Unit 3 Assignment 2 for mn551, Summaries of Nursing

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Structure and Function of the Cardiovascular System with Orthostatic Hypotension

Purdue University Global School of Nursing MN551 ADVANCED PHYSIOLOGY AND PATHOPHYSIOLOGY ACROSS THE LIFE SPAN Professor:

Structure and Function of the Cardiovascular System with Orthostatic Hypotension Elderly patients frequently feel worried about orthostatic hypotension, a medical problem that occurs when standing causes a significant decrease in blood pressure. This is mainly true too in those who have been bedridden for a long amount of time. In this case study, I look at the changes in the body that 81-year-old Bertha's community-acquired pneumonia had when she tried to stand up following three days in bed. Then will look into the cause of her illness, the effects of radius and vascular resistance on blood flow, the body's compensating responses to orthostatic hypotension, and the importance of venous circulation in bringing blood back to the heart from the lower part of the body. Bertha has recently suffered a diagnosis of community acquired pneumonia and now faces a syncopal episode after standing when she has been bed ridden for 3 days. Pathophysiological Changes in Orthostatic Hypotension When systolic blood pressure (SBP) drops by 20 mm Hg or more, or when diastolic blood pressure (DBP) drops by 10 mm Hg or more within three minutes of standing up or during a head tilt test at 60° or higher, it is known as orthostatic hypotension (Fedorowski, 2022). Blood builds up in the lower limbs and splanchnic veins because of orthostatic hypotension, that is caused by a lack of increased vascular resistance on standing. According to Magkas et al. (2019), this pooling lowers cardiac output, stroke volume, and venous return, and lowers blood pressure. Because of her extended bed rest, Bertha's condition was probably made worse by a decrease in her plasma volume and vasomotor tone, both of which are important to blood pressure adjustment when moving positions.

resistance to compensate for the effects of gravity because of orthostatic hypotension, which is caused by poor blood vessel constriction upon standing (Fedorowski, 2022). Venous Circulation and Blood Return The skeletal muscles are some of the systems that help return blood from the lower extremities to the heart. Muscle contractions during exercise compress the veins, forcing blood in the direction of the heart. Venous valves maintain normal blood flow by preventing backflow (Arnold & Raj, 2017). Also, the respiratory pump helps venous return by drawing blood into the heart during inhalation by creating negative pressure in the thoracic cavity (Arnold & Raj, 2017). Bertha's lengthy bed rest probably caused muscular deconditioning, which decreased the skeletal muscle pump's strength and added to her orthostatic hypotension. Hydrostatic Pressure Changes Because of gravity on blood movement, Bertha's capillary hydrostatic pressure changed when she moved from a lying to a standing position. Blood flows evenly throughout the body when lying down, but it pools in the lower extremities when one stands (Magkas et al., 2019). This pooling causes a temporary imbalance until compensating processes restore balance by raising capillary hydrostatic pressure in the lower extremities and decreasing it in the upper body (Magkas et al., 2019). Management and Treatment Bertha and other elderly patients need the use of both non-pharmacological and pharmaceutical methods to treat orthostatic hypotension. Non-pharmacological methods that reduce venous pooling include squatting, leg crossing, gradual position changes, and active leg muscle stretching (Arnold & Raj, 2017). By giving blood vessels outside assistance and

minimizing blood pooling, compression stockings and abdominal bands can also be helpful (Arnold & Raj, 2017). When alternatives to drugs are not enough, pharmaceutical treatments are taken into consideration. According to Arnold and Raj (2017), midodrine, a prodrug that stimulates α1- adrenoreceptors, is useful for improving orthostatic sensitivity and vascular resistance. Another medication that raises norepinephrine levels and improves vascular resistance is called drotopa (Arnold & Raj, 2017). Increased intravascular volume and improved blood pressure stability are possible through the administration of fludrocortisone, which promotes the retention of water and salt (Arnold & Raj, 2017). Conclusion Bertha's episode with orthostatic hypotension shows the difficult task of controlling cardiovascular function, especially in senior citizens having prolonged bed rest. Creating successful treatment plans needs a good understanding of the changes in the body and compensatory mechanisms related to orthostatic hypotension. We can help patients like Bertha with keeping blood pressure stability and improving their whole way of life by combining non- pharmacological and pharmaceutical techniques as well.