Orthostatic HypotensionPatricia ChenetteLearning Issue: 1/27/15NURS 388

Case Study Review 78 YO female DX: Hypertension 2 mo. Ago (initial BP: 160/102) Prescribed hydrochlorothiazide 25mg/day

Caused syncope, nocturia, incontinence stopped taking Family HX: CVA (stroke), MI, CAD, Diabetes, HTN BMI: 18.9 (Normal is 18.5-24.9) Elevated BUN/Creatinine

BUN: 24mg/dl (Normal = 6 – 20) Creatinine: 1.4mg/dl (Normal = 0.6-1.3)

Hydrochlorothiazide (HCTZ) Usually given 12.5 to 25mg/day PO Thiazide diuretic: inhibits Na

reabsorption in distal renal tubules more excretion of water, sodium, potassium, hydrogen ions

Increases hypotensive side effects in the elderly

Can create electrolyte imbalance

A and P Sitting to Standing, 750mL or thoracic blood

moves downward decrease venous return, decrease cardiac output, lose central blood volume

Requires circulatory and neuro compensation to maintain BP and cerebral blood flow (required for consciousness)

Muscle pumps prevent venous pooling Neurovascular compensation: vasoconstriction

Test for Orthostatic Hypotension Lying, sitting, and standing BP (2min

between each) Decrease of > 20mm Hg Systolic Decrease of > 10mm Hg Diastolic OR Increase of HR > 20 beats per

minute

Usually from volume loss or problems with vasoconstrictor response (disease or meds)

Sources http://

emedicine.medscape.com/article/902155-overview#aw2aab6b4

http://www.medscape.com/viewarticle/559578_2

Dirksen and Bucher “Medical Surgical Nursing: Assessment and Management of Clinical Problems.” (723-724).