Vertigo is a spinning or moving sensation that is often confused with dizziness. Most patients have described vertigo as dizziness or nausea, but it is not the same as experiencing simple lightheadedness.
The symptoms will most likely vary depending on what is causing the occurrences and the type of vertigo that the patient has.
This sensation of vertigo can be mild or severe, making it difficult for patients to maintain their balance and perform daily tasks.
Vertigo attacks can occur instantaneously and may last for only a few minutes, while sometimes they can last much longer. When a person suffers from severe vertigo, their symptoms may be persistent and continue for several days, which can make doing activities of daily living (ADLs) extremely difficult.
Types of Vertigo
- Peripheral Vertigo. Peripheral vertigo happens due to a problem in the component of the inner ear that maintains balance. These areas of the ear that are affected during episodes of peripheral vertigo are the vestibular labyrinth or semicircular canals. Peripheral vertigo can also affect the vestibular nerve, which connects the inner ear to the brain stem.
- Benign paroxysmal positional vertigo (BPPV). BPPV is the most prevalent type of peripheral vertigo, in which specific head movements trigger the condition.
- Labyrinthitis. Labyrinthitis induces dizziness or the perception that the environment is moving when it is not. An infection in the ear causes this type of vertigo. Thus, it frequently coincides with other symptoms, including fever and earache.
- Vestibular neuronitis. Vestibular neuritis is another name for vestibular neuronitis. This type of vertigo appears suddenly and can cause dizziness, ear infection, vomiting, and nausea.
- Meniere’s disease. Meniere’s disease causes vertigo that can last a maximum of 24 hours. This type of peripheral vertigo is frequently severe enough to cause vomiting and nausea.
- Central Vertigo. Central vertigo is a medical condition in which a person experiences hallucinations of movement in their surroundings or sensory perception of spinning while remaining still due to vestibular structure dysfunction in the central nervous system (CNS). Central vertigo is also caused by neurological dysfunction, most commonly in the brain stem or the back of the brain (cerebellum).
Symptoms of Vertigo
Dizziness is one of the most prevalent symptoms of vertigo, and it usually becomes exacerbated due to extreme head motion. Patients usually describe it as a spinning sensory perception, with the room or things around them appearing to move. Other vertigo symptoms include:
- migraine
- increased perspiration
- nausea
- uncontrollable eye movements
- loss of equilibrium
- vomiting
- the ears are vibrating or buzzing
- loss of hearing
Causes of Vertigo
- Causes of Peripheral Vertigo
- Benign positional vertigo
- Vestibular nerve inflammation (neuronitis)
- Inner ear irritation and swelling (labyrinthitis)
- Pressure on the vestibular nerve, typically caused by a benign tumor such as a meningioma or schwannoma
- Certain medications that are toxic to the inner ear structures, such as aminoglycoside antibiotics, antineoplastics, or diuretics.
- Head trauma or injury
- Meniere’s syndrome
- Causes of Central Vertigo
- Blood vessel disorders
- Certain medications, including anticonvulsants, some NSAIDs, and alcohol
- Multiple sclerosis (MS)
- Seizures (rarely)
- Stroke
- Cancerous and noncancerous tumors
- A type of migraine headache known as vestibular migraine
Less common causes of vertigo include the following:
- Stroke. A blood clot or bleeding in the brain, also known as a stroke, can cause vertigo symptoms.
- Migraine. Around 40% of patients with severe migraine experience dizziness or loss of balance at some point.
- Diabetes. Diabetes complications can sometimes cause artery hardening and decreased blood supply to the brain, resulting in vertigo symptoms.
- Pregnancy. Dizziness and vertigo can occur during pregnancy due to hormonal changes, low blood glucose levels, pressure on coronary arteries caused by an expanding uterus, or the baby pressing on a vein carrying blood to the heart.
- Anxiety Disorder. Anxiety and panic attacks can both cause vertigo manifestations. Stress can aggravate the condition as well.
- Brain tumor. A tumor can cause vertigo symptoms in the cerebellum, a brain region.
- Allergies. When exposed to allergens such as dust, molds, pollens, dander, or foods, some people experience dizziness or vertigo attacks.
- Medications. Several medicines can cause dizziness and vertigo as side effects. Common culprits include anti-seizure medications, antidepressants, sedatives, blood pressure medications, and tranquilizers.
Risk Factors to Vertigo
Vertigo symptoms can affect anyone, but several risk factors may increase the chances. These are some examples:
- Age. Vertigo is more common in people over the age of 50.
- Gender. Females are more likely to experience vertigo.
- Sustaining a head injury
- Taking certain medications, particularly antidepressants or antipsychotics
- Having a medical condition that interferes with balance or affects the ears.
- Past medical history of vertigo
- Family history of vertigo
- Infection of the inner ear
- Extreme or high level of stress
- Excessive alcohol consumption
Complications of Vertigo
Vertigo increases the likelihood of falling and injuring oneself. Driving a car or operating heavy machinery with vertigo can increase the likelihood of an accident. Patients may also suffer long-term consequences if an existing medical condition causing their vertigo is not treated.
Other conditions that patients may experience if vertigo is left untreated:
- Autoimmune inner ear disease. An autoimmune reaction occurs when the body’s immune system attacks itself. When the attack is directed at the inner ear system, the condition is known as Autoimmune Inner Ear Disease. In many cases, this can result in vestibular damage and symptoms similar to other vestibular disorders. Thus, vertigo might be a sign of inner ear disorders.
- Cholesteatoma. Cholesteatoma occurs when an abnormal tissue growth or skin cyst becomes stuck behind the eardrum. Some of the symptoms are hearing loss, ear infection, and vertigo.
- Enlarged vestibular aqueduct. Enlarged vestibular aqueduct (EVA) is a disorder characterized by an inner ear malformation that results in hearing and vestibular function loss. EVA is the most prevalent inner ear malformation connected with sensory loss of hearing, and it can be identified with a CT scan.
Diagnosis of Vertigo
- ENG (electronystagmography). Electronystagmography is a diagnostic test used to monitor involuntary eye movements caused by nystagmus. It can also be used to assess the vestibular system to determine the cause of vertigo, dizziness, or balance dysfunction.
- Fukuda-Unterberger’s test. The Fukuda Stepping Test is used to evaluate labyrinthine function using vestibulospinal reflexes.
- Romberg’s test. Romberg’s test, Romberg’s sign, or the Romberg maneuver, is a neurological function test for balance. It is also helpful in determining vertigo.
- Head impulse test. The head impulse test (HIT) is a practical bedside examination for detecting a peripheral vestibular deficit, such as in patients suffering from vestibular neuritis (VN). It is done by grasping the patient’s head and delivering concise, small-amplitude, high-acceleration head impulses to one side, then the other.
- Vestibular test battery. Various tests are conducted in a vestibular test battery to determine the efficiency of the vestibular portion of the patient’s inner ear system. If the patient has symptoms of dizziness, vertigo, or loss of balance, the doctor may recommend a vestibular test battery.
- Hearing and Balance Tests.
- Eye movement analysis. When the patient tracks a moving object, the doctor may observe the path of the eyes through this procedure.
- Head movement evaluation. If the doctor thinks the patient has benign paroxysmal positional vertigo, he or she may perform a simple head movement test known as the Dix-Hallpike maneuver to confirm the diagnosis.
- Posturography. This test informs the doctor about which aspects of the balance system the patient relies on the most and which may be causing them problems. The patient will stand on a platform with bare feet, attempting to maintain their balance under varying conditions.
- Rotary chair testing. This test involves sitting in a computer-controlled chair that moves slowly around a circle. At higher speeds, it begins to move in a tiny arc back and forth.
- Imaging Test. CT scans and MRIs can help rule out nervous system issues as a reason for vertigo.
Treatment for Vertigo
Medications
- Diuretics. The doctor may prescribe diuretics if the patient has Meniere’s disease. This medication and a low-salt diet may help reduce the frequency of dizziness episodes in the patient.
- Antihistamines and anticholinergic. The doctor may prescribe these medications to provide immediate relief from vertigo, dizziness, and nausea.
- Anxiolytics. Benzodiazepines can also help with vertigo management, primarily if it is caused by anxiety.
- Antimigraine medications. Certain medications may prevent migraines and vertigo.
Therapy
- Head position maneuvers. Canalith repositioning (or the Epley maneuver) usually helps manage benign paroxysmal positional vertigo faster than waiting for it to go away.
- Balance Therapy. This type of physical therapy is known as vestibular rehabilitation. It treats vertigo caused by inner ear conditions such as vestibular neuritis.
- Psychotherapy. This therapy may benefit people who experience vertigo due to anxiety disorders.
Injectable or Surgical Procedures
- Injections. To disable the balance function, the doctor may inject the aminoglycoside antibiotic into the inner ear. The unaffected ear takes over that function.
- Removal of an inner ear sense organ. Labyrinthectomy is a rarely performed procedure. The other ear takes over the balance function. This technique may be used if the patient has severe hearing loss and vertigo has not responded to other treatments.
Nursing Diagnosis for Vertigo
Nursing Care Plan for Vertigo 1
Nursing Diagnosis: Risk for Falls related to impaired balance, lightheadedness, and migraine headaches secondary to vertigo.
Desired Outcome: The patient will follow adequate safety precautions, avoid injury, and reduce the risk of falling.
| Nursing Interventions for Vertigo | Rationale |
| Examine the patient’s history of vertigo, dizziness, other neurological diseases, medication, and sensory impairments. | This evaluation aids in the identification of functional disorders that cause vertigo. Proper treatment, care, and fall precautions are required for the patient’s safety. Furthermore, a detailed medical history is required to determine beneficial interventions. |
| Provide an emergency light that is easily accessible to the patient. Encourage the patient to seek medical attention. | Vertigo may impair the patient’s ability to navigate his environment. Therefore, this emergency light would be highly beneficial to the patient. |
| Give the patient a fall risk wristband to warn other healthcare professionals of the patient’s strong tendency or risk of falling. | This intervention enables other healthcare providers to identify patients who are more likely to fall and suffer injury. The fall risk wristband will also be beneficial especially if the patient has communication difficulties, as it will serve as a reminder for the healthcare team. |
| Ensure that the patient’s environment is clean and safe. The bed should have protective covers or cushions. | The cushions are designed to protect the patient against damage from accidental hitting or bumping. This method also reduces the possibility of falls, trauma, and other injuries. |
| Encourage the patient to have adequate bed rest and enough sleep. | Adequate bed rest and enough sleep can help relieve vestibular vertigo. |
| Maintain the patient’s bed in the lowest position, adjacent to the floor. | This intervention is a standard fall preventative measure that ensures the patient’s safety and protects them from further injuries caused by falls. |
Nursing Care Plan for Vertigo 2
Nursing Diagnosis: Risk for Injury related to dizziness and loss of balance secondary to vertigo.
Desired Outcomes:
- The patient will be able to recognize risk factors that may increase the risk of injury.
- The patient will gain knowledge about different ways to prevent vertigo-induced injuries.
| Nursing Interventions for Vertigo | Rationale |
| Determine the patient’s level of cognitive awareness. Assess the patient’s ability to control action and comprehend and carry out complex instructions or processes. | Underestimation of cognitive abilities could lead to unfavorable outcomes and serious injuries. Patients who suffer from vertigo may be prone to falls and injuries and have impaired judgment. |
| Provide a medical emergency light or an alert system connected to the nurse station that is easily accessible or within their reach. | This approach will help the patient to call for help in time of need. |
| Recognize the patient’s negative feelings and any concerns that bother him or her. | Validation fosters positive feelings and motivates the patient to seek assistance without hesitation or fear. Having someone who understands their fears and concerns gives them confidence that they are heard and acknowledged. |
| Evaluate the patient’s lifestyle and determine any risk factors contributing to vertigo. | A sedentary lifestyle and poor physical activities can significantly increase the likelihood of vertigo. |
| Ensure that the patient’s bed has rails and that his or her surroundings are free of hazardous materials that may cause harm. | Precautionary measures are always better than anything else. Therefore, ensure the patient’s safety by providing safety beds and creating a safe environment for him or her. |
| Examine the patient for ambulation concerns and sensory perception impairment. | Vertigo and loss of balance can impair the patient’s ability to move around and respond to environmental stimuli. |
Nursing Care Plan for Vertigo 3
Impaired Adjustment
Nursing Diagnosis: Impaired Adjustment related to vertigo secondary to Meniere’s disease as evidenced by ringing in the ears (tinnitus), diaphoresis, and recurrent episodes of nausea.
Desired Outcome: The patient will exhibit a changed behavior and a willingness to modify their lifestyle that is appropriate for their current medical condition.
| Nursing Interventions for Vertigo | Rationale |
| Examine the patient’s hearing and vestibular function. | This intervention aims to provide details on the severity of hearing loss and vestibular deficit, both of which can cause severe vertigo. This method also enables the healthcare professional to define the limitations of the current illness and acknowledges the requirement for activity adjustments with altered body modifications. |
| During vertigo attacks of the patient, stay alert and provide immediate care. | The patient’s ability to stand and walk is impaired during vertigo attacks. In addition, the patient might be unable to refocus their attention, necessitating constant reassurance that the vertigo episode will pass. Anxiety can be exacerbated by a loss of balance and syncope sensations. As a result, the health care provider must remain calm and composed to provide appropriate intervention for the patient. |
| Explain the nature of the illness, its implications, and treatments to the patient. | The illness and its clinical manifestations can cause the patient to have significant anxiety and stress. These issues may interfere with their adjustment to the circumstance and prevent them from successfully coping. |
| Educate the patient on the importance of minimizing the intake of stimulants like caffeine. | Stimulants increase the chances of sleep disruption and recurring night awakenings. Caffeine also causes increased sensitivity and anxiety, which affects their willingness to participate in their treatment regimen. |
| Ensure the patient’s surroundings are free of unnecessary noises, hazards, and stimulation, and emphasize the significance of bed rest. | Meniere’s Disease patients have an illusionary effect of rotational movement in their surroundings. Any safety concerns in the patient’s environment can be a source of harm. |
Nursing Care Plan for Vertigo 4
Nursing Diagnosis: Impaired Physical Mobility related to headache and lightheadedness secondary to vertigo as evidenced by loss of balance and inability to move purposefully within the physical environment, including bed mobility, transfers, and ambulation.
Desired Outcomes:
- The patient will engage in physical activity on his or her own or within the limits of the disease.
- The patient will demonstrate methods for increased mobility.
- The patient will rate his or her pain and the quality of care.
| Nursing Interventions for Vertigo | Rationale |
| Educate the patient or family on how to keep their home safe and free of hazards. | A safe environment will aid in the prevention of falls. Home modifications can assist the patient in maintaining the desired level of functional independence while reducing fatigue from activity. |
| Explain to the patient the importance of using a call bell and a special sensitive call light to summon assistance. | In patients with limited physical mobility, this intervention gives them a sense of control and reduces their fear of being alone. |
| Assist the patient in accepting his or her limitations. | Allow the patient to recognize and accept his or her limitations and abilities. Assistance, on the other hand, must be balanced in order to keep the patient from becoming overly reliant. |
| Provide the patient with a variety of activities. Examine emotional or behavioral responses to immobility. | Forced immobility exacerbates the patient’s restlessness and irritability. Diversional activity helps promote coping with limitations and aids in refocusing attention. |
| Provide dietary recommendations for adequate energy resources and metabolic requirements. | Proper nutrition is required to maintain adequate energy levels and improve physical mobility. To provide energy resources, the patient will require an adequate and well-balanced intake of carbohydrates, fats, proteins, vitamins, and minerals. |
| Every day, assess the patient’s ability to perform Activities of Daily Living efficiently and safely using this reference. 0 – Completely self-sufficient 1 – necessitates the use of equipment or a device 2 – Requires the assistance, supervision, or teaching of another person. 3 – Requires assistance from another person as well as the use of equipment or a device 4 – Is dependent and does not engage in any activity | The restricted movement impacts the ability to perform most daily activities. The importance of ambulation safety cannot be overstated. This method identifies strengths and weaknesses and may provide information about recovery. |
Nursing Care Plan for Vertigo 5
Impaired Transfer Ability
Nursing Diagnosis: Impaired Transfer Ability related to dizziness, perceptual impairment, and postural instability when performing ADLs secondary to vertigo as evidenced by loss of balance, nausea, headache, and loss of hearing.
Desired Outcomes:
- The patient will demonstrate the ability to utilize safety measures to reduce the risk of injury.
- The patient will carry out activities within the scope of his abilities.
| Nursing Interventions for Vertigo | Rationale |
| Using the 0-4 functional level classification, determine the patient’s level of impairment and gross motor function. | The goal of this intervention is to collect baseline data. |
| Motivate the patient to seek help as needed. Place the call light beside his bed. | Patients suffering from severe vertigo frequently experience mental and motor function problems. They cannot be expected to perform heavy or complex tasks alone because this could negatively affect the patient’s safety. This intervention aims to make the patient feel safe and confident that the healthcare team will assist him or her in times of need. |
| Maintain a safe environment by keeping bed rails up, the bed in a low position, and the bedside free of unnecessary stuff. | This intervention lowers the risk of accidents, falls, and injuries. Patients with vertigo typically have difficulty walking, navigating, coordinating movement, and maintaining balance. As a result, providing a safe environment is critical for the patient’s safety. |
| Encourage the patient to go at his or her own pace when performing tasks. | In a fast-paced care setting, the patient may experience extreme stress and pressure, making them more prone to injury. Avoid aggressive interventions, which can aggravate vertigo. |
| As directed, administer anti-vertigo medications. | Anti-vertigo medications help to alleviate dizziness as well as nausea and vomiting. |
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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