Blood Pressure: Orthostatics

How to take Orthostatics...

  1. Determine patient's medication history, because certain medications—such as sympatholytic drugs, diuretics, nitrates, narcotics, antihistamines, psychotropic agents, barbiturates, antihypertensives, and anticholinergics—can predispose a patient to orthostatic hypotension in the absence of hypovolemia. Studies have demonstrated a significant incidence of orthostatic hypotension, even in euvolemic patients.
  2. Verify the patient's identity in accordance with institutional policy.
  3. Perform hand hygiene.
  4. Measure the blood pressure and heart rate after the patient has been in a supine position for 2 to 3 minutes. Take two sets of measurements and use the second set as baseline to help prevent false-positive results that are based on patient's sympathetic response.
  5. Have the patient move from the supine to the sitting position (if three measurements are taken) or from supine to standing. If the patient is unable to stand for blood pressure measurement, try the high Fowler position, although the results may be less credible. A supine-to-standing measurement is more accurate than a supine-to-sitting measurement.
  6. Question the patient about weakness, dizziness, or visual dimming associated with a change of position. Note any pallor or diaphoresis. These symptoms are as important as the measurement of vital signs. If the patient becomes extremely dizzy and needs to lie down or becomes syncopal, the measurement should be terminated.
  7. Take the standing or sitting blood pressure (in the same arm as the initial readings), and determine the heart rate within 1 minute. Support the patient's forearm at heart level when taking the blood pressure to prevent an inaccurate measurement.
  8. If an intermediate sitting measurement was taken, have the patient move into the standing position and repeat steps 5 and 6.
  9. Return patient to supine or sitting position.
  10. Perform hand hygiene.
  11. Document all measurements on the patient's record, including the position in which they were taken (i.e., with the patient lying, sitting, or standing).