A patient arrives to the emergency room complaining of dizziness. Postural hypotension is suspected. The provider orders orthostatic vital signs. But how do we obtain these accurately?

When measuring orthostatic vital signs, the blood pressure and pulse are taken in two positions: supine and standing. A measurement while sitting may also be included.

Begin by asking the patient to lie supine. Wait three to 10 minutes before measuring the vital signs. Record the pulse and blood pressure. Next, ask the patient to stand (while supervised). Within three minutes of rising, record pulse and blood pressure. Alternatively, you may ask the patient to sit erect and within three minutes record the pulse and blood pressure.

A drop in blood pressure of at least 20 mmHg in systolic blood pressure or at least 10 mmHg in diastolic blood pressure is indicative of orthostatic hypotension.
Remember…

• A digital oscillatory blood pressure cuff may be helpful to provide multiple readings and allow the nurse to remain vigilant if the patient becomes dizzy.
• The proper size blood pressure cuff is essential for accurate readings.

Reference:
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s Guide to Physical Examination and History Taking (13th ed.). Wolters Kluwer Health: Philadelphia.

 

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