NURS 3046 Nursing Project
Question:
Document a symptom-focused history for ear assessment involving dizziness/vertigo. Also, include how you would perform the physical assessment and what treatment you would prescribe.
Answer:
Symptom focused history assessment for dizziness/Vertigo
Vertigo is associated with different signs and symptoms that the physician should look out for. The most notable symptoms that should be assessed include spinning, tilting, swaying, unbalanced and pulled to one direction. Besides, this common symptoms that the physician should dwell on, the other minor symptoms include nausea, vomiting, nystagmus, headache, sweating and finally ringing in the ears or hearing impairments(R, 2018). During the history symptom focused assessment, the doctor or nurse should look out for the above mentioned symptoms.
Physical assessment of vertigo/dizziness
There are different physical assessments that can be carried out to diagnose vertigo. One of the assessment includes the measuring blood pressure while the patient is in a supine position and one minute after the patient stands. A 20mm Hg and 10 mm Hg decrease in systolic and diastolic pressure and an increase in pulse of 30 beats per minute implies orthostatic hypotension.
The Dix-Hall pike maneuver is another important physical assessment for vertigo. It is usually performed on a flat table while the patient is seated (Duderstadt, 2014). The doctor then turns the head of the patient at 45 degrees on one side and immediately turns the patient in a supine position while the head hangs at 20 degrees at the end of the table (Marioni, 2015). The doctor then examines the patient’s eyes for around 30 seconds. The procedure is repeated but this time with the head turned in the opposite direction.
A picture illustrating the Dix-Hall pike maneuver technique (Marioni, 2015)
Romberg test is another physical examination of vertigo. This test is carried out together with observation of the gait. The Romberg test usually check the sense of the body’s positioning. If the patient is fond of swaying on one side, then that indicates vestibular dysfunction especially in the ipsilateral side (Kahraman, Yildirim, Tugrul, & Ozturan, 2016). Observation of the gait is also important and in patients with the condition, the gait is usually slow, wide based and irregular. It also leans towards the vestibular lesion.
Treatment that would be prescribed for dizziness/vertigo
There are different options in treatment of vertigo. The choice of the treatment method usually depend with the cause of the condition. Vestibular rehabilitation is one of the methods of treatment. It is a physical therapy that strengthens the vestibular system so that it is able to send signals to the brain on the movement of the head and the body. Surgery is also a mode of treatment for vertigo. This is used if the condition is caused by serious underlying factors such as tumors or injury to the neck and brain. I would also prescribe different drugs to treat vertigo. Drugs are mostly used if the condition is as a result of infection or inflammation (Hilton & Pinder, 2014). Different antibiotics and steroids can be prescribed to reduce swelling and then cure infections. Diuretics can also be prescribed in the case of the Meniere’s disease to reduce pressure from the buildup of fluids. The final treatment plan that I would recommend is the canalith repositioning maneuvers that can be done to move calcium deposits out of the canal to inner ear so that they can be effectively absorbed into the body.
References
Duderstadt, K. G. (2014). Pediatric Physical Examination: An illustrated handbook (2nd Ed.). st. Louis, MO: Mosby.
Hilton, M. P., & Pinder, D. K. (2014). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003162.pub3
Kahraman, S. S., Yildirim, Y. S., Tugrul, S., & Ozturan, O. (2016). Repositioning intervals in the modified Epley’s maneuver and their effect on benign paroxysmal positional vertigo treatment outcome. Acta Oto-Laryngologica, 137(5), 490-494. doi:10.1080/00016489.2016.1252852
Marioni, G. (2015). Balance Function Assessment and Management. Hearing, Balance and Communication, 13(4), 178-178. doi:10.3109/21695717.2015.1076978
R, D. Y. (2018). Effectiveness of Epley’s Manoeuvre in Benign Paroxysmal Positional Vertigo- A Prospective Study. Journal of Medical Science And clinical Research, 6(3). doi:10.18535/jmscr/v6i3.134
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