Please help with critical thinking question

[kikibibi]

I was doing this question and I want to make sure that if I am on the right track..Please help ....Here is the question...

You are a student nurse visiting Lucille Delanty, a resident of Assisted Living Facility. She is a 75 year old female with a history of hypertension. Her most recent blood pressure was 145/83. She is on two medications for her hypertension. She tells you that she had to get up in the middle of the night a few nights ago to go to the bathroom. She stated that she "became dizzy when she stood up and almost fell." You check her for postural hypotension and find that her lying BP is 148/85, her sitting BP is 135/72, and her standing BP is 112/70. When you ask her some questions about her blood pressure medications she states: "I don't really know what the medications do exactly. I just know I am supposed to take them for my blood pressure."

1) Given the information above, what do you believe is the cause of Mrs. Delanty's dizziness? Support your suspected cause of dizziness by giving rationale to demonstrate your thinking.

I believe the cause of Mrs. Delanty's dizziness is that Low blood pressure on standing up (postural or orthostatic hypotension). This is a sudden drop in blood pressure when you stand up from a sitting position or if you stand up after lying down. Ordinarily, blood pools in your legs whenever you stand, but your body compensates for this by increasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to your brain. But in people with postural hypotension, this compensating mechanism fails and blood pressure falls, leading to dizziness, lightheadedness, blurred vision and even fainting.

Postural hypotension can occur for a variety of reasons including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurological disorders. A number of medications can also cause postural hypotension, particularly drugs used to treat high blood pressure-diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors

Postural hypotension is especially common in older adults, of those over age 65 experiencing postural hypotension. I believe Dizziness is also caused by low blood sugar levels that may occur as your body adapts to changes in your metabolism.

2) What suggestions would you make to reduce her dizziness?

There are a number of things that I would suggestion to reduce the amount of her dizziness she experience. I would suggest that to get up slowly from either sitting or lying down, since this is a common reason for dizziness. Eat regularly. Avoid long periods between meals it is better to snack throughout the day.

[RNLola035]

I think that answer is great, but you should also address the fact that this woman doesn't know about her medications.

[ShortStackRN]

I think you are definitely on the right track...teach her to "dangle" before getting all the way up after rising from a resting position. I think the other concern that you should address is poor patient education, since she knows nothing about her medications. This could also be an indication of non-compliance with her meds...causing her BP to still be high...just a thought!

[pharmgirl]

excellect answer and ditto the other posters......educate about her meds.

[Daytonite, BSN, RN]

(1) Your reasoning sounds OK.

(2) She needs to change positions slowly.

She should use an assistive device and her doctor needs to be notified immediately about the results of the lying sitting and standing B/Ps. You can't let this condition go without notification of her doctor. She needs to be seen by her doctor as soon as she can get an appointment with him. Her medication needs to be evaluated. It is a safety issue for a 75-year old because she is at risk of falling.

[Jedi of Zen]

I pretty much agree with the OP. I would only add, like others have said, to make sure she does understand when to take her meds as well.