Overview
Clinical Meaning
The nurse must differentiate types of orthostatic hypotension and implement appropriate management strategies.
The nurse must differentiate types of orthostatic hypotension and implement appropriate management strategies. OH is classified as: (1) Initial OH -- transient BP drop within 15 seconds of standing with quick recovery (common, benign); (2) Classic OH -- sustained BP drop within 3 minutes of standing (standard definition); (3) Delayed OH -- BP drop occurring after 3 minutes of standing, often missed with standard testing (requires prolonged standing test or tilt-table). Neurogenic OH (nOH) is distinguished from non-neurogenic causes by the heart rate response: nOH shows absent or blunted HR increase (less than 15 bpm) because the autonomic nervous system cannot generate a compensatory tachycardia. Non-neurogenic OH (hypovolemia, medication-related) shows an appropriate HR increase of 20+ bpm. The nurse also assesses for postural orthostatic tachycardia syndrome (POTS): HR increase of 30+ bpm (or HR above 120) within 10 minutes of standing WITHOUT significant BP drop; more common in young women; symptoms include palpitations, lightheadedness, exercise intolerance, fatigue. The head-up tilt-table test (HUT) is the gold standard for evaluating orthostatic intolerance, performed at 60-70 degrees for 20-45 minutes with continuous BP...
