A patient is seen in the clinic for complaints of fainting episodes that started last week. How should the nurse proceed with the examination?
a. Blood pressure readings are taken in both the arms and the thighs.
b. The patient is assisted to a lying position, and his blood pressure is taken.
c. His blood pressure is recorded in the lying, sitting, and standing positions.
d. His blood pressure is recorded in the lying and sitting positions; these numbers are then averaged to obtain a mean blood pressure.
The correct answer and explanation is:
The correct answer is c. His blood pressure is recorded in the lying, sitting, and standing positions.
Explanation:
Fainting episodes, also known as syncope, can be caused by a variety of factors, including cardiovascular issues like orthostatic hypotension, dehydration, heart arrhythmias, or neurological disorders. The nurse must take a thorough history and perform an assessment to identify the cause. One of the key assessments in such a situation is measuring the patient’s blood pressure in different positions: lying, sitting, and standing. This helps to evaluate the patient’s response to changes in posture and can provide valuable insights into orthostatic hypotension, which is a condition where blood pressure drops significantly upon standing.
When a person stands up, gravity causes blood to pool in the lower extremities, which can temporarily reduce the amount of blood returning to the heart, leading to a drop in blood pressure. In a healthy individual, the body compensates by constricting blood vessels and increasing heart rate. However, in people with orthostatic hypotension, this compensatory mechanism is impaired, and they may experience a significant drop in blood pressure, leading to dizziness or fainting.
By taking blood pressure readings in all three positions, the nurse can monitor for significant changes in systolic or diastolic blood pressure that may suggest orthostatic hypotension. A drop in systolic blood pressure of 20 mm Hg or more, or a drop in diastolic blood pressure of 10 mm Hg or more, upon standing is generally considered indicative of orthostatic hypotension.
In contrast, measuring blood pressure in only the lying and sitting positions (option d) may miss important data that could be observed when the patient stands. Similarly, measuring blood pressure only in the arms and thighs (option a) or just in the lying position (option b) would not provide a comprehensive view of how the body responds to changes in position. Therefore, recording blood pressure in all three positions (lying, sitting, and standing) is the most effective way to assess for orthostatic hypotension and help identify potential causes of fainting.