Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Hypotension


Related Terms

  • Low Blood Pressure

Differential Diagnosis

  • Addison's disease
  • Atherosclerosis
  • Diabetes
  • Neurological disorders

Specialists

  • Cardiovascular Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Diabetes
  • Multiple system atrophy
  • Obesity

Factors Influencing Duration

Factors that influence the duration of hypotension include the underlying cause and the individual's compliance with suggested lifestyle changes and/or medication.

Medical Codes

ICD-9-CM:
458.0 - Hypotension, Orthostatic
458.1 - Hypotension, Chronic
458.21 - Hypotension of Hemodialysis; Intra-dialytic Hypotension
458.29 - Iatrogenic Hypotension, Other; Postoperative Hypotension
458.8 - Hypotension, Other Specified
458.9 - Hypotension, Unspecified

Overview

Hypotension is an abnormal condition in which an individual's blood pressure is too low for normal functioning.

Blood pressure is measured in millimeters of mercury (mmHg). The first number represents the maximum pressure exerted in the blood vessels when the heart contracts (systolic blood pressure), and the second number represents the pressure between contractions when the heart is at rest (diastolic blood pressure). Hypotension is diagnosed if an individual's blood pressure falls below 90/60 mmHg (or 90/60). Hypotension may also be diagnosed if an individual has a sudden drop in blood pressure of 30 mmHg or more from their baseline, or more than 20 mmHg systolic or 10 mmHg diastolic blood pressure. In such cases, the blood pressure may remain higher than 90/60 mmHg, but the sudden drop may cause symptoms.

Orthostatic hypotension (also called postural hypotension) refers to a sudden decrease in blood pressure that occurs as an individual makes a sudden change in body position, usually from a lying to an upright position.

Hypotension can be caused by a number of conditions, including dehydration or electrolyte loss due to physical exertion, exposure to high/humid temperatures, sudden change from low to high temperatures, diarrhea, or vomiting; vasovagal syncope (blood vessels' response to stimulation of the vagus nerve); anaphylaxis (life-threatening allergic response); pregnancy; trauma; shock; stress; allergic reactions; anxiety; depression; or alcohol toxicity. Certain drugs can also contribute to hypotension, such as those used to treat high blood pressure (hypertension), drugs that cause a decrease in fluid volume in the body (hypovolemia), anesthesia, calcium channel blockers, diuretics, anti-arrhythmics, vasodilators, and drugs used to treat Parkinson's disease.

Hypovolemic shock should be considered in situations in which significant blood or fluid loss has occurred and/or may be continuing, including hemorrhage following trauma, diuresis secondary to hyperglycemia, or polyuria due to diabetes insipidus. Failure of cardiac contractility (cardiogenic shock) may occur as a manifestation of longstanding congestive heart failure or secondary to acute coronary ischemia. Chronic orthostatic hypotension may be caused by an underlying disease such as diabetes, Addison's disease, a buildup of fatty deposits on the arteries (atherosclerosis), multiple system atrophy, cardiovascular disease, alcoholism, and nutritional diseases.

Incidence and Prevalence: In the elderly population, approximately 10% to 20% have postural hypotension, and up to one-third experience postprandial (after meals) hypotension, which is a common cause of dizziness and falls after eating (Grayson).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Although hypotension affects men and women equally and can occur in individuals of any age, the incidence of hypotension and orthostatic hypotension increases with age. Excessive dieting may cause hypotension.

Source: Medical Disability Advisor



Diagnosis

History: Individuals may report lightheadedness; dizziness; fainting (syncope); unsteadiness; blurred vision; fatigue; recent illness, accident, or trauma; nausea; or loss of consciousness. Individuals should be asked to provide their normal blood pressure reading as a baseline for comparison.

Physical exam: Frequent monitoring of vital signs (blood pressure, pulse, rate of breathing, temperature) will be necessary. Blood pressure is measured with an instrument called a sphygmomanometer. Orthostatic hypotension is evaluated by measuring the individual's blood pressure and pulse rate while he or she is reclining and again after the individual swiftly moves to a standing position. Because the hypotensive response may be delayed, prolonged standing or a tilt test may be required to detect a delayed hypotensive response. In general, blood pressure that drops below 90/60 mmHg results in a diagnosis of hypotension. Other physical exam findings may include an abnormally low pulse rate and signs of dehydration in the mucous membranes.

Tests: Diagnostic tests that may be performed include blood tests (CBC to detect electrolyte imbalances, blood cultures), an electrocardiogram (ECG), urinalysis, and x-rays of the abdomen and chest.

Source: Medical Disability Advisor



Treatment

Chronic hypotension that is not caused by an underlying disease can often be treated with diet and lifestyle changes. Such changes may include following a diet higher in salt, drinking plenty of fluids (particularly while exercising, during hot weather or when sick with a viral illness), getting regular exercise to promote blood flow, stretching prior to moving from a reclining to a standing position, drinking caffeinated beverages, eating smaller, more frequent meals (in cases of postprandial hypotension), and avoiding prolonged exposure to hot water. If these measures do not alleviate the condition, medications such as steroids that promote fluid retention or drugs that cause constricting of the blood vessels may be prescribed.

Source: Medical Disability Advisor



Prognosis

The prognosis for individuals with hypotension depends on the underlying cause of the condition. Chronic low blood pressure is usually not serious. However, hypotension may be caused by more serious underlying conditions such as multiple system atrophy or by certain cancers, for which the prognosis is often less optimistic. Hypotension that occurs when an individual experiences shock (a condition in which the cardiovascular system is unable to provide adequate blood circulation to the body) is life-threatening.

Source: Medical Disability Advisor



Rehabilitation

Traditional rehabilitative therapy is not necessary. Individuals with hypotension should follow a diet with extra sodium, potassium, and fluids and should get regular exercise to promote blood flow.

Source: Medical Disability Advisor



Complications

The most common complications of hypotension are lightheadedness and dizziness, both of which can result in falls and/or injury. Extremely low blood pressure can result in shock.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals susceptible to hypotension should avoid lengthy exposure to heat, long periods of physical exertion, and heavy lifting. Individuals with orthostatic hypotension should have the opportunity to take short walking breaks throughout the day.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Is individual‘s blood pressure under 90/60?
  • What is individual's normal blood pressure?
  • Does individual have orthostatic hypotension?
  • Is individual dehydrated?
  • Does individual have vasovagal syncope? Anaphylaxis? Excessive dieting? Pregnancy? Trauma or shock? Stress, anxiety, or depression? Alcohol or drug toxicity?
  • Has individual had significant blood or fluid loss? Diuresis secondary to hyperglycemia or polyuria due to diabetes?
  • Does individual have longstanding congestive heart failure or acute coronary ischemia?
  • Does individual have Addison's disease, atherosclerosis, multiple system atrophy, alcoholism, or nutritional diseases?
  • Does individual report lightheadedness, dizziness, syncope, unsteadiness, blurred vision, fatigue, recent illness, accident, or trauma, nausea, or loss of consciousness?
  • Has individual had blood tests, urinalysis, ECG, and x-rays of the abdomen and chest?
  • Have conditions with similar symptoms been ruled out?

Regarding treatment:

  • Has individual made diet and lifestyle changes, including following a diet higher in salt; drinking plenty of fluids; getting regular exercise to promote blood flow; stretching prior to moving from a reclining to a standing position; drinking caffeinated beverages; eating smaller, more frequent meals; and avoiding prolonged exposure to hot water?
  • Was it necessary to use medications such as steroids to promote fluid retention or drugs that cause constriction of the blood vessels?

Regarding prognosis:

  • What is the underlying cause for individual's hypotension?
  • Does individual have any conditions that may affect ability to recover?
  • Does individual have any complications such as falls, injury, or shock?

Source: Medical Disability Advisor



References

Cited

Grayson, Charlotte E. "What is Low Blood Pressure?" Hunterdon Healthcare System. Aug. 2002. WebMD, LLC. 8 Oct. 2004 <http://www.hunterdonhealthcare.org/webmd/topics/low_blood_pressure/basics.asp>.

Source: Medical Disability Advisor






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