📚 Deeper Dive · Scenario 33 of 57

The Dizzy Stand-Up, In Depth

Orthostatic hypotension & fall prevention — the why behind "safety first"
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Coach Katie
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When standing up drops the pressure

Mrs. Pearson stood up after hours in bed and immediately felt dizzy and gray. That is orthostatic (postural) hypotension — a drop in blood pressure when a person moves from lying or sitting to standing. It causes dizziness, lightheadedness, and sometimes fainting, which makes it a major fall risk, especially in older adults.

Think of gravity pulling water downhill. When you stand, blood wants to pool in your legs. Normally the body instantly tightens vessels and nudges the heart to keep blood flowing up to the brain. When that reflex is slow — after bed rest, when dehydrated, or on certain medications — the brain briefly runs short, and the world goes gray.

Who's most at risk

Older adults, patients after prolonged bed rest, those who are dehydrated or have lost blood, and people on blood-pressure-lowering medications are especially prone to orthostatic drops.

Safety always comes first

Because the real danger is a fall, the first move when someone goes dizzy standing is to keep them safe: support them, ease them back to sitting or lying, and stay with them. Confirming the diagnosis comes second.

Never let go of a swaying patient to go get the blood pressure cuff. The fall you're trying to prevent happens in the seconds you'd be away. Call for help or bring equipment without leaving.

Confirming it: orthostatic vitals

First let the patient rest lying flat (supine) for at least 5 minutes, then take a lying blood pressure and pulse. Next have them stand and measure again on standing at about 1 and 3 minutes so the readings reflect the body's real response. A significant fall in blood pressure on standing (often with a marked rise in heart rate) plus symptoms confirms orthostatic hypotension.