Orthostatic Hypotension

A patient may have an acceptable blood pressure while lying down and still become unsafe within seconds of standing. Gravity shifts blood into the legs and abdominal circulation; if the cardiovascular system cannot restore venous return and vascular tone, cerebral perfusion falls. The result may be visual dimming, weakness, cognitive slowing, a fall, or syncope. The nurse’s first task is not to make the standing number normal. It is to prevent injury, confirm whether a postural pressure fall is present, identify whether the response suggests volume loss, medication effect, or autonomic failure, and look for an acute illness that needs urgent treatment. A patient can have orthostatic hypotension without dizziness, so a negative symptom report does not replace lying and standing measurements.