Question

The educator is reviewing the causes of orthostatic hypotension with the nurse. Which information should the educator include? Select all that apply.

		Medications.
		Dehydration.
		Renal disease.
		Cardiovascular disorder.
		Endocrine disorder.

Answer 1

Orthostatic hypotension

It is also called postural hypotension, which is defined as a sudden decrease in blood pressure caused by a change in posture from supine to the quickly standing. This decrease may be in systolic by 20 mmHg or diastolic by 10 mmHg and happens withing 3-5 minutes after going in standing position.

Causes

Negative water balance or loss of body water, decrease in blood volume due to dehydration brought by vomiting, diarrhea, or certain medications like diuretics. Diuretics are used to get rid of excess water from the body to maintain water balance. Working in a hot climate for a long time can also lead to this.

The decrease in RBC, hemorrhage, anemia, and some other conditions that lead to a decrease in blood volume may also result in hypotension. Lower RBC leads to a decrease in oxygen supply and that could cause dizziness and light-headedness.

Some of the medications are also found to produce orthostatic hypotension such as beta-blockers and antidepressants.

Symptoms are light-headedness, dizziness, blurred vision, fainting, falling, nausea, and fatigue. If someone experiences these symptoms regularly while standing from the sitting position, need attention.

The educator should include all information relating to medications, dehydration, renal disease, and cardiovascular disorder to explain orthostatic hypotension.

Medications:

Some drugs like diuretics (Frusemide, spironolactone) for the treatment of hypertension or renal diseases, alpha-adrenoceptor blockers (Prazosin, terazosin) used for the treatment of prostatic hypertrophy, antihypertensive drugs (Atenolol, methyldopa, guanethidine), and calcium channel blockers (Nifedipine, verapamil) used for the treatment of hypertension. Tricyclic antidepressants can cause vasodilation, this leads to the postural hypotension.

Dehydration

Loss of body water or negative water balance is the most common cause of orthostatic hypotension.

Renal disease

Renal insufficiencies and glomerulonephritis in primary stages can lead to a decrease in blood volume and this leads to orthostatic hypotension.

Cardiovascular disease

Hypertension is an increase in blood pressure. The medication received for its treatment have side effects as postural hypotension. So one should ask for the history of such drugs in the treatment.

Endocrine disorders can lead to continuous hypotension, it may not relate to change in posture.