An older patient being treated for hypertension experiences lightheadedness when getting up in the middle of the night to void and when making sudden movements. How should the nurse instruct this patient?

Question

1. Encourage a sleeping pill to prevent nighttime waking.
2. Ensure that the side rails are upright on the bed to prevent the patient from ambulating.
3. Move slowly from a lying to a sitting position and then slowly from sitting to standing.
4. Decrease fluid intake in the evening to prevent the need to get up in the middle of the night.

Answer 1

3. Move slowly from a lying to a sitting position and then slowly from sitting to standing.

Explanation: 1. Other alternatives would be indicated before encouraging a patient to take a medication for sleep.
2. The patient is being treated for hypertension and should not be discouraged from walking to the bathroom if proper precautions are made. This may be considered a restraint.
3. Patients taking antihypertensive medications should be instructed to change positions slowly. Rising too quickly from lying to standing position can result in pooling of blood in the extremities and reduced blood flow to the head. This can cause orthostatic hypotension, which is experienced as lightheadedness or syncope.
4. The nurse should not encourage the patient to restrict fluids since this could potentiate other health problems.