Hypotension: Diagnostics and Treatment Essay

Introduction

Low blood pressure seems desirable and causes no problems for some individuals. However, abnormal blood pressure also referred to as hypotension, causes fainting or dizziness in most people and can be 60/90 or lower¹. Hypotension can be dangerous in severe cases; therefore, patients and healthcare professionals should be cautious. An individual’s blood pumping measurement through the arteries when the heart’s ventricles squeeze is systole or systolic pressure, while diastole is the rest period of blood pressure examination¹. Therefore, it is essential to understand the causes of hypotension, its effects, strategies for dealing with the illness, and nursing implications.

Causes

Pregnancy and Heart Issues

Every person’s blood pressure goes down at one point or the other. However, this might not be accompanied by any noticeable signs and symptoms. The expansion of the circulatory system during the gestation period is likely to cause low blood pressure. This can be caused by the increase in blood demand from the mother and the growing fetus. Hypotension is normal during pregnancy, and blood pressure normalizes after birth². Some heart problems that can lead to low blood pressure in an individual include; heart attack, bradycardia (extremely low heart rate, heart attack, and valve problems².

Dehydration and Endocrinal Problems

Dizziness, weakness, and fatigue can occur when a person’s body loses more water than it takes in. Additionally, dehydration can be caused by strenuous exercise, vomiting, diarrhea, fever, and diuretic overuse leading to hypotension²⁽³⁷¹⁾. Low blood pressure can be triggered by hypoglycemia (low blood sugar), parathyroid illness, diabetes, and adrenal insufficiency. However, these hypotension causes can be managed through changing lifestyle and adhering to medications.

Loss of Blood and Anaphylaxis (severe allergic reaction)

Blood loss from internal bleeding or a major injury minimizes blood in the body, resulting in a severe blood pressure drop. This potentially serious reaction is caused by common triggers such as foods, medication, latex, and insect venoms. Severe allergic reactions can result in a drop in blood pressure, breathing issues, swollen throat, and itching²⁽³⁷³⁾. Therefore, these factors significantly contribute to low blood pressure.

Septicemia (severe infection), insufficient Nutrients in the Diet and Medications

A significant blood pressure drop known as septic shock can be experienced when an infection in the body gets into the patient’s bloodstream. Inadequate iron, folate, and vitamin B-12 in foods can prevent the body from producing enough red blood cells, resulting in low blood pressure²⁽³⁷⁴⁾. The medications include water pills (furosemide), alpha-blockers (prazosin), certain antidepressants, and erectile dysfunction medicines.

Effects

Hypotension causes both biological and physical abnormalities in individuals. They include; fatigue, fainting, lightheadedness, fading or blurred vision, nausea, and lack of concentration. Extreme low blood pressure can cause a severe form of shock characterized by a rapid or weak pulse, confusion, and pale, clammy, or cold skin and confusion²⁽³⁷⁸⁾. However, the effects of hyptension on people are determined by its primary cause.

Patient Education

Rare treatment is required when hypotension fails to exhibit signs or is characterized by no or mild symptoms. Healthcare professionals offer patients educated based on the cause of low blood pressure. For example, a patient might be advised to change or stop the specific medication if the drugs are the primary cause of hypotension. However, if the exact cause of low blood pressure is unknown, raising it should be the only option to reduce the signs and symptoms. Healthcare professionals can advise patients to control hypotension by applying different strategies³.

Using More Salt and Increase Water Intake

Limiting salt in an individual’s diet is recommended by most experts because sodium raises blood pressure dramatically. However, this can be a good strategy in patients with low blood pressure. At the same time, excess sodium can cause heart failure, mostly in the elderly; therefore, patients should seek medical advice. Fluids play a vital role in increasing the volume of blood in the body and prevents dehydration. This strategy is essential in the management and treatment of hypotension³⁽¹⁶³⁾. For instance, a patient should take half a liter of liquids before meals or in the morning to increase blood pressure.

Use Compression Stockings and appropriate body positions

Compression stockings are elastic and play a significant role in relieving pain and reducing varicose veins’ swelling. Moreover, they help to minimize blood pooling in the legs. Patients should be educated about the essentiality of maintaining correct body positions⁴. For example, it is also advisable to sit up first after getting out of bed and moving the legs slowly to the bedside. Patients who experience hypotension symptoms should quickly sit down. Practicing these moves helps the flow of blood from the legs to the heart.

Medications

Healthcare providers can advise patients to use several medications that lower blood pressure when they stand up, also known as orthostatic hypotension. A perfect example is fludrocortisone, which treats orthostatic low blood pressure by boosting the volume of blood in the body. The drug midodrine (Orvaten) also works by restricting blood vessel expansion³⁽¹⁶⁵⁾. This minimizes the possibility of blood pressure drop resulting in its rise.

Eat Small Meals

Taking small portions of food several times daily and minimizing high-carbohydrate meals such as rice and potatoes prevents blood pressure from dropping. Moreover, patients should be advised to take utmost two cups of strong tea or coffee during breakfast⁴⁽³⁸⁾. However, caffeine should not be taken throughout the day because the patient can become less sensitive and suffer dehydration.

Exercise and Avoid Alcohol

Physical activity plays a vital role in increasing blood pressure and the flow of blood to the heart. Thirty to sixty minutes’ of exercise daily raises an individual’s heart rate. However, hypotension patients should avoid humid conditions because they lower blood pressure. For instance, patients should limit their outside time during hot days⁴⁽³⁴⁾. Alcohol causes water loss in the body; therefore, it lowers blood pressure even when taken moderately.

Nursing Implications

Low blood pressure should be considered an emergency in the healthcare sector. The primary aim of nursing interventions is to stabilize the patient’s condition, diagnose and ask for help from experts⁵. Nurses should implement the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach to monitor vital signs and call for assistance if necessary. It is also essential to ensure that patients can breathe adequately and have a clear airway. The nurse might administer high-concentration oxygen, for example, using a mask with sufficient airflow. Healthcare professionals should also monitor the patient’s pulse, which incorporates its regularity, rate and volume, peripheral skin temperature, the balance of fluids, capillary refill time, and blood pressure⁴⁽³⁸⁾. Additionally, lying horizontally with the face and torso facing up and tilting the bed to raise their legs helps to improve cerebral perfusion. It is helpful to stop any medication that causes hypotension and consider administering an antidote if available⁵. These approaches are essential because they promote the adequate flow of blood in a person’s body.

A nurse can insert a large intravenous (IV) canal because they allow rapid drug infusion and have the highest flow rate. Further IV fluids can be administered if the patient does not exhibit any improvement signs. Moreover, a second cannula might be used to provide a different route for administering IV fluids and drugs. It is vital to take blood for clinical examinations, such as liver function tests, full blood count, lactate and coagulation screen, and glucose. A challenge of fluid rapid (above five to ten minutes) of crystalloid solution that is warmed, for example, 0.9% of normal saline can be prescribed⁵. However, extra caution should be exercised on patients with cardiac failure; therefore, smaller IV fluid volumes should be administered. Blood transfusion might be required if bleeding is suspected, while blood cultures might be useful in case of sepsis. Nurses can consider inserting a urinary catheter to monitor the output of urine when necessary⁵. Clinicians might also take the responsibility of identifying and treating the primary causes of hypotension if possible.

Conclusion

In summary, hypotension is also referred to as low blood pressure, which is 60/90 or more down. Although this condition is necessary for individuals with high blood pressure, it can be life-threatening if left untreated. Certain ailments associated with hypotension include; pregnancy, loss of blood, circulation issues, endocrine problems, dehydration, a severe form of an allergic reaction (anaphylactic shock), infections, medications, and inadequate nutrients in the diet. Low blood pressure is a condition that causes biological and physical adverse effects on an individual. They include blurred vision, fatigue, lightheadedness, confusion, pale or cold skin, and lack of concentration. The treatment and management of hypotension require the collaboration of healthcare professionals and patients. Patient education plays a significant role in preventing a drop in blood pressure. Sick individuals should be advised to quit alcohol, increase the intake of fluids, use compression stockings and eat smaller portions several times daily. Additionally, hypotension patients should use more salt, maintain specific body positions, exercise for 30-60 minutes every day, and take various medications to improve their conditions.

Nursing implications play a crucial role in stabilizing and diagnosing hypotension patients before asking for help from experts. Nurses should implement the ABCDE method when assessing sick individuals to determine the disease’s severity. It is important to monitor the patient’s pulse and ensure that they breathe adequately. The nurse can help the sick person be supine and elevate their legs to enable an uninterrupted flow of air from the legs to the heart. Any medication that contributes to hypotension can be stopped and prescribe an alternative. Nurses can also administer more IV fluids if the patient’s condition does not improve. Clinicians can also identify and treat the primary cause of hypotension if they are capable of doing it.

References

Briesenick L, Saugel B. Intraoperative hypotension: Pathophysiology, clinical relevance, and therapeutic approaches. Indian Journal of Anaesthesia. 2020;64(2):90. Web.

Chisholm P, Anpalahan M. Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension. Internal Medicine Journal. 2017;47(4):370-379.

Chen H, Su Y, He Y, et al. Controlling blood pressure under transcranial doppler guidance after endovascular treatment in patients with acute ischemic stroke. Cerebrovascular Diseases. 2020;49(2):160-169.

Palma JA, Gonzalez-Duarte A, Kaufmann H. Orthostatic hypotension in hereditary transthyretin amyloidosis: epidemiology, diagnosis, and management. Clinical Autonomic Research. 2019; 29(1):33-44.

Baha G, Ilhan B, Tufan A, et al. Hypotension in Nursing Home Residents on Antihypertensive Treatment: Is it Associated with Mortality?Journal of the American Medical Directors Association. 2021.

Footnotes

1. Kouz K, Hoppe P, Briesenick L, Saugel B. Intraoperative hypotension: Pathophysiology, clinical relevance, and therapeutic approaches. Indian Journal of Anaesthesia. 2020;64(2):90. Web.
2. Chisholm P, Anpalahan M. Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension. Internal Medicine Journal. 2017;47(4):370-379. Web.
3. Chen H, Su Y, He Y, et al. Controlling blood pressure under transcranial doppler guidance after endovascular treatment in patients with acute ischemic stroke. Cerebrovascular Diseases. 2020;49(2):160-169. Web.
4. Palma JA, Gonzalez-Duarte A, Kaufmann H. Orthostatic hypotension in hereditary transthyretin amyloidosis: epidemiology, diagnosis, and management. Clinical Autonomic Research. 2019; 29(1):33-44. Web.
5. Baha G, Ilhan B, Tufan A, et al. Hypotension in Nursing Home Residents on Antihypertensive Treatment: Is it Associated with Mortality? Journal of the American Medical Directors Association. 2021. Web.