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Bill To Reduce Nurse Injuries

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Tip of the Week– Orthostatic Vital Signs (assessing for hypovolemia)

Orthstatic vital signs are used by RNs and other health care professionals to determine if recent symptoms experienced by a patient are related to fluid volume deficit.  The basis of this is that changes in the patient’s posture or positioning have an effect on the cardiovascular response to maintain blood pressure.

Look at patients who are experiencing syncopal episodes (fainting spells), dizziness, GI symptoms (like nausea, vomiting, and diarrhea), or other symptoms related to potential cardiovascular system response.  Is there a problem with their heart? Is it a GI bleed?  Is it a seizure or stroke?  You don’t know as a nurses or other practitioner.

In comes the orthostatic vital signs series.  This is also known as a “tilt test” or “postural vital signs.” This test of changes to blood pressure and heart rate examines the cardiovascular response to changes in position.  The body would normally have a temporary change in BP and pulse rate after a change, however after a minute or so, the changes should have evened out somewhat.

In a patient who is fluid deficient for some reason, this stabilization doesn’t happen as fast or at all. There isn’t enough fluid to shift to correct for gravity and the heart rate needs to compensate by rising and remaining raised to push more blood around the system.  The vasculature can’t clamp down enough to squeeze fluid to the central circulation.  Thus, the blood pressure remains depressed (usually by 20 mm of hg or more systolic) and the heart rate remains raised (by 20 bpm or more) this can be an indicator of a need for fluid volume replacement therapy.

Follow the links below for more on vital signs and orthostatic or tilt testing.

Orthostatic Measurment

Beyond the Basics: Interpreting Vital Signs

How is dizziness diagnosed?


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Laura Clapp — I’m Not Responsible

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