Clinical Skills - Assessing Orthostatics

Hi. I'm Ellis with Level Up RN. In this video, I'll be demonstrating how to obtain a patient's orthostatic blood pressure. I'll be following along with the steps from our clinical nursing skills deck, so if you have the deck, grab the cards and follow along with me. If you don't have the deck, you can check it out at LevelUpRN.com. To demonstrate orthostatic blood pressures accurately, I did need the help of a very special guest. I hope you enjoy.

ELLIS: Hi, Miss Cathy.

CATHY: Hi.

ELLIS: So your doctor's ordered for us to do some orthostatic blood pressure checks on you.

CATHY: What does that mean?

ELLIS: So I understand that you've been feeling a little bit dizzy maybe when you stand up or a little bit weak, so we're just going to check to see if your blood pressure is changing when you change positions.

CATHY: Okay. Whatever you say.

ELLIS: So you've been laying down for at least five minutes?

CATHY: I've been laying down all day.

ELLIS: Oh, perfect.

CATHY: I'm tired.

ELLIS: So we'll go ahead and get that first check. So I'm going to turn on my machine. I'm going to just need your forearm, upper arm, line up my artery marker, and take your blood pressure.

CATHY: I'm very tired today.

ELLIS: Very tired?

CATHY: Yeah.

ELLIS: Are you feeling weak or dizzy?

CATHY: A little bit.

ELLIS: All right. Well, we'll just take it easy. We'll go slowly through this process. All right. So I'm going to make sure I document your blood pressure and your heart rate so that we can see if there are any changes. It's 115/77, and your heart rate is 63. So we'll just leave that cuff on you if that's okay. And I'm going to have you swing your legs over to the side of the bed and just sit with your feet touching the floor.

CATHY: Can I get some apple juice when we're done?

ELLIS: We'll get some apple juice when we're done. All right. So let's just sit up on the side of the bed. And don't try to get up or anything. I just want you to swing your legs over. Beautiful. So we're going to sit like this for a couple of minutes, and then we'll go ahead and take your blood pressure again. How are you feeling sitting up?

CATHY: It's okay.

ELLIS: Feels okay?

CATHY: It's okay.

ELLIS: All right.

[silence]

ELLIS: And then once this is done, we'll go ahead and stand. And I see you've got your no-slip socks on so that we're not hopefully going to slip and fall or anything like that. We don't need to do any of that today. All right. We got 125/81 and 58 for your pulse. So we'll go ahead and just stand up. Beautiful. All right. You feel okay?

CATHY: I think so.

ELLIS: Any excessive dizziness or weakness?

CATHY: No, I think I'm okay.

ELLIS: Okay. If that happened, I would have you sit back down, but we'll have you stand for a few minutes, check that blood pressure and pulse one more time. So what we're looking for is if your blood pressure or pulse changes significantly.

[silence]

ELLIS: All right. We got 127/78, and your pulse is 56. So I'll go ahead and tell your practitioner those results, and we'll be back in to chat with you about it.

CATHY: Okay.

ELLIS: All right. You can have a seat.

CATHY: Can I get my apple juice?

ELLIS: I'll get your apple juice. Go ahead and sit down for me. [laughter]