Definition
The word comes from the Greek vertigo vertere which means play. Definition of vertigo are: the sensation of movement or sense of motion of the body or surrounding environment, can be accompanied by other symptoms, mainly due to disruption of autonomic networking tool balance Vertigo may not consist of only one symptom of dizziness alone, but rather a collection of symptoms or a syndrome consisting of somatic symptoms (nystagmus, unstable), autonomic (pale, cold sweat, nausea, vomiting) and dizziness. From (http://www.kalbefarma.com).
Etiology
According to (Burton, 1990: 170), namely:
a) vestibular lesion
 Physiologic
 Labirinitis
 Meniere
 Drugs, for example quinine, salicylates.
 Otitis media
 "Motion sickness"
 "Benign positional vertigo post-traumatic"
b) vestibular nerve lesions
 Neuroma akustikv
 Drugs, for example streptomycinv
 Neuronitis vestibularv
c) Lesions of the brain stem, cerebellum or temporal lobe
 Pontine infarction or hemorrhage
 Vertebro-basilar insufficiency
 Basilar artery migraine
 Disseminated Sklerosi
 Tumor
 Siringobulbia
 Temporal lobe epilepsy
By (http://www.kalbefarma.com)
1. Disease Peripheral vestibular system:
a. Outer ear: wax, foreign objects.
b. Middle ear: tympanic membrane retraction, akuta purulent otitis media, otitis media with effusion, labirintitis, cholesteatomas, involuntary bleeding.
c. Inner ear: labirintitis akuta toksika, trauma, vascular attack, allergies, hydrops maze (Morbus Meniere), drunken movements, postural vertigo.
d. Nerve VIII. : Infection, trauma, tumor.
e. Core
Vestibular: infection, trauma, hemorrhage, thrombosis arteria serebeli posterior inferior, tumors, sclerosis multiplex.
2. CNS Disease:
a. Hypoxia ischemia brain. : Chronic hypertension, atherosclerosis, anemia, hypertension, cardiovascular disease, paroxysmal atrial fibrillation, aortic stenosis and insufficiency, carotid sinus syndrome, syncope, orthostatic hypotension, heart block.
b. Infection: meningitis, encephalitis, abscess, Lues.
c. Trauma to the head / maze.
d. Tumor.
e. Migraines.
f. Epilepsy.
3. Endocrine disorders: hypothyroidism, hypoglycemia, hipoparatiroid, tumor adrenal medulla, state-pregnant-menopausal period.
4. Psychiatric disorders: depression, anxiety neurosa, hyperventilation syndrome, phobias.
5. Eye disorders: abnormalities proprioseptik.
6. Intoxication.
Pathophysiology
Vertigo occurs if there is a mismatch afferent information conveyed to the center of consciousness. Composition of Afferent the most important in this system is the arrangement of vestibular or balance, which is continuously deliver impulses to the center of balance. Another arrangement is the role of optical systems and pro-prioseptik, pathway-pathway connecting the vestibular nuclei with the nuclei N. III, IV and VI, the structure vestibuloretikularis and vestibulospinalis.
Useful information for the balance of the body would be arrested by the vestibular receptors, visual, and proprioseptik; vestibular receptors contribute the most, ie more than 50% followed the visual receptors and the smallest contribution is proprioseptik.

Under conditions of physiological / normal information arrived in the center of integration tools from the balance receptors vestibular, visual and proprioseptik left and right will be compared, if everything is in a state of synchronous and reasonable, will be processed further. The response appears in the form of adjustment of the eye muscles and body movers
state moves. In addition, people are aware of the position of the head and body to the surrounding environment. If the function of the tool body balance in the peripheral or central in a state of normal / not physiological, or there is a strange movement stimuli or excessive, then the processing of information would be disturbed, resulting in symptoms of vertigo and autonomic symptoms; in addition, the response becomes muscle adjustment adequately so that they appear to be abnormal movements nystagmus, unsteadiness, ataxia when standing / walking and other symptoms (http://www.kalbefarma.com).

Classification of Vertigo
Based on clinical symptoms, vertigo can be divided into several groups:
1. Paroxysmal vertigo
That sudden attack of vertigo, lasting a few minutes or days, then disappeared perfect: but once these attacks may occur again. In between attacks, patients are completely free of complaints. Vertigo types are divided into:
Accompanied by ear complaints:
Included in this group are: Morbus Meniere, Arakhnoiditis pontoserebelaris, Lermoyes Syndrome, Cogan's Syndrome, cranii posterior fossa tumors, abnormalities of teeth / odontogen.
A complaint without ears; included here are: Ischemic Attack cursory arteria vertebrobasilaris, Epilepsy, Migraine equivalents, Vertigo in children (Vertigo de L'enfance), Maze trigger (trigger labyrinth).
Its onset is affected by changes in position, included here are: paroxysmal positional vertigo latent, benign paroxysmal positional vertigo.
2. Chronic Vertigo
That persistent vertigo, a constant complaint without (Mirror World No. Medicine. 144, 2004: 47) acute attacks, can be divided into:
Accompanied by complaints ear: Otitis media chronica, Tb meningitis, chronic labirintitis, Lues cerebral lesion caused by material ototoksik maze, serebelopontin tumor.
Without ear complaints: cerebral contusion, Pontis encephalitis, post-komosio syndrome, pellagra, siringobulbi, hypoglycemia, multiple sclerosis, ocular disorders, drug intoxication, psychological disorders, cardiovascular disorders, endocrine disorders.
Vertigo-influenced position: Orthostatic Hypotension, Vertigo cervical.
3. Sudden attack of vertigo / acute, then gradually lessen, divided into:
Accompanied complaints ear: Trauma maze, herpes zoster otikus, labirintitis akuta, bleeding maze, neuritis n.VIII, injury to internal auditiva / arteria vestibulokoklearis.
Without complaint ear: vestibular Neuronitis, anterior vestibular artery syndrome, encephalitis vestibular, vertigo epidemika, sclerosis multiplex, hematobulbi, serebeli inferior posterior artery blockage.
There is also a divide vertigo becomes:
Vestibular vertigo: a result of vestibular system disorders.
Non vestibular vertigo: a disorder cavernosometry and visual system.

Clinical manifestations
A whirling sensation that is sometimes accompanied by symptoms associated with reactionary and humid nausea, vomiting, severe headache taste, appetite down, tired, pale tongue with sticky white membrane, weak pulse, headache (dizziness), headache, blurred vision, tinnitus , bitter mouth, red eyes, irritability, restlessness, red tongue with a thin membrane.

Supporting examination
1) Physical examination:
 Examination mata
 The perusal of the balance tubuh
 Examination neurologik
 Examination otologik
 Physical examination umum.
2) special examination:
 Engo
 Audiometric and BAEPØ
 PsikiatrikØ
3) Additional examination:
 LaboratoriumØ
 Radiological and ImagingØ
 EEG, EMG, and EKG.Ø

Medical management.
Therapy according to (Mirror World No. Medicine. 144, 2004: 48):
Consists of:
Causal therapy
Symptomatic therapy
Rehabilitative therapy

Nursing Management
1. Assessment
a. Activity / Rest
• Tired, weak, malaise
• Limitations of motion
• Tension eyes, difficulty reading
• Insomnia, waking up in the morning with a head ache
• severe headaches when changes in posture, activity (work) or because of changes in weather.
b. Circulation
• History of hypertension
• vascular throbbing, eg temporal regions
• Pale, face look red.
c. Ego Integrity
• Emotional stress factors / environment specific
• Changes in disability, despair, hopelessness depression
• Worry, anxiety, sensitive to stimulation for headaches
• Mechanisms repressive / dekensif (chronic headache)
d. Food and fluid
• Foods that are high vasorektiknya such as caffeine, chocolate, onions, cheese, alcohol, wine, meat, tomatoes, fatty foods, citrus, sauces, hotdogs, MSG (the migraine).
• Nausea / vomiting, anorexia (for pain)
• Weight loss
e. Neurosensoris
• Dizziness, disorientation (for headaches)
• History of seizures, head injury has just happened, trauma, stroke.
• Aura; facial, olfactory, tinnitus.
• Changes in visual sensitivity to light / sound harsh, epitaksis.
• Parastesia, progressive weakness / paralysis one side tempore
• Changes in patterns of speech / thought patterns
• Easily aroused, sensitive to stimulus.
• Decreased deep tendon reflexes
• papilledema.
f. Pain / comfort
• Characteristics of pain depends on the types of headaches, such as migraine, tension, cluster, brain tumors, post-traumatic, sinusitis.
• Pain, redness, pale in the face
• Focus narrows
• Focus on self sndiri
• Response emotional / behavioral undirected like crying, restless.
• Muscles tighten the neck area as well, frigidity vocals.
g. Security
• History of allergies or allergic reactions
• Fever (headache)
• Impaired gait, parastesia, paralysis
• purulent nasal drainage (sinus headache disorders)
h. Social Interaction
• Changes in responsibility / role of social interaction associated with the disease.
i. Guidance / learning
• History of hypertension, migraine, stroke, illness in the family
• Use of alcohol / other drugs, including caffeine. Oral contraceptives / hormone, menopause.

2. Nursing Diagnosis (Doengoes, 1999:2021)
Pain (acute / chronic) associated with stress and tension, irritation / nerve pressure, vasospressor, characterized by increased intracranial pain states are influenced by such factors, changes in position, changes in sleep patterns, anxiety.
Ineffective individual coping related to non-adekuatan relaxation, coping methods are not adequate, excess workload.
Lack of knowledge (learning need) regarding condition and treatment needs related to cognitive limitations, lack of information and do not know remember characterized by asking information, non-adekuatannya follow instructions.

3. Nursing Intervention
a) pain (acute / chronic) associated with stress and tension, irritation / nerve pressure, vasospasm, increased intracranial states characterized by pain that is affected by such factors, changes in position, changes in sleep patterns, anxiety.
Purpose: Pain is lost or reduced
Criteria results: - The client expressed reduced pain
- Normal vital signs
- The patient was calm and relaxed
Intervention / Implementation
 Monitor vital signs, the intensity / scale nyeriØ
Rationale: Identify and facilitate the nursing action.
 Encourage clients to break the place tidurØ
Rational: break to reduce the intensity of pain
 Adjust the position of the patient as comfortable as mungkinØ
Rational: the exact position reduces stress and prevents muscle tension and reduce pain.

 Teach relaxation techniques and breathing dalamØ
Rational: relaxation reduces tension and create a feeling more comfortable
 Collaboration for granting analgetik.Ø
Rationale: useful analgesic to relieve pain so that patients become more comfortable.

b) individually ineffective Coping related to non-adekuatan relaxation, coping methods are not adequate, excess workload.
Objective: individuals become more adequate coping
Results Criteria: - identify the behaviors that are ineffective
expressed awareness of coping abilities which is owned
megkaji accurate current situation
demonstrate the necessary lifestyle changes or appropriate situations.
Intervention / Implementation
 Assess physiological capacity is umum.Ø
Rationale: Knowing the extent and identify deviations physiological functions of the body and ease the nursing action
 Suggest untukØ client to express his feelings.
Rationale: The client will feel relief after revealing all his feelings and become calmer
 Provide information on the cause of headache, sedation, and results diharapkan.Ø
Rationale: that clients know the condition and medication, and give clients hope and encouragement to recover.

 Approach the patient with a friendly and attentive, take advantage of the activities that can be taught.
Rational: to make clients feel more meaningful and appreciated.

a) Lack of knowledge (learning need) regarding condition and treatment needs related to cognitive limitations, lack of information and do not know remember characterized by asking information, non-adekuatannya follow instructions.
Objective: patient expressed understanding of the conditions, procedures and treatment process effects.
Criteria results:
- Perform necessary procedures and explain the reason of an act.
- Initiate the necessary lifestyle changes and participate in treatment regimen.
Intervention / Implementation:
Assess the level of knowledge of the client and family about penyakitnya.Ø
Rational: megetahui how much experience and knowledge of the client and family about the disease.
 Provide a description of the client about his illness and his condition sekarang.Ø
Rational: by knowing the disease and its present state, the client and his family will feel calm and reduce anxiety.
Discuss the individual causes of headaches when diketahui.Ø
Rational: to reduce anxiety and increase the knowledge of the client client neighbor illness.
Request a repeat client and family about the material that has been diberikan.Ø
Rational: knowing how much understanding of clients and their families and assess the success of the action taken.

Discuss the importance of body position or location normalØ
Rationale: that the client can do and change the position / location of the body is not good.
 Instruct the patient to always take the headaches they experienced and the factors that berhubungan.Ø
Rational: by considering factors related to the client can reduce the headache itself with simple actions, such as lying down, resting at the time of the attack.

4. Evaluation
Evaluation is a systematic comparison of the patient's health or well-planned with its intended purpose, is done by continuous, involving patients, families and other health professionals. (Carpenito, 1999:28)
Return of the vertigo purposes are:
a. Pain can be removed or overcome.
b. Changes in lifestyle or behavior to control or prevent recurrence.
c. Understanding the needs or condition of the disease process and therapeutic needs.

  REFERENCES
Lynda Juall carpernito, nursing care plan and documentation of nursing, Nursing Diagnosis and Collaborative Problems, ed. 2, EGC, Jakarta, 1999.
Marilynn E. Doenges, Nursing care plan guidelines for planning and documenting patient, ed.3, EGC, Jakarta, 1999.

Kang L S,. Vertigo Treatment with Acupuncture, Medical World No. Mirror. 144, Jakarta, 2004.

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