Dizziness
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 an abrupt or a 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, respiratory and cardiovascular disorders, and postconcussion syndrome. It's a key symptom in certain serious disorders, such as hypertension and vertebrobasilar artery insufficiency.
Dizziness is commonly 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, a staggering gait, and tinnitus or hearing loss. Dizziness and vertigo may occur together, as in postconcussion syndrome.
Action stat!
If the patient complains of dizziness, first ensure his safety by assisting him back to bed and preventing falls. Then determine the severity and onset of the dizziness. Ask him to describe it. Is the dizziness associated with a headache or blurred vision? Next, take his blood pressure while he's lying down, sitting, and standing to check for orthostatic hypotension. Ask about a history of high blood pressure. Determine if he's at risk for hypoglycemia. Check his blood glucose level. Tell him to lie down, and recheck his vital signs every 15 minutes. Insert an I.V. catheter, and prepare to administer medications and fluids as ordered.
History and physical examination
Ask about a history of diabetes and cardiovascular disease. Is the patient taking drugs prescribed for high blood pressure? If so, when did he take his last dose?
If the patient's blood pressure is normal, obtain a more complete history. Ask about myocardial infarction, heart failure, kidney disease, or atherosclerosis, which may predispose the patient to cardiac arrhythmias, hypertension, and a transient ischemic attack. Does he have a history of anemia, chronic obstructive pulmonary disease, anxiety disorders, or head injury? Obtain a complete drug history.
Next, explore the patient's dizziness. How often does it occur? How long does each episode last? Does the dizziness abate spontaneously? Does it lead to loss of consciousness? Find out if dizziness is triggered by sitting or standing up suddenly or stooping over. Does being in a crowd make the patient feel dizzy? Ask about emotional stress. Has the patient been irritable or anxious lately? Does he have insomnia or difficulty concentrating? Look for fidgeting and eyelid twitching. Does the patient startle easily? Also, ask about palpitations, chest pain, diaphoresis, shortness of breath, and chronic cough.
Next, perform a physical examination. Begin with a quick neurologic assessment, checking the patient's level of consciousness (LOC), motor and sensory functions, and reflexes. Then inspect for poor skin turgor and dry mucous membranes, signs of dehydration. Auscultate heart rate and rhythm. Inspect for barrel chest, clubbing, cyanosis, and use of accessory muscles. Also auscultate breath sounds. Take the patient's blood pressure while he's lying down, sitting, and standing to check for orthostatic hypotension. Test capillary refill time in the extremities, and palpate for edema.
Medical causes
Anemia.Typically, anemia causes dizziness that's aggravated by postural changes or exertion. Other signs and symptoms include pallor, dyspnea, fatigue, tachycardia, and a bounding pulse. The capillary refill time is increased.
Cardiac arrhythmias.Dizziness may occur for several seconds or longer and may precede fainting in arrhythmias. The patient may experience palpitations; irregular, rapid, or thready pulse; and, possibly, hypotension. He may also experience weakness, blurred vision, paresthesia, and confusion.
Emphysema.Dizziness may follow exertion or the chronic productive cough in patients with emphysema. Associated signs and symptoms include dyspnea, anorexia, weight loss, malaise, use of accessory muscles, pursed-lip breathing, tachypnea, peripheral cyanosis, and diminished breath sounds. Barrel chest and clubbing may be seen.
Generalized anxiety disorder.Generalized anxiety disorder produces continuous dizziness that may intensify as the disorder worsens. Associated signs and symptoms are persistent anxiety (for at least 1 month), insomnia, difficulty concentrating, and irritability. The patient may show signs of motor tension—for example, twitching or fidgeting, muscle aches, a furrowed brow, and a tendency to be startled. He may also display signs of autonomic hyperactivity, such as diaphoresis, palpitations, cold and clammy hands, dry mouth, paresthesia, indigestion, hot or cold flashes, frequent urination, diarrhea, a lump in the throat, pallor, and increased pulse and respiratory rates.
Hypertension.With hypertension, dizziness may precede fainting, but it may also be relieved by rest. Other common signs and symptoms include a headache and blurred vision. Retinal changes include hemorrhage, sclerosis of retinal blood vessels, exudate, and papilledema.
Hyperventilation syndrome.Episodes of hyperventilation cause dizziness that usually lasts a few minutes; however, if these episodes occur frequently, dizziness may persist between them. Other effects include apprehension, diaphoresis, pallor, dyspnea, chest tightness, palpitations, trembling, fatigue, and peripheral and circumoral paresthesia.
Hypovolemia.A lack of circulating blood volume may cause dizziness and may be accompanied by other signs of fluid volume deficit (dry mucous membranes, decreased blood pressure, increased heart rate).
Orthostatic hypotension.Orthostatic hypotension produces dizziness that may terminate in fainting or disappear with rest. Related findings include dim vision, spots before the eyes, pallor, diaphoresis, hypotension, tachycardia and, possibly, signs of dehydration.
Postconcussion syndrome.Occurring 1 to 3 weeks after a head injury, postconcussion syndrome is marked by dizziness, a headache (throbbing, aching, bandlike, or stabbing), emotional lability, alcohol intolerance, fatigue, anxiety and, possibly, vertigo. Dizziness and other symptoms are intensified by mental or physical stress. The syndrome may persist for years, but symptoms eventually abate.
Rift Valley fever.Typical signs and symptoms of Rift Valley fever include dizziness, a fever, myalgia, weakness, and back pain. A small percentage of patients may develop encephalitis or may progress to hemorrhagic fever that can lead to shock and hemorrhage. Inflammation of the retina may result in some permanent vision loss.
Transient ischemic attack (TIA).Lasting from a few seconds to 24 hours, a TIA commonly signals an impending stroke and may be triggered by turning the head to the side. Besides dizziness of varying severity, TIAs are accompanied by unilateral or bilateral diplopia, blindness or visual field deficits, ptosis, tinnitus, hearing loss, paresis, and numbness. Other findings include dysarthria, dysphagia, vomiting, hiccups, confusion, a decreased LOC, and pallor.
Other causes
Drugs.Anxiolytics, central nervous system depressants, opioids, decongestants, antihistamines, antihypertensives, and vasodilators commonly cause dizziness.
Nursing considerations
▪ Prepare the patient for diagnostic tests, such as blood studies, arteriography, a computed tomography scan, EEG, magnetic resonance imaging, and tilt-table studies.
▪ Ensure safety measures.
Patient teaching
▪ Teach the patient how to control dizziness.
▪ Discuss safety measures.
▪ Teach the patient about his underlying disorder and its treatment.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Syncope
Read excerpts from these other book chapters related to Syncope:
Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Syncope
» Next page: Level of consciousness, decreased (Nursing: Interpreting Signs and Symptoms)
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