What is the position for orthostatic hypotension?
This website uses cookies. By continuing to use this website you are giving consent to cookies being used. For information on cookies and how you can disable them visit our Privacy and Policy. Show Blood pressure is a standard vital sign in patients evaluated in an Emergency Department. The American Heart Association has recommended a preferred position of the arm and cuff when measuring blood pressure. There is no formal recommendation for arm position when measuring orthostatic blood pressure. The objective of this study was to assess the impact of different arm positions on the measurement of postural changes in blood pressure. This was a prospective, unblinded, convenience study involving Emergency Department patients with complaints unrelated to cardiovascular instability. Repeated blood pressure measurements were obtained using an automatic non-invasive device with each subject in a supine and standing position and with the arm parallel and perpendicular to the torso. Orthostatic hypotension was defined as a difference of >or= 20 mm Hg systolic or >or= 10 mm Hg diastolic when subtracting standing from supine measurements. There were four comparisons made: group W, arm perpendicular supine and standing; group X, arm parallel supine and standing; group Y, arm parallel supine and perpendicular standing; and group Z, arm perpendicular supine and parallel standing. There were 100 patients enrolled, 55 men, mean age 44 years. Four blood pressure measurements were obtained on each patient. The percentage of patients meeting orthostatic hypotension criteria in each group was: W systolic 6% (95% CI 1%, 11%), diastolic 4% (95% CI 0%, 8%), X systolic 8% (95% CI 3%, 13%), diastolic 9% (95% CI 3%, 13%), Y systolic 19% (95% CI 11%, 27%), diastolic 30% (95% CI 21%, 39%), Z systolic 2% (95% CI 0%, 5%), diastolic 2% (95% CI 0%, 5%). Comparison of Group Y vs. X, Z, and W was statistically significant (p < 0.0001). Arm position has a significant impact on determination of postural changes in blood pressure. The combination of the arm parallel when supine and perpendicular when standing may significantly overestimate the orthostatic change. Arm position should be held constant in supine and standing positions when assessing for orthostatic change in blood pressure. Background: This tool can be used to identify orthostatic hypotension, a risk factor for falls in hospitalized patients. Reference: Adapted from: John Dempsey Hospital Department of Nursing Clinical Manual/Nursing Practice Manual (available at: http://nursing.uchc.edu/nursing_standards/docs/Orthostatic%20(Postural)%20Vital%20Sign%20Measurement.pdf) with information from MaineHealth Cardiovascular Health (available at: http://www.mainehealth.org/workfiles/mh_healthinformation/Measuring_Orthostatic_Vital_Signs.pdf) How to use this tool: Staff nurses and nursing assistants typically complete this protocol. All findings should be reported to the treating medical provider. The decision whether to use this protocol on all patients (e.g., on admission), or as needed, will depend on the specific unit. However, consider checking orthostatic vital signs:
Use this tool in conjunction with clinical assessment and a standard assessment of fall risk factors (e.g., Tool 3H, "Morse Fall Scale for Identifying Fall Risk Factors," or Tool 3G, "STRATIFY Scale for Identifying Fall Risk Factors") to determine a patient's risk factors for falls, and then plan care accordingly. Protocol for Orthostatic (Postural) Vital Sign MeasurementPolicy
Equipment
Procedure
Evaluation
Sometimes it may be difficult to determine if the resident/patient has orthostatic hypotension when checking only at one point in time. If the resident/patient does not show evidence of orthostatic hypotension during the assessment but has complained of lightheadedness or dizziness, perform the measurements when the resident/patient complains or within 2 hours of the start of a meal. What are the positions for orthostatic blood pressure?1 Have the patient lie down for 5 minutes. 2 Measure blood pressure and pulse rate. 3 Have the patient stand. 4 Repeat blood pressure and pulse rate measurements after standing 1 and 3 minutes.
What position is the patient in if a nurse is checking for orthostatic hypotension?Orthostatic vital signs (blood pressure, pulse, and symptoms) will be obtained and recorded while the patient is in the supine position as well as in the standing position. If the patient is unable to stand, orthostatics may be taken while the patient is sitting with feet dangling.
Should you elevate legs with orthostatic hypotension?Raising your legs above the level of your heart increases the blood flow to your brain. The light-headed feeling will quickly disappear. You can gradually return to a sitting position once you are feeling better. Wearing an abdominal binder and elastic TED hose or compression stockings on your legs is also helpful.
Should I sit or stand with low blood pressure?The main symptom of orthostatic hypotension is dizziness or lightheadedness when you stand. You should feel better when you sit or lie down. Some people faint (syncope).
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