rhythm. The doctor may advise the patient to monitor their heart rate at home. A Holter monitor, a portable ECG device, can be worn by the patient within 24 hours or more to track the heart’s rhythm during daily activities.
- Tilt table test. The tilt table test demonstrates how the body responds to position changes. It consists of lying on a flat table that tilts to raise the upper body.
Treatment for Orthostatic Hypotension
The treatment for orthostatic hypotension focuses on the underlying cause instead of the low blood pressure. For example, if dehydration is the cause of orthostatic hypotension, the doctor may advise the patient to increase water intake. If a medication induces a low blood pressure while standing, treatment may include adjusting the dose or discontinuing the medication.
- Sit or lie down immediately. One of the simplest treatments for mild orthostatic hypotension is to sit or lie down quickly after experiencing light-headedness while standing. Symptoms frequently are resolved. However, if the symptoms persist, medication is sometimes required.
- Medications. If sitting or lying down does not improve orthostatic hypotension, doctors may prescribe blood pressure medications or increase blood volume. The type of orthostatic hypotension determines the medication used. Consult with the doctor to determine which option is best for the patient. Also, to discuss the risks and benefits of these medications.
- Exercise. Exercising. Routine cardiovascular and strength training may help to alleviate the symptoms of orthostatic hypotension. However, Avoid exercising in extremely hot and humid weather.
- Consuming small meals. Small, low-carbohydrate meals may help if the blood pressure falls after eating.
- Increase intake of oral fluids. Maintaining hydration aids in the prevention of low blood pressure symptoms. Staying hydrated by drinking plenty of water before long periods of standing or any activities that are likely to trigger symptoms, unless contraindicated.
- Limiting or eliminating alcohol consumption. Alcohol can exacerbate orthostatic hypotension, reducing or avoiding it entirely is advisable.
- Slowly getting out of bed. Slowly rise from a lying to a standing position. Also, when getting out of bed, sit for a moment on the end of the bed prior to actually standing.
- Raising the bed’s head. Sleeping with the head of the bed slightly elevated can prevent gravity’s effects that may cause dizziness and lightheadedness.
Nursing Diagnosis for Orthostatic Hypotension
Nursing Care Plan Orthostatic Hypotension 1
Nursing Diagnosis: Nausea related to motion sickness and dizziness upon standing secondary to orthostatic hypotension, as evidenced by expression of nausea, increased salivation, and gagging sensation.
Desired Outcome: The patient will be able to express decreased severity or total elimination of nausea.
| Intervention | Rationale |
| Assess the patient and determine the origin of nausea. | The choice of treatment will be determined by evaluating the patient’s causes of nausea. If the stimulus is managed, treatment might not be required. |
| Determine the patient’s daily weight, blood pressure, intake, and output, as well as measure skin turgor. | Vomiting, which is frequently accompanied by nausea, can alter a patient’s level of hydration due to fluid loss. Blood volume reduces with dehydration. Weakness, vertigo, and fatigue are symptoms of orthostatic hypotension that can be brought on by mild dehydration. |
| Place an emesis basin within the patient’s easy reach. | Vomiting and nausea frequently occur together. If there is a psychogenic component to nausea, keep the emesis basin out of sight but within the patient’s reach. |
| Advance the patient to increase fluid intake while maintaining fluid balance. | Remaining hydrated helps avoid low blood pressure symptoms. Before extended periods of standing or any other activity that can cause symptoms, advise the patient to drink a lot of water. The risk of motion sickness in these circumstances can be decreased by drinking enough water. |
| Assist the patient in getting ready for diagnostic exams. | To identify the contributing cause, a number of procedures may be performed, including an electrocardiogram (ECG or EKG), blood pressure monitoring, an echocardiogram, and a tilt table test. |
| Allow the patient to utilize alternative methods of controlling the nausea, such as deep breathing exercises, music therapy, guided imagery, or relaxation. | Although these should be employed before the problem arises, these techniques have benefitted patients with it. |
| Allow the patient to have frequent small portions of an appealing meal. | This strategy will aid in preserving nutritional status. Small, low-carbohydrate meals may be beneficial if blood pressure declines after eating and some patients find that being sick on an empty stomach makes them feel worse. |
| Place the patient in an upright position while eating and for one to two hours after. | This may aid in reducing the nausea. |
| Offer the patient some soup or bouillon at room temperature, cold water, ice chips, ginger items, and cold water if tolerated and suitable for the patient’s diet. | This promotes hydration. Whether it’s used to make ginger ale, ginger tea, or consumed as crystallized ginger, ginger helps reduce nausea. It may be difficult to accept hot or cold liquids. |
Nursing Care Plan Orthostatic Hypotension 2
Nursing Diagnosis: Activity Intolerance related to insufficient sleep, prescribed activity restriction, and altered nutritional status secondary to orthostatic hypotension, as evidenced by mild dehydration, insomnia, fatigue, and difficulty engaging in activities.
Desired Outcomes:
- The patient will be able to achieve an adequate nutritional status.
- The patient will be able to perform activities of daily living with minimal help.
- The patient will be able to reach a higher state of physical conditioning.
- The patient will be able to demonstrate energy conservation techniques.
| Intervention | Rationale |
| Determine what is causing the patient’s activity intolerance. | Planning and treatments will be based on the patient’s inability to participate in activities. |
| Assess the patient’s capacity and tolerance for activity participation. | This will help to determine the starting point for care planning. |
| Determine if the patient can tolerate the arranged daily activities. | Every day, the patient’s condition may alter. To mobilize the patient as quickly as feasible, frequent evaluations are essential. |
| Educate the patient about how stretching and moving in certain ways will help to avoid orthostatic hypotension. | Before sitting up, flex and stretch the leg muscles. Squeeze the muscles in the stomach, buttocks, and thighs together to treat the symptoms. Squat, stand on tiptoes, or march in place. |
| Advise the patient to rise gradually, slowly get up from a lying down position. Additionally, instruct the patient that before getting out of bed, take a minute to sit on the edge of the mattress before standing. | These will help to avoid orthostatic hypotension when the patient desires to move. |
| Monitor the patient’s dietary intake. | The requirement for nutrition is crucial since it gives the patient energy to carry out the daily tasks. |
| Encourage the patient to do exercise and monitor the patient’s vital signs while doing exercise. | Regular cardiovascular and weight training may help lessen orthostatic hypotension symptoms. Orthostatic hypotension may result from inactivity and prolonged bed rest. A heart rate increase shouldn’t be more than 20 to 30 beats over the baseline heart rate, the patient could require more oxygen supply. |
| Encourage the patient to perform ROM exercises. | Maintaining muscular strength, flexibility, and joint and tendon alignment with regular exercise. Exercises that are done repeatedly over time assist build tolerance, which is necessary to carry out ADLs. |
Nursing Care Plan Orthostatic Hypotension 3
Nursing Diagnosis: Risk for Falls related to Impaired levels of alertness, lack of sleep and body weakness secondary to orthostatic hypotension.
Desired Outcomes:
- The patient will be able to avoid incidents of falls.
- The patient will be able to express the intent to apply safety measures to prevent falls.
- The patient will be able to demonstrate specific fall preventive measures.
- The patient and caregiver will be able to implement strategies to improve safety and reduce falls at home.
| Intervention | Rationale |
| Determine the patient’s history of falls. | If a person has experienced one or more falls in the previous six months, they are more likely to fall again. Based on a study that identified the characteristics predictive of repeat falls linked outcomes, the senior population is more likely to have readmissions related to falls. |
| Assess the changes in the patient’s mental status. | Disoriented and handicapped individuals might not know where they are or how to get aid for themselves. They could stray from one location to another, endangering their security. The patient’s risk of falling is further increased by bewilderment and poor judgment. |
| Assess the patient’s gait and balance. | Older persons who have trouble walking or have poor balance are more prone to trip and fall. These issues might be brought on by inactivity, neurological issues, arthritis, or other illnesses and medications. |
| Examine the patient’s surroundings including the home environment, workplace, or community. | An individual is more prone to fall if the surroundings, such as the positioning of furniture and equipment in a particular space, are new. Due to increasing exposure to fall risks and an increase in the percentage of falls happening outside the house, environmental hazards cause falls more often in older healthy people than in older frail people. |
| Create a personalized care plan for preventing falls. Individualize the patient’s care plan to meet the patient’s particular needs. | Nursing care in every healthcare setting requires the planning of an individual fall prevention program, which requires a diversified approach. Since everyone has distinct needs, it’s best to not depend too much on general fall prevention measures. |
| Transfer the patient to a room close to the nurses’ station. | In order to plan ahead, predict nearby locations, give more continual watch, and respond quickly to urgent requirements, it is crucial to identify which patients are more prone to falling. |
| Place the patient’s things such as the phone, urinal, water, and call light, within easy reach. | The patient may need to stretch out or ambulate further than necessary to access items that are too far away, it can potentially be dangerous or contribute to falls. |
Nursing Care Plan Orthostatic Hypotension 4
Nursing Diagnosis: Knowledge Deficit related to disinterest and lack of motivation to learn secondary to orthostatic hypotension as evidenced by expressions of inaccurate information about the current condition and inability to perform newly learned tasks related to the treatment plan.
Desired Outcomes:
- The patient will be able to perform newly learned tasks related to the treatment plan safely and correctly at the time of discharge.
- The patient will be able to give the correct information about the current condition.
- The patient will be able to determine when and where to seek help in learning new information.
| Nursing Interventions for Orthostatic Hypotension | Rationale |
| Analyze the patient’s current understanding of the new diagnosis. | Establishing the patient’s knowledge base is a great technique to create a teaching plan’s foundation without overwhelming the patient. The nurse will be able to choose which subjects to cover first because of this. |
| Assess the patient’s readiness to acquire new information regarding the condition. | Hospitalization and sudden changes in a person’s health might have an impact on their capacity to take in and process information. When educating, it’s crucial to take timing into account and make adjustments based on the patient’s circumstances and perceptions. |
| Allow the patient to participate in the creation of the treatment plan. | The patient feels more autonomous when they make decisions regarding their treatment strategy. The teaching plan is more likely to be carried out if the patient is actively involved in it. |
| Identify any obstacle that can make learning more challenging. | Patients who suffer from physical or mental disabilities or from socioeconomic disadvantages like illiteracy may find it challenging to learn. The care plan can be tailored using this information. |
| Identify the patient’s preferred learning method. | The same knowledge may be learned in a variety of ways. The usage of certain teaching and learning materials to promote learning depends on the patient’s preferred method of learning. |
| Allow the patient to ask questions. | The patient can participate in the learning process by asking questions. It indicates that the patient is paying attention to the information and has a desire to learn. By asking questions, the patient engages in care and informs the medical staff of the issues that should be covered next. |
| Provide the patient a conducive learning environment. | Unfamiliar surroundings and anxiety about a new medical diagnosis might intimidate patients and make them reluctant to participate in learning. The patient opens up and feels more at ease when they are made to feel welcome. The patient will be more forthcoming about feelings and knowledge, resulting in a more successful treatment plan. |
Nursing Care Plan Orthostatic Hypotension 5
Nursing Diagnosis: Risk for Injury related to inadequate nutritional status, presence of environmental hazards and changes in cognitive function secondary to orthostatic hypotension.
Desired Outcomes:
- The patient will be able to identify the factors that increase the risk for injury and will be able to demonstrate behaviors to avoid it.
- The patient will be able to stay free from injuries.
| Nursing Interventions for Orthostatic Hypotension | Rationale |
| Analyze the patient’s mobility and identify any potential fall risks. | Falls are more likely to occur when there are changes in mobility brought on by muscular weakness, paralysis, poor balance, and loss of coordination. |
| Encourage the patient to wear waist-high compression stockings. | These could aid in enhancing blood flow and easing orthostatic hypotension symptoms. Advice to wear them all day, but take them off before going to sleep and when lying down. |
| Ensure proper positioning of the patient and lift the head of the patient’s bed. | Gravity effects can be lessened by sleeping with the head of the bed slightly lifted, thus reducing the incidence of orthostatic hypotension. |
| Perform a safety evaluation in the patient’s home or care facility. | In order to identify the existence of equipment or items (such as cord or hooks) that may be utilized in suicide hanging, nurses conduct an environmental risk assessment. Therefore, it needs to be eliminated to ensure the client’s safety. |
| Transfer the patient to a room near the nurses’ station. Place the call light nearby and demonstrate how to use it to signal for help. | To avoid accidents, the patient has to be familiar with the layout of the area. Things that are too far away from the patient might cause risk for injury. |
| Utilize alternative restraint options to reduce the risk of falls and injury. | There are several alternatives to restraints, such as alarm systems with ankle or wrist bands, alarms for wheelchairs or beds, frequent and close patient observation, secured unit doors and keeping the bed low. |
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. (2020). 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
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