Vertigo is a sensation that makes the patient feel that the surrounding environment is spinning or moving, resulting in dizziness and poor balance.
This condition is often caused by a problem with the inner ear but may also occur due to infections or tumors in the brain. Typical causes include:
- Benign paroxysmal positional vertigo (BPPV) (the most common cause)
- Meniere’s disease
- Labyrinthitis or vestibular neuritis
- Brain injuries
- Stroke
- Migraine headaches
- Multiple sclerosis
Clinical manifestations of vertigo are often triggered by a change in the position of the head and result in:
- Nausea and vomiting
- Loss of balance
- Tinnitus
- Motion sickness
- Ear fullness
- Dizziness
Romberg’s test, Fukuda-Unterberger’s test, and head impulse test are evaluations that the provider can perform quickly without equipment to assess for vertigo. CT scans and MRIs can assess for underlying conditions like tumors or a stroke.
Nursing Process
Managing vertigo will depend on various factors, including the root cause but may include vestibular rehabilitation, drug therapy, or surgery. Nursing care priorities for patients with vertigo include improving visual disturbances with head movement, decreasing the risk of falls, improving balance and dizziness, and providing accurate information about the condition and its treatment options.
Nursing Care Plans Related to Vertigo
Risk for Falls
Vertigo is described as a spinning sensation that makes the patient feel off balance, increasing the patient’s risk of falling.
Nursing Diagnosis: Risk for Falls
Related to:
- Multiple sclerosis
- Dizziness
- Migraines
- Impaired balance
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.
Expected outcomes:
- Patient will verbalize understanding of the condition and its safety issues.
- Patient will demonstrate interventions that reduce the risk of falls.
Assessment:
1. Assess the patient’s history of dizziness and vertigo.
Accurate patient history can help determine risk factors and an appropriate plan of care for patients with vertigo.
2. Assess the patient’s ability to ambulate safely.
Determining the patient’s functional abilities can help plan ways to improve and manage vertigo while reducing the risk of falls.
3. Assess the results of the diagnostic audiometry tests.
Audiometry tests can help assess the ability to hear tones and pitch, as a loss of hearing is common with vertigo. Tympanometry tests the middle ear for fullness, as this is a common complaint of patients with vertigo.
4. Perform Romberg’s test.
This neurological test examines balance. The nurse instructs the patient to stand with the feet slightly apart, and the arms either by the sides or crossed over the chest. If the patient sways to the point of losing balance or moving the feet, this is a positive result.
Interventions:
1. Use extra time to stand.
Encourage the patient to move and stand slowly to allow their equilibrium to adjust.
2. Sit down during a vertigo attack.
If spinning or dizziness occurs, sit down to prevent losing balance and falling.
3. Squat to pick something up.
Bending over at the hip with the head down can trigger vertigo. Instruct the patient to squat instead of bending over when picking something up.
4. Encourage the use of ambulation devices.
The patient may need to use a walker or wheelchair if vertigo occurs suddenly or frequently to support their balance.
Risk for Injury
Vertigo can cause disorientation and issues with balance and mobility, increasing the risk of injuries.
Nursing Diagnosis: Risk for Injury
Related to:
- Dizziness
- Loss of balance
- Fluid in the middle ear
- Inflammation of the vestibular nerve
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms.
Expected outcomes:
- Patient will remain free from any signs of injury.
- Patient will explain and demonstrate interventions to prevent or relieve vertigo.
Assessment:
1. Assess the patient’s self-care abilities.
Patients with vertigo who have difficulty dressing, bathing, or other ADLs may be more prone to injuries when vertigo occurs.
2. Assess the patient’s medical history.
Determining vertigo triggers and causes can help plan appropriate care, determine preventive measures, and promote interventions related to the underlying cause.
Interventions:
1. Provide a safe environment.
Safety measures like side rails and removing hazardous items around the patient can help decrease the risk of injuries in patients with vertigo. Patients with frequent vertigo may not want to navigate stairs without assistance.
2. Provide assistive devices.
Preventing injuries in the home related to vertigo can be accomplished by using shower benches so the patient can sit, using a bedside commode to limit walking to the bathroom at night, and placing rails near stairways.
3. Encourage family members to support and closely supervise patients with vertigo.
Close supervision is vital for patients with vertigo, especially the elderly, to ensure safety and reduce the risk of injuries.
4. Encourage vestibular rehabilitation exercises.
These include exercises of the eyes, head, and positioning. Ensure the patient is in a safe area, such as a supported chair, before attempting exercises.
Deficient Knowledge
Patient education is essential for patients experiencing vertigo to promote adherence to the treatment regimen and prevent injuries.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Inadequate information
- Inadequate interest in learning
- Inadequate participation in care planning
- Misinterpretation of causes of vertigo
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about vertigo
- Nonadherence to rehabilitative exercises
Expected outcomes:
- Patient will verbalize understanding of the causes of vertigo and treatment options.
- Patient will demonstrate measures to help manage vertigo and its related symptoms.
Assessment:
1. Assess the patient’s knowledge about vertigo and its treatment options.
Understanding the learning needs of the patient can help determine additional information to help the patient manage their vertigo.
2. Assess the patient’s willingness to learn.
The patient’s motivation and willingness to learn can affect their adherence to the treatment regimen and utilization of treatment options.
3. Assess the patient’s health literacy.
Health literacy is closely related to healthcare decision-making. Understanding the patient’s health literacy can help with the appropriate planning of health education and treatment.
Interventions:
1. Educate on canalith repositioning procedures for BPPV.
BPPV is triggered by changes in head position. Specialists can perform maneuvers of the head and neck to reduce dizziness.
2. Educate the patient about the medications for vertigo.
Medications for vertigo include antihistamines and anticholinergics, as they can relieve vertigo, lightheadedness, nausea, and dizziness.
3. Advise the patient to avoid stressful situations.
Vertigo can be triggered by stress. Anxiety can make the associated symptoms of vertigo worse.
4. Educate on surgical options.
Surgical options include draining fluid in the inner ear, removing the part of the ear causing vertigo (which will also cause complete hearing loss), and cutting the vestibular nerve.
References
- ACCN Essentials of Critical Care Nursing. 3rd Edition. Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP. 2014. McGraw Hill Education.
- Benign paroxysmal positional vertigo (BPPV). Mayo Clinic. Reviewed: August 5, 2022. From: https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055
- Vertigo. Cleveland Clinic. Reviewed: September 9, 2021. From: https://my.clevelandclinic.org/health/diseases/21769-vertigo
- Vertigo. NHS inform. Updated: November 28, 2022. From: https://www.nhsinform.scot/illnesses-and-conditions/ears-nose-and-throat/vertigo
