Question About Postural Vitals

[Rhonda V]

We had a lady come into our clinic tonight with c/o nausea, vomiting, and dizziness. When her BP was first taken, it was around 112/68 (taken by another nurse). The doctor then asked me to do a set of postural vitals on her. I first laid the patient back on the exam table, gave her a pillow, and elevated her feet. Her BP while laying down briefly at dropped to 78/52! Her pulse was around 76. I then sat her up, waited 1 minute, and took her BP sitting which was 98/68 and pulse was stable. I again waited another minute while she stood and took her BP again. This time it was 110/66 and pulse had remained near baseline. The whole time I was doing these vitals, the patient c/o feeling dizzy. Later on, after the doctor reviewd the vitals I had taken, he then asked the original nurse to go back in, wait a while, and retake her blood pressure while laying down and sitting....she got a much more normal blood pressure reading than I had obtained while the patient was laying down. I kind of felt bad when the doctor told me that he should have been notified immediately when her BP was 78/52...plus, it made me feel like I don't know how to do BP when I've been a nurse for 9 years.

My question is: I understand that with orthostatic hypotension, the BP normally drops with standing...in this case, her BP seemed to remain normal. The doctor said that he thinks she may have had some sort of vaso-vagal episode due to recent N/V she was having, and she was dehydrated. Could it be possible that her BP could drop so low when going from sitting to laying down position? Thanks for any and all help with this

[William_SRNA]

Sure it can, and he was right any BP that low he should have been notified or atleast the vitals retaken and notified.

We had a lady come into our clinic tonight with c/o nausea, vomiting, and dizziness. When her BP was first taken, it was around 112/68 (taken by another nurse). The doctor then asked me to do a set of postural vitals on her. I first laid the patient back on the exam table, gave her a pillow, and elevated her feet. Her BP while laying down briefly at dropped to 78/52! Her pulse was around 76. I then sat her up, waited 1 minute, and took her BP sitting which was 98/68 and pulse was stable. I again waited another minute while she stood and took her BP again. This time it was 110/66 and pulse had remained near baseline. The whole time I was doing these vitals, the patient c/o feeling dizzy. Later on, after the doctor reviewd the vitals I had taken, he then asked the original nurse to go back in, wait a while, and retake her blood pressure while laying down and sitting....she got a much more normal blood pressure reading than I had obtained while the patient was laying down. I kind of felt bad when the doctor told me that he should have been notified immediately when her BP was 78/52...plus, it made me feel like I don't know how to do BP when I've been a nurse for 9 years.

My question is: I understand that with orthostatic hypotension, the BP normally drops with standing...in this case, her BP seemed to remain normal. The doctor said that he thinks she may have had some sort of vaso-vagal episode due to recent N/V she was having, and she was dehydrated. Could it be possible that her BP could drop so low when going from sitting to laying down position? Thanks for any and all help with this

[zacarias, ASN, RN]

Before I got to the part where you said the doc thought she vagaled, I was already thinking that. So you were trying to get posturals on a patient that was recovering from a vagal drop.

Between each set of posturals, I would wait at least five to ten good minutes.

[MIA-RN1, RN]

question from a student...whats the rationale for elevating her feet while she was laying down? I was taught to do them flat. Maybe I missed something?