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.
