What should the nurse teach a client, who is taking antihypertensive, to minimize orthostatic hypotension?

BHU NO-2019

Medical & Surgical Nursing

Medium

Appeared in: BHU NO-2019

Explanation

Antihypertensive medications can cause orthostatic (postural) hypotension, which is a sudden drop in blood pressure upon standing.
Sitting on the edge of the bed for a few minutes before standing allows the body's baroreceptors and vascular system to adapt to the change in gravity.
This technique, often called 'dangling,' prevents the pooling of blood in the lower extremities.
By allowing time for adjustment, adequate blood flow to the brain is maintained, which prevents symptoms like dizziness, lightheadedness, and potential falls.

Option A: The term 'continuously' makes this option incorrect. Compression stockings must be removed periodically to assess skin integrity and allow for hygiene.
Option B: Regular, moderate exercise is a key non-pharmacological treatment for hypertension and improves overall cardiovascular health.
Option C: This action does not address the physiological cause of orthostatic hypotension, which is the change in position against gravity. The blood pressure drop will still occur when the client eventually stands up.

Clinical Relevance

Nursing practice connection: Use the key finding related to Patient education for managing orthostatic hypotension secondary to antihypertensive medication to guide bedside assessment, documentation, and the next nursing action.
Patient safety and fall prevention are paramount for clients on antihypertensives. Teaching strategies to manage orthostatic hypotension directly reduces the risk of injury.
Nurses must assess for orthostatic hypotension by measuring blood pressure and pulse with the patient in supine, sitting, and standing positions. A drop in systolic BP of 20 mmHg or diastolic BP of 10 mmHg within three minutes of standing is diagnostic.
What if? If the client is also dehydrated or has been on prolonged bed rest, the risk for orthostatic hypotension is significantly higher. The nurse must be extra vigilant in teaching, assisting with ambulation, and ensuring adequate hydration.

How to Approach the Question

First, identify the core concept of the question: It's about a common side effect of antihypertensive medication, which is orthostatic hypotension.
Next, recall the pathophysiology of orthostatic hypotension: a drop in blood pressure due to a gravitational shift of blood when moving to an upright position.
Analyze the options to see which one directly counteracts this physiological mechanism.
The strategy of changing positions slowly (sitting before standing) allows the body's compensatory mechanisms (baroreceptors) time to activate, constrict blood vessels, and maintain stable blood pressure.
Eliminate the other options: 'Avoid exercise' is contrary to hypertension management, 'wear support hose continuously' is unsafe, and 'lie down after taking medication' doesn't prevent the problem upon standing.

Concept Tested & Keywords

Concept Tested: Patient education for managing orthostatic hypotension secondary to antihypertensive medication.
Stem keywords: nurse teach, client, antihypertensive, minimize orthostatic hypotension
Lead-in keywords: What should

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E6 Nursing Fundamentals Taylor p. 131-133

E6 Pharmacology Nursing Lilley 11e Part 2 pp. 49-51, 46-48