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VERTIGO SIM 5/21/20 - Coggle Diagram
VERTIGO SIM 5/21/20
Pathophysiology
The neurochemistry of vertigo includes six primary neurotransmitters that have been identified between the three-neuron arc that drives the vestibulo-ocular reflex (VOR).
Glutamate maintains the resting discharge of the central vestibular neurons and may modulate synaptic transmission in all three neurons of the VOR arc. Acetylcholine appears to function as an excitatory neurotransmitter in both the peripheral and central synapses.
Gamma-Aminobutyric acid (GABA) is thought to be inhibitory for the commissures of the medial vestibular nucleus, the connections between the cerebellar Purkinje cells, and the lateral vestibular nucleus, and the vertical VOR.
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Norepinephrine modulates the intensity of central reactions to vestibular stimulation and facilitates compensation. Histamine is present only centrally, but its role is unclear. Dopamine, histamine, serotonin, and acetylcholine are neurotransmitters thought to produce vomiting. It is known that centrally acting antihistamines modulate the symptoms of acute symptomatic vertigo.
Medication
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Antihistamines such as betahistine, dimenhydrinate, or meclizine, which may have antiemetic properties
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Corticosteroids such as methylprednisolone for inflammatory conditions such as vestibular neuritis or dexamethasone as a second-line agent for Ménière's disease
Nursing Interventions
Have the patient wear a wristband identification to remind healthcare providers to implement fall precautions.
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Place the call light within the patient’s easy reach and encourage to call for assistance immediately.
Make sure to keep the patient’s bed is in the lowest position. Keep it as adjacent to the floor as possible.
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Patient Education
Teach the patient to move slowly, like sitting up slowly and taking a few minutes before standing up.
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Nursing Considerations
Assess conditions that can increase the patient’s level of fall risk, such as a history of falls, changes in mental status, sensory deficits, balance, medications, and symptoms related to diseases.
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