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Background/ Significance

Orthostatic vital signs are defined as a change in blood pressure, heart rate, or onset of symptoms after a change in position in individuals..

When Standing up gravity causes blood to pool in your legs.

decreased blood pressure

Baroreceptors sense this lower blood pressure and beat faster and pump more blood

Dehydration

Heart problem

Nervous system disorders

In our Neuro-clinic

Syncope

Important tool / data for us to understand what is going on...

What are we looking for?

Objectives

Blood pressure

Heart rate

hypovolemia

neurological condition

Dizziness

Light-headedness

Importance of orthostatic blood pressure

learn accurate way to obtain orthostatic vital signs

autonomic, cardiac, neurologic, psychiatric, or metabolic cause, or may be idiopathic.

1st step

Evidence from the literature

Supine - 5~ 20 minutes

Conflicting evidence from the literature

AHA ( american heart association) recommends blood pressure measurements to be made in the upper arm with 5 min of rest time prior to the 1st blood pressure measurement

"The procedure for measurement of orthostatic vital signs is not standardized as evidenced by a review of the literature reflecting significant variations in practice."

  • Refrain from talking and the legs should be uncrossed and the back and arm supported

  • Crossing the legs elevate the SBP and unsupported raise diastolic blood pressure.

Time varies for 'accurate' assessment.

  • Failure to support the arm will also impact blood pressure readings..

  • Readings taken above the level of the heart are artificially low while those taken below heart level are artificially high.

2nd Step

Orthostatic blood pressure

Sitting actually lessen the orthostatic effect

However, it is important to consider patient safety regarding moving from lying down to standing.

Reference

CDC (2012) How to measure orthostatc blood pressure. retrieved from www.cdc.org

3rd step

Lilian C.M. (2002) Evaluation of Skills and knowledge on orthostatic blood pressure measurements in elderly patients. age and aging. 1;211-216

Standing

Narccarato, M. (2011) Clinical practice guidline: Orthostatic vital signs. Emergency Nursing Resource. 1-9

  • Can measure within two minutes of standing

  • 1 minute after standing demonstrated the greatest change in pulse rate

  • Enhanced by the measurement of vital signs at multiple points per position.

In summary

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 minute.

A drop in bp of ≥20 mm Hg, or in diastolic bp of ≥10 mm Hg

or

experiencing lightheadedness or dizziness is considered abnormal.

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