If systolic BP falls ≥ 20 mm Hg after patients stand, orthostatic hypotension is diagnosed. BP is measured with patients in the supine position, then after they have been standing for 3 to 5 min. This rare condition, called pseudohypertension, should be suspected if dizziness develops after antihypertensives are begun or doses are increased to treat elevated systolic BP.Īll elderly patients are checked for orthostatic hypotension because it is common. Because many factors can alter BP, BP is measured several times after patients have rested > 5 min.īP may be overestimated in elderly patients because their arteries are stiff. Pulse is taken for 30 sec, and any irregularity is noted. Absence of fever does not exclude infection. Hypothermia can be missed if the thermometer cannot measure temperatures more than a few degrees lower than normal. Height is recorded annually to check for height loss due to osteoporosis. During measurement, patients with balance problems may need to grasp grab bars placed near or on the scale. If they are examined at bedside, use of protective padding or a protective mattress, bedside rails (partial or full), restraints, a urinary catheter, or an adult diaper should be noted. Portions of the examination may be more comfortable if patients sit in a chair.Ĭlinicians should describe the general appearance of patients (eg, comfortable, restless, undernourished, inattentive, pale, dyspneic, cyanotic). Frail patients must not be left alone on the table. The examining table should be adjusted to a height that patients can easily access a footstool facilitates mounting. Elderly patients may require additional time to undress and transfer to the examining table they should not be rushed. If patients become fatigued, the physical examination may need to be stopped and continued at another visit. Their personal hygiene (eg, state of dress, cleanliness, smell) may provide information about mental status and the ability to care for themselves. Observing patients and their movements (eg, walking into the examination room, sitting in or rising from a chair, getting on and off an examination table, taking off or putting on socks and shoes) can provide valuable information about their function.
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