Orthostatic hypotension makes walking unsafe today
Before gait training in a client with hemiplegia, the nurse checks sitting and standing balance and orthostatic blood pressure. His blood pressure is 136/82 mmHg lying and 110/70 mmHg standing, a fall of 26 mmHg systolic. A drop of 20 mmHg or more systolic, or 10 mmHg or more diastolic, on standing indicates orthostatic hypotension. A 26 mmHg systolic fall on standing puts him at risk of fainting and falling, so it is reported and walking practice is postponed.
Why orthostatic hypotension matters after stroke
After a stroke and days of reduced activity, the body's reflex responses to standing are weakened. When he stands, blood pools in the legs, cerebral blood flow can fall, and he may become dizzy, faint, or fall. A fall in a client with right-sided weakness who is taking aspirin could cause injury, including head injury with bleeding. Reduced cerebral perfusion could also be harmful to the recovering brain. The nurse reports the finding so the cause can be evaluated, for example dehydration or medication effects, and walking is resumed when standing blood pressure is stable.
| Finding | Significance | Postpone walking? |
|---|
| Resting heart rate 88, regular | Within normal limits | No |
| Blood pressure 136/82 lying, 110/70 standing | Orthostatic hypotension | Yes |
| Word-finding pauses | Expressive aphasia; does not affect gait safety | No |
| Right leg strength 3/5 | Moves against gravity; supported gait possible | No |
Why the other findings do not stop the session
A regular resting heart rate of 88 beats/min is normal. Word-finding pauses reflect his expressive aphasia, which affects language, not balance or safety while walking. Right leg strength of 3/5 means he can move the leg against gravity, which allows supported gait training with a gait belt and assistance. Watch out! Weakness may look like the most important finding in a walking question, but the immediate safety risk here is the drop in blood pressure.
Exam takeaway
Before mobilizing a client, check orthostatic vital signs, balance, and readiness, and protect the client with a gait belt and assistance. Key point! A systolic drop of 20 mmHg or more on standing is orthostatic hypotension and a reason to postpone walking practice and report.