Orthostatic blood pressure assessment compares measurements after lying down with measurements after standing. For nurses, the useful result includes the blood pressure, pulse, timing, and symptoms. Recording only “orthostatics positive” leaves the next clinician without the details needed to interpret the test.
The procedure requires a patient who can stand with appropriate support. Assess mobility and the clinical situation first, and follow the facility’s protocol. Do not attempt standing simply to complete a set of measurements when it would put the person at risk.
Prepare the patient and equipment
Explain that you will measure blood pressure in different positions and ask about dizziness. Make sure the cuff and equipment are appropriate and that help is available for the transition to standing. Plan where the patient can sit or lie down if symptoms develop.
Ask about symptoms already present before starting. Distinguishing baseline lightheadedness from a change during standing makes the record more informative. Note any reason the usual procedure cannot be followed.
Use a defined sequence
The CDC STEADI assessment uses this sequence:
- Have the patient rest lying down for five minutes.
- Measure blood pressure and pulse while lying down.
- Assist the patient to stand as appropriate.
- Repeat blood pressure and pulse after one minute and three minutes standing, recording associated symptoms.
Use actual elapsed times. A measurement taken immediately on standing should not be labeled as the three-minute reading. If your organization uses a different validated protocol, identify the procedure used instead of combining pieces of different methods.
Watch the person throughout the test
The CDC’s postural hypotension brochure explains that the fall in pressure with position change can contribute to falls. Ask about lightheadedness and observe whether the patient can remain standing comfortably.
If the person becomes faint or cannot continue, prioritize assistance and clinical evaluation. Record that the assessment was stopped, the position and timing reached, and the symptoms. An incomplete test with an accurate explanation is more useful than an invented final value.
Interpret the pattern within the clinical picture
STEADI identifies a fall of at least 20 mm Hg systolic, at least 10 mm Hg diastolic, or lightheadedness or dizziness as abnormal findings. Report symptoms even if the measured change does not meet the numerical threshold. The treating clinician evaluates the cause and the next steps.
An illustrative calculation: a systolic pressure of 132 mm Hg while lying down and 108 mm Hg after standing represents a 24 mm Hg decrease. Record the full readings and timing as well as the calculation. These example values are for learning, not patient-specific treatment advice.
Document what the next person needs
- The protocol and positions used.
- Rest and standing measurement times.
- Blood pressure and pulse at each point.
- Symptoms, assistance needed, and whether the test was completed.
- Who was notified and the resulting plan.
Do not turn a finding into an independent medication or fluid change. Review the plan with the responsible clinician, particularly when symptoms affect mobility. Reinforce the current assistance instructions so the patient knows to call before getting up.
Our vital signs assessment guide provides related context. A clear orthostatic record preserves both the numbers and the patient’s experience of changing position.