STUDY - Technical - New Dacian's Medicine
Dizziness
(Classical / Allopathic Medicine)
A common symptom,
dizziness is a sensation of imbalance or faintness, sometimes
associated with giddiness, weakness, confusion, and blurred or
double vision. Episodes of dizziness are usually brief; they
may be mild or severe with abrupt or gradual onset. Dizziness
may be aggravated by standing up quickly and alleviated by
lying down and by rest.
Dizziness
typically results from inadequate blood flow and oxygen supply
to the cerebrum and spinal cord. It may occur with anxiety, a
respiratory or cardiovascular disorder, and postconcussion
syndrome. It's a key symptom of certain serious disorders,
such as hypertension and vertebrobasilar artery insufficiency.
Dizziness is
sometimes confused with vertigo - a sensation of revolving in
space or of surroundings revolving about oneself. However,
unlike dizziness, vertigo is commonly accompanied by nausea,
vomiting, nystagmus, staggering gait, and tinnitus or hearing
loss. Dizziness and vertigo may occur together, as in
postconcussion syndrome.
ALERT:
If the patient complains of dizziness:
- ask him to describe it (Is the dizziness associated with headache or blurred vision?)
- take his vital signs, and ask about a history of high blood pressure; then tell him to lie down, and recheck his vital signs
- ask about a history of diabetes and cardiovascular disease (Is he taking a drug prescribed for high blood pressure? If so, when did he take his last dose?)
If the patient's blood pressure is normal, perform a focused assessment.
If the patient complains of dizziness:
- ask him to describe it (Is the dizziness associated with headache or blurred vision?)
- take his vital signs, and ask about a history of high blood pressure; then tell him to lie down, and recheck his vital signs
- ask about a history of diabetes and cardiovascular disease (Is he taking a drug prescribed for high blood pressure? If so, when did he take his last dose?)
If the patient's blood pressure is normal, perform a focused assessment.
HISTORY:
Review the patient's medical history for hypertension, transient ischemic attack, anemia, chronic obstructive pulmonary disease, anxiety disorders, head injury, and anything that may predispose him to cardiac arrhythmias, such as myocardial infarction, heart failure, or atherosclerosis.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient how often dizziness occurs and how long each episode lasts.
Ask the patient if dizziness abates spontaneously or if it ever leads to loss of consciousness.
Ask the patient if dizziness is triggered by sitting or standing up suddenly or stooping over.
Ask the patient if being in a crowd makes him feel dizzy.
Ask the patient about emotional stress. Has he been irritable or anxious lately? Does he have insomnia or difficulty concentrating?
Ask the patient if he has experienced palpitations, chest pain, diaphoresis, shortness of breath, or chronic cough.
Review the patient's medical history for hypertension, transient ischemic attack, anemia, chronic obstructive pulmonary disease, anxiety disorders, head injury, and anything that may predispose him to cardiac arrhythmias, such as myocardial infarction, heart failure, or atherosclerosis.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient how often dizziness occurs and how long each episode lasts.
Ask the patient if dizziness abates spontaneously or if it ever leads to loss of consciousness.
Ask the patient if dizziness is triggered by sitting or standing up suddenly or stooping over.
Ask the patient if being in a crowd makes him feel dizzy.
Ask the patient about emotional stress. Has he been irritable or anxious lately? Does he have insomnia or difficulty concentrating?
Ask the patient if he has experienced palpitations, chest pain, diaphoresis, shortness of breath, or chronic cough.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs, then take his blood pressure while he's lying, sitting, and standing to check for orthostatic hypotension.
Assess the patient's level of consciousness, motor and sensory functions, and reflexes.
Inspect for poor skin turgor and dry mucous membranes, which are signs of dehydration.
Auscultate heart rate and rhythm.
Inspect for barrel chest, clubbing, cyanosis, and use of accessory muscles. Also, auscultate breath sounds.
Test capillary refill time in the extremities, and palpate for edema.
Take the patient's vital signs, then take his blood pressure while he's lying, sitting, and standing to check for orthostatic hypotension.
Assess the patient's level of consciousness, motor and sensory functions, and reflexes.
Inspect for poor skin turgor and dry mucous membranes, which are signs of dehydration.
Auscultate heart rate and rhythm.
Inspect for barrel chest, clubbing, cyanosis, and use of accessory muscles. Also, auscultate breath sounds.
Test capillary refill time in the extremities, and palpate for edema.
SPECIAL
CONSIDERATIONS:
Provide a safe environment, and assist with ambulation to ensure the patient's safety.
Provide a safe environment, and assist with ambulation to ensure the patient's safety.
PEDIATRIC
POINTERS:
Dizziness is less common in children than in adults.
Children may have difficulty describing this symptom and instead complain of tiredness, stomachache, or feeling sick. If you suspect dizziness, assess the patient for vertigo as well.
A more common symptom in children, vertigo may result from a vision disorder, an ear infection, or the effects of an antibiotic.
Dizziness is less common in children than in adults.
Children may have difficulty describing this symptom and instead complain of tiredness, stomachache, or feeling sick. If you suspect dizziness, assess the patient for vertigo as well.
A more common symptom in children, vertigo may result from a vision disorder, an ear infection, or the effects of an antibiotic.
PATIENT
COUNSELING:
Teach the patient ways to control dizziness. If he's hyperventilating, have him breathe and rebreathe into his cupped hands or a paper bag. If he experiences dizziness in an upright position, tell him to lie down and rest and then rise slowly. Advise the patient with carotid sinus hypersensitivity to avoid wearing garments that fit tightly at the neck. Instruct the patient who risks a transient ischemic attack from vertebrobasilar insufficiency to turn his body instead of sharply turning his head to one side.
Instruct the patient on what to expect from diagnostic testing, which may include blood studies, arteriography, computed tomography scan, EEG, and magnetic resonance imaging, as appropriate.
Teach the patient ways to control dizziness. If he's hyperventilating, have him breathe and rebreathe into his cupped hands or a paper bag. If he experiences dizziness in an upright position, tell him to lie down and rest and then rise slowly. Advise the patient with carotid sinus hypersensitivity to avoid wearing garments that fit tightly at the neck. Instruct the patient who risks a transient ischemic attack from vertebrobasilar insufficiency to turn his body instead of sharply turning his head to one side.
Instruct the patient on what to expect from diagnostic testing, which may include blood studies, arteriography, computed tomography scan, EEG, and magnetic resonance imaging, as appropriate.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)