Dizziness usually covers neurophysiological sensations and feelings of lightheadedness and loss of balance. The condition known as vertigo, in which a person has a false perception that their surroundings are moving or spinning, is frequently interrelated with dizziness in terms of disease concepts.
However, they may vary in etiological factors, presentation, and treatment approach.
Signs and Symptoms of Dizziness
- vertigo
- lightheadedness
- unsteadiness
- impaired stance
- gait instability
- movement-induced dizziness
- imbalance
- hearing loss
Causes of Dizziness
- Ear problems. Conditions affecting the ear may cause dizziness. These include:
- Meniere’s disease (MD). Involves endolymphatic fluid accumulation in the ear, causing intense and sudden vertigo attacks. Symptoms include a ringing sound in the inner ear (tinnitus), acute deafness, and aural fullness.
- Benign paroxysmal positional vertigo (BPPV). Involves intense and recurrent episodes of vertigo due to calcium displacement in the semicircular canal. It is triggered by head movement and position changes, such as turning, tilting, looking up, or bending over.
- Infection. Vestibular neuronitis involves nerve inflammation in the vestibular system that manifests as intense vertigo. Another disorder causing dizziness is labyrinthitis, an inflammation of the vestibular and cochlear nerve.
- Migraine. Migraine-related vertigo can present with a combination of symptoms, including moderate or severe headaches on one side, phonophobia, and impaired stance.
- Circulatory causes of dizziness
- Hypotension. Postural hypotension is the most prevalent cause of vertigo and lightheadedness, occurring shortly after standing or sitting up. Blood pooling in the extremities, resulting in a drop in blood pressure, frequently causes this condition.
- Impaired blood circulation. Involves a decrease in blood volume causing dizziness. It is often associated with blood clots, anemia, myocardial infarction, heart failure, and transient ischemic attacks, which impairs the supply of oxygenated blood in the brain.
- Other causes of dizziness
- Dehydration and hypoglycemia. Decreases BP leading to a dizzy sensation.
- Medications. Medications such as antidepressants, antihypertensives, sedatives, and anticonvulsants can cause dizziness as a side effect.
- Neurodegenerative disorders. Parkinson’s disease can impair the release of norepinephrine (which acts as a vasoconstrictor to increase BP).
- Anxiety disorders. Hyperventilation can impair blood gas balance, resulting in vestibular symptoms.
Risks Factors to Dizziness
- Family history. Several predisposing factors for childhood and adult vertigo include labyrinthine malformation, familial vestibular areflexia, migraine history, and perilymph fistulas.
- Previous traumatic brain injury (TBI). Patient history of TBI typically causes loss of balance and dizzy sensation in the recovery phase. The risk of injury and falls due to neuromotor and cognitive deficits contributes to prolonged recovery.
- Vitamin D deficiency. Considered a risk factor for the development of BPPV.
- Recurrent otitis media. Increased upper way resistance, allergies, and recurrent ear infections have been associated with the prevalence of vestibular symptoms.
- Bone malformation. Defects in the bone architecture of the labyrinth channels of the inner ear can transmit pressure and trigger sound disturbances, thereby significantly increasing the risk of vestibular symptoms.
- Gender. Women are more susceptible to the development of BPPV since estrogen directly affects the level of serum vitamin D. They are also more prone to migraines than men and are more likely to develop Cogan’s syndrome, which is characterized by vestibular deficits and audiological symptoms.
- Age. The onset and prevalence of dizziness have been associated with increasing age. Older adults are more prone to BP fluctuations due to a decline in pumping action of the circulatory system. Degeneration of the cervical disc can lead to dizziness due to sensory mismatches and increased muscle sensitivity.
- Alcoholism. Alcohol abuse can alter the equilibrium of fluid volume in the ear due to its absorption and illusory or dehydrating effect.
Complications of Dizziness
- Increased risk of injury. Dizziness can make regular activities, such as ambulation and self-care, difficult to perform. Indications of activity intolerance can prompt the implementation of safety measures to safeguard the patient’s safety.
- Increased risk of falls. The presence of vertigo can interfere with postural balance, muscle control, and navigation abilities. The tendency to sway and fall to one side can result in serious harm, including pain and even bleeding.
Diagnosis of Dizziness
- Clinical analysis of eye gaze and movement. The attending physician examines the eyes for misalignment, fixation difficulties, and nystagmus (e.g., gaze-evoked nystagmus, spontaneous peripheral vestibular nystagmus). The evaluation of axial misalignment and range of eye movements is aided by the use of a fixation object or flashlight.
- Water caloric test. Water is irrigated in the ear canal to evaluate vertigo. The absence of eye movement reflects vestibular dysfunction.
- Posturography. Allows the examiner to assess and quantify balance and postural control. It involves a moving boxlike platform to measure postural sway.
- Head movement testing. This procedure (also known as the Dix-Hallpike maneuver) is typically performed to identify the presence of BPPV. The patient suspected of vertigo may be asked to move and tilt their head to one side, about forty-five degrees, before being assisted to a supine position with the head slightly hanging over the edge of the examination table. The movement of loosened crystals in the semicircular canals as a result of this procedure can cause vertigo symptoms and thus affect eye motion. If there are absent signs and symptoms of vertigo, other tests may be used to identify the potential cause of dizziness.
- Rotary chair testing. This test evaluates the function of the peripheral vestibular system and identifies loss of balance by having the patient sit in a rotational or computer-controlled chair.
- Imaging tests. These involve the use of computed tomography or cranial magnetic resonance imaging to clarify the potential cause of dizziness, such as ischemia, neurodegenerative diseases, inflammation, and the presence of a tumor.
Treatment of Dizziness
Dizziness usually subsides on its own (self-limiting) and may take a couple of weeks to resolve, depending on its underlying cause.
- Diuretics. Patients with MD are often prescribed diuretics to minimize recurrent vertigo episodes and stabilize hearing. It also prevents attacks from precipitating by reducing the pressure and volume caused by fluid accumulation in the cochlea.
- Drug therapy. Drugs that alleviate nausea, motion sickness, and dizziness include anticholinergics, antiemetics, and antihistamines; however, they do not directly treat the probable cause of dizziness. Anti-vertigo medications may also relieve individual attacks, whereas migraine drugs and analgesics can manage migraine-related dizziness. Anti-anxiety drugs alleviate vestibular symptoms resulting from panic or anxiety disorders. It should be noted, however, that these medications are intended solely for the symptomatic treatment of vertigo and are not recommended for long-term use as they may produce drowsiness and impede central compensation, which can lead to addiction. Other medications, such as antidepressants, can induce dizziness as a side effect.
- Therapy
- Balance training. Helps improve central vestibular dysfunction and sensitivity to motion. It entails various exercises targeting the somatosensory, vestibular, and oculomotor systems and is used as a treatment for patients suffering from conditions (e.g., vestibular neuritis) causing dizziness.
- Psychotherapy. This intervention includes behavioral therapy, which aims to alleviate anxiety disorders and improve vertiginous sensations. Cognitive behavioral therapy has also been suggested for the treatment of mental disorders and their related symptoms, such as vertigo, migraines, and tinnitus.
- Surgery
- Injections. Administration of antibiotics is usually indicated for ear infections that impair balance function.
- Labyrinthectomy. An invasive procedure for the correction of vertigo. This is typically reserved for patients with no serviceable or dysfunctional hearing and is considered only as a last resort treatment. Surgery is performed with the patient under general anesthesia and is monitored using a facial nerve monitor to ensure patient safety.
Nursing Diagnosis for Dizziness
Nursing Care Plan for Dizziness 1
Nursing Diagnosis: Risk for Falls related to dizziness secondary to multiple sclerosis.
Desired Outcome: The patient will effectively implement safety precautions and will not sustain an injury or fall.
| Nursing Intervention for Dizziness | Rationale |
| Assess the patient’s medical history for vertigo, dizziness, neurodegenerative disorders, drug therapy, and sensory impairments. | This assessment helps to identify functional disorders causing dizziness. Proper treatment, care, and fall precautions are all necessary for patient safety; therefore, a thorough history is required to establish which interventions are essential. For instance, patients with BPPV are advised to avoid sudden movements and postural changes since these actions can cause dizziness, affecting balance and coordination. |
| Provide the patient with a medical alert wristband containing information about the patient’s fall risk | This intervention adds insurance to prevent injury resulting from falls. Moreover, it notifies healthcare providers about the patient’s risk for falls if they have communication deficiencies. |
| Ensure the patient’s environment is clutter-free and safe. Equip the bed rails with protective covers or cushioning to prevent damage from accidental hitting or bumping. | Reduces the likelihood of falls, trauma, or injury |
| Provide a call light within easy reach of the patient. Encourage him or her to seek immediate assistance. | The patient’s ability to navigate his or her environment may be impaired by disorientation and dizziness. This is particularly important for elderly individuals who may need to void or urinate during the night. This intervention also provides the patient with the ability to seek assistance. |
| Ensure the patient is receiving adequate bed rest. | Provides relief from vestibular vertigo |
| Adjust the patient’s bed to its lowest height and maintain it adjacent to the floor. | This is a standard fall precaution measure that ensures patient safety and protects them from suffering from injury or trauma from fall accidents. |
| Refrain from using restraints. | Although these restrictive interventions may provide temporary patient and staff protection, they limit the patient’s mobility and autonomy. It is only recommended in emergency cases where the patient poses a danger to themselves or others. |
Nursing Care Plan for Dizziness 2
Nursing Diagnosis: Risk for Injury related to dizziness secondary to benign paroxysmal positional vertigo (BPPV).
Desired Outcome: The patient will effectively identify the factors that enhance their risk of harm and take safety precautions to remain free of injury.
| Nursing Intervention for Dizziness | Rationale |
| Assess the patient’s cognitive awareness. | Evaluate the patient’s capacity to control action and to comprehend and execute complex processes. The underestimation of cognitive abilities might result in unfavorable patient outcomes and severe health issues. Patients suffering from disorientation, dizziness, perception of spinning motion, and confusion due to BPPV or as a side effect of medications may be prone to falls or injury and impair their judgment. |
| Assess for ambulation difficulties and impairment in sensory perception. | Dizziness and loss of muscle coordination and balance secondary to BPPV can affect the patient’s ability to maneuver and respond to environmental stimuli. These functional losses must be accounted for in order to guarantee patient safety. |
| Assess lifestyle factors contributing to BPPV. | A sedentary lifestyle or a lack of physical activity can be a pathogenic factor in the development of the condition. This may also be associated with vitamin D insufficiency, as the patient may choose to remain indoors rather than participate in outdoor activities. As BPPV poses a risk for accidents, the patient’s surroundings and working conditions may also become hazardous. |
| Assist the patient in navigating their immediate environment. Instill a medical alert system or call light within easy reach. | Prevents accidents and helps the patients navigate their surroundings, which may pose a physical or mechanical hazard. |
| Provide safety beds and a structured environment. | Patient safety is a priority, and with symptoms of dizziness, it is typical that eliminating any potential hazards is a preventative option. Enclosure beds offer a layer of security to prevent falls in the event of an attack. A consistent environment helps the patient measure the distance and rate of movement required. |
| Understand and validate negative feelings and concerns about environmental risks. | Validation promotes positive feelings and enables the patient to ask for help without fear. It conveys assurance that the patient’s concerns are heard and acknowledged and enables the healthcare provider to develop an individualized care plan suited according to the patient’s needs and concerns. |
Nursing Care Plan for Dizziness 3
Impaired Adjustment
Nursing Diagnosis: Impaired Adjustment related to dizziness secondary to Meniere’s disease, as evidenced by tinnitus, nausea, diaphoresis, and recurrent episodes of vertigo.
Desired Outcome: The patient will demonstrate a change in behavior as evidenced by a readiness to adapt their lifestyle to their current health situation.
| Nursing Intervention for Dizziness | Rationale |
| Assess the patient’s hearing ability and vestibular function | Provides information about the extent of hearing loss and vestibular deficit, which could lead to severe vertigo. This intervention also allows the healthcare provider to delineate the limitations of the present illness and recognizes the need for activity modifications with altered body orientation. |
| Ensure the care environment is free from clutter, noises, hazards, stimulation, and stress on the importance of bed rest. | Patients with MD tend to experience the illusionary effect of rotational movement in their surroundings (true vertigo). Any safety issues in the care environment can be a potential cause of injury and falls. |
| Stay and provide care to the patient during vertigo attacks. | During an attack, the ability to stand and walk is impacted. The patient may also be unable to refocus their attention, thus needing constant reassurance that the vertigo episode will pass. Loss of balance and fainting sensations can contribute to anxiety, affecting normal processes (e.g., adherence to treatment, sleep). The nurse must remain calm and composed when responding to the patient’s anxiety during this event |
| Explain the nature of the illness, its implications, and treatment. | The illness and its clinical presentation can cause profound stress and anxiety to the patient. These problems may affect their adaptation to the situation and interrupt successful coping. |
| Discuss the significance of avoiding stimulants such as caffeine. | Stimulants increase the likelihood of sleep disturbance and frequent night awakenings. It also results in increased sensitivity and anxiety, affecting their interest in participating in care activities. |
| Provide information and instructions on self-care to minimize vertigo attacks (e.g., sleeping with head propped against a pillow, avoiding sudden movements, taking medications, changing dietary intake). Ensure that the patient is receiving sufficient emotional support from his or her support network. | Maladaptive responses to the change in health status can be alleviated with the help of patient education and a strong support system. |
Nursing Care Plan for Dizziness 4
Risk for Activity Intolerance
Nursing Diagnosis: Risk for Activity Intolerance related to dizziness secondary to prolonged bed rest.
Desired Outcome: The patient will demonstrate improved muscle strength and the ability to perform a range of motion exercises with a normal systolic blood pressure and a rate of perceived exertion of less than three out of three.
| Nursing Intervention for Dizziness | Rationale |
| Assess the patient’s tolerance to activity by noting any physiologic changes | A decrease in cardiac output can be indicative of circulatory failure and may result in dyspnea, ineffective perfusion, and hypotension. Severe physiologic changes and the inability of the body to meet oxygen and cardiac output demands can cause changes in mentation and dizziness, rendering the patient unable to perform functional tasks. |
| Observe the presence of orthostatic hypotension. | Dizziness, tachycardia, lightheadedness, pallor, and general fatigue during ambulation and exercises are clinical indicators of orthostatic hypotension. This often occurs when the compensatory mechanisms are weakened or when the blood volume is reduced. |
| Avoid isometric exercises if the patient has a preexisting cardiovascular condition or a family history of cardiovascular disease. Encourage them to perform range of motion or ROM exercises instead. | Although isometric exercises promote venous return, these can also increase systemic arterial BP in cardiac patients. Meanwhile, ROM exercises can increase the patient’s tolerance to activity and prevent muscle atrophy by building muscle strength and endurance. |
| Monitor for activity intolerance and discontinue the activity immediately if the patient presents with the following signs and symptoms: dyspnea, dizziness, muscular pain, syncope, and headaches. Notify the handling physician and refer the patient to a physical therapist. | These are signs of overexertion, which could signal decreased tissue oxygenation. Certain exercises should be used with caution to avoid injury to the joint. |
| Encourage the patient to initially perform passive exercises. Initiate activity using motions of flexion and extension about four times a day and targeted abduction and adduction exercises. Incorporate active-assistive exercises and provide resistance if the patient is able to. | Allows the patient to achieve gradual tolerance to activity. |
Nursing Care Plan for Dizziness 5
Impaired Transfer Ability
Nursing Diagnosis: Impaired Transfer Ability related to dizziness secondary to orthostatic hypotension, as evidenced by headache, loss of balance, nausea, vomiting, and hearing loss.
Desired Outcome: The patient will demonstrate the ability to perform tasks and use safety measures to prevent injury.
| Nursing Intervention for Dizziness | Rationale |
| Assess the patient’s gross motor function using a 0-4 scale (i.e., functional level classification). | Identifies unstable baseline. |
| Instill environmental safety measures and protections such as raising padded side rails, keeping the bed in a lowered position, and clearing the area around the patient’s bed. | Reduces the likelihood of accidents, falls, and injuries. Patients with vertigo typically have trouble walking, navigating, coordinating movement, and keeping balance; hence, the patient’s care environment must be adapted to his or her deficiencies and rehabilitation requirements. |
| Ensure that the patient can perform the activities according to his or her restrictions and pacing. | The patient may suffer from extreme stress and pressure in a fast-paced care setting that necessitates multitasking and prompt responses, but it also makes them susceptible to injury. Aggressive interventions should be avoided as these can precipitate dizziness. |
| Advise the patient to move slowly during ambulation, feeding, repositioning, conducting activities, and exercise. | Spontaneous movements can precipitate and trigger dizziness. This intervention also prevents postural hypotension, impaired bowel movements, and injury. |
| Encourage the patient to request assistance when necessary and install a bedside communication system (e.g., call light, tap bell) | Patients experiencing dizziness tend to have mental and motor function deficits. They cannot be expected to perform heavy or difficult tasks without assistance since it could compromise the patient’s safety. This intervention also allows the patient to feel a sense of control over their situation and reduces the fear of isolation. |
| Administer anti-vertigo medications as ordered. | This medication is used as a countermeasure against dizziness. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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