Why can a first walk after surgery end in a fall?

The question

Your patient is about to stand for her first walk with a frame after hip surgery: why can she fall now, and what do I do before she stands?

Understand

Mrs Smith feels fine in bed, so why could standing for her first walk after hip surgery put her at risk of a fall? When we stand, blood pools in the legs, and if the body's squeeze is slow, blood pressure drops and she can feel dizzy. With the supervising nurse's plan, a student nurse sits her on the bed edge and asks about dizziness. Dizzy? She stays sitting and the student tells the nurse. Steady? She stands slowly with hands-on help.

1. On standing, blood pools in the leg vessels. If the squeeze that pushes it back up is slow, less reaches the brain and blood pressure drops.
2. Days in bed, blood loss, dehydration and some medicines make the drop more likely.

Key takeaways

• Standing pools blood in the legs, and the body's usual response is to tighten the vessels. In postural hypotension that response is delayed or missing.
• Dizziness is a symptom (what she says). Unsteadiness on her feet is a sign (what you see). Either way: stay sitting and tell your nurse.
• Symptoms usually improve if she sits or lies back down. Don't walk a dizzy patient.
• Some wards check blood pressure lying and standing for older patients with dizziness. Follow your hospital's policy.

In practice

• Check the plan with your supervising nurse first.
• Sit her on the bed's edge and ask about dizziness. Dizzy? She stays sitting and you tell the nurse in charge.
• Steady and your supervisor agrees: stand slowly, in safe shoes, with hands-on help.

Check yourself

A patient on the bed's edge says she's a bit woozy. Her frame is beside her. What now?

Words to know

Postural hypotension

low blood pressure when you stand up (hypo- (low) + tension (pressure))

Transcript

Sources

1. Better Health Victoria, Dizziness and orthostatic hypotension: about 800 ml pools in the legs on standing; the drop cuts blood flow to the brain; prolonged bed rest, dehydration, some medicines and significant blood loss as causes (read 4 November 2026)
2. healthdirect, Low blood pressure (hypotension): BP drops on standing, light-headedness or dizziness; sit first when moving from lying to standing (read 4 November 2026)
3. Healthify NZ, Low blood pressure: postural hypotension when you change position; baroreceptors respond more slowly with age; bed rest; don't walk if dizzy (read 4 November 2026)
4. ACSQHC, Preventing falls and harm from falls in older people: best practice guidelines for Australian hospitals (2025): balance and strength poorer in hospital; unfamiliar surroundings; falls linked to the toilet; most falls result in injury; hands-on assistance; safe footwear; lying and standing BP (read 4 November 2026)
5. Canberra Health Services, Staying safe from falls in hospital: let staff know if you feel dizzy or unsteady (read 4 November 2026)

Checked against these sources at the time of publishing. Sources change, so check the date above and your local policy. Spotted an error? Tell us and we'll correct it.