Orthostasis Screening
Script: “I would like to measure your heart rate and blood pressure now. First, I’m going to take the measurements while you are lying down (insert the term sitting, if applicable). Then I’m going to ask you to stand up and I’ll take both measurements two more times, once immediately after you stand, and then again after you have been standing for 2 minutes. Would that be OK?”
If subject consents – Ask “Is it OK if I use your left arm to take your blood pressure?” **Note to tester: Take the blood pressure measurement in the left upper extremity unless there is a contraindication to doing so, such as a history of mastectomy with lymph node resection, AV fistula, stroke involving that side of the body, or any injury that would result in pain with inflation of the cuff. If there is a contraindication or the subject has a strong preference, use the right upper extremity for both heart rate and blood pressure measurements. Make sure to indicate on the data collection form which arm was used.
Initial Measurements: Have the subject lie supine if they are able and it is appropriate given the testing environment. If not, have them sit comfortably in a chair. Take the pulse manually using the left wrist if palpable. If not, move to the left elbow. Palpate the pulse for 15 seconds if the heart rate is regular and 30 seconds if irregular. Record the value in beats per minute. Measure blood pressure manually, with the arm elevated to at least the level of the heart and well supported by your arm so it is fully relaxed. Record the value.
Ask: “Do you feel dizzy, light-headed or nauseous right now? Is your vision blurred?” Record the answer on your data collection form.
Immediate Standing:Say to the subject:“Now I would like you to stand up please, and I am going to take your heart rate and blood pressure again after you stand.” Assist the patient as needed to a full upright standing position and remain close, guarding them at all times. The subject can use their free upper extremity to touch furniture or an assistive device for stability if needed. Once they are standing, immediately repeat the measurements of heart rate and blood pressure, using the same arm that was used for the initial measures, and record the values.
Ask the subject:“Do you feel dizzy, light-headed or nauseous now that you are standing? Is your vision blurred?” Record the answer on your data collection form.
(**Note to Tester: If the subject reports symptoms that are severe or that worsen rather than improve with time, or if you observe presyncopal signs such as decreased alertness or sudden onset of pallor or diaphoresis: Assist the subject into a supine position, elevating their legs above the level of their heart if symptoms do not immediately improve. Summon assistance if needed, but do not leave the subject unattended at any time. Continue to monitor vital signs and stop the testing procedure.)
Two Minutes Standing: After the subject has been standing for a total of 2 minutes,say to them:“I am going to take your heart rate and blood pressure one last time now, and then you can have a seat.” Repeat the measurements of heart rate and blood pressure, using the same arm that was used for the previous measures, and record the values.
Ask the subject:“Do you feel dizzy, light-headed or nauseous now that you have been standing here? Is your vision blurred?” Record the answer on your data collection form.
Say: “You may sit down now if you would like. We are finished with this test.”