Vertigo is a sensation that makes the patient feel that the surrounding environment is spinning or moving, resulting in dizziness and poor balance.
In this article:
- Overview
- Nursing Process
- Nursing Care Plans
- Deficient Knowledge
- Risk for Falls
- Risk For Ineffective Cerebral Tissue Perfusion
- Risk for Injury
Overview
Vertigo 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
Once the nurse identifies nursing diagnoses for vertigo, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for vertigo.
Acute Confusion
Depending on the underlying cause, vertigo may be accompanied by other neurological symptoms, including blurred vision, headaches, and acute confusion.
Nursing Diagnosis: Acute Confusion
Related to:
- Disease process
- Sensory deprivation
- Infection
- Dehydration
- Shock
- Medication misuse
- Substance abuse
- Compromised cerebral blood flow
As evidenced by:
- Cognitive dysfunction
- Altered level of consciousness
- Memory loss
- Inability to initiate purposeful behavior
Expected outcomes:
- Patient will display restoration of neurological functioning to baseline.
- Patient will demonstrate the ability to follow commands and appropriate motor behavior.
Assessment:
1. Obtain an accurate history and physical.
Obtaining an accurate history and physical can identify various underlying health conditions that contribute to vertigo and confusion and is essential in planning an appropriate treatment regimen.
2. Review the patient’s medications.
The side effects of medications may contribute to symptoms of vertigo and confusion, such as opioids, sedatives, benzodiazepines, antidepressants, and more. Older adults are especially at risk.
3. Consider the use of illegal substances.
Excessive alcohol use or illegal substances may contribute to symptoms of vertigo and confusion, among other CNS symptoms like dilated pupils, lethargy, and changes in mood and behavior. The nurse may consider a toxicology screen if illegal substances are suspected.
Interventions:
1. Continuously monitor the patient’s behavior and cognition.
A patient experiencing vertigo who develops additional neurological symptoms like confusion, vision changes, a headache, or gait changes may indicate a developing complication and must be addressed promptly.
2. Maintain safety.
The patient who is confused and dizzy is at a very high risk for falls and injuries. The nurse should ensure their safety by utilizing a bed alarm, keeping the bed locked and in a low position, and keeping personal items within reach.
3. Reduce unnecessary environmental stimuli.
Excessive and loud environmental stimuli can overwhelm a patient experiencing confusion. Reducing environmental stimuli promotes rest, reduces anxiety, and improves vertigo symptoms.
4. Take caution with medication administration.
Common medications used to treat vertigo/dizziness, such as meclizine, may cause side effects of confusion or drowsiness in older adults.
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.
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 yet occurred. Nursing interventions are aimed at prevention.
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 Ineffective Cerebral Tissue Perfusion
In some instances, vertigo may be related to strokes, tumors, or blood vessel abnormalities, causing inadequate cerebral perfusion.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Disease process
- Stroke/TIA
- Cardiomyopathies
- Arrythmias
- Brain injuries
- Blood vessel disease
- Brain tumors
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Neurological exam will display findings within normal limits.
- Patient will maintain equal bilateral motor strength.
Assessment:
1. Assess for symptoms of decreased cerebral tissue perfusion.
Along with vertigo, other symptoms associated with decreased cerebral tissue perfusion include slurred speech, sudden weakness, numbness, loss of balance, loss of vision, a severe headache, and confusion.
2. Review diagnostic and imaging test results.
Diagnostic tests like CT scans or MRIs may be indicated to help confirm or rule out causes of central vertigo like stroke or brain tumors.
3. Assess and monitor the patient’s vital signs.
Cardiac conditions may precipitate ineffective cerebral tissue perfusion. Monitoring the patient’s vital signs, especially blood pressure and heart rate, is essential in the management of vertigo and the prevention of cerebral tissue perfusion complications.
Interventions:
1. Perform frequent neurological exams.
The patient presenting with vertigo should be assessed frequently for other alterations of the central nervous system, such as altered mental status, speech changes, and muscle weakness.
2. Refer the patient to appropriate specialists.
Patients who are complaining of vertigo and other neurologic symptoms associated with decreased cerebral tissue perfusion can benefit from having a neurology consult. If cardiac complications are identified, refer to a cardiologist.
3. Reduce activities that can trigger increased intracranial pressure.
Activities like vomiting, coughing, and suctioning must be minimized as these can trigger an increase in intracranial pressure, which can further aggravate cerebral tissue perfusion and worsen vertigo.
4. Discuss surgical options.
In rare cases, if a brain tumor is causing vertigo and disrupting cerebral perfusion, surgery may be required.
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 yet occurred. Nursing interventions are aimed at prevention.
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.
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
