Hello, the assignment is to respond to these two discussion post. The topic is about nursing assessment of the Neurological system. Please see attached rubric for discussion response requirement. Please type discussion 1 and put your response under it as if you were replying to the writer. Be sure to include references of peer reviewed article used in theresponse. Each discussion should include 3 references. 400 words to each response.
Discussion 1: Karen
A 36 y.o. comes into the hospital with complaints of dizziness. As an Emergency Room RN I see this complaint often. Obtaining a thorough history is essential to determine which medical treatments are proper for this complaint. It can be as simple as an ear infection to something more serious. “Dizziness is a nonspecific term used by patients encompassing several disorders that clinicians must carefully sort out. A detailed history identifies the primary etiology” (Bickley, et.al., 2017).
I would start off my exam with a complete current and past history. Does she have any pain? Where is it located? If she states ‘headache’ I would also like to know if she has been diagnosed with migraine headaches. What, if any, other symptoms does she have? Does she take any medications? “Feeling light-headed, weak in the legs, or about to faints points to pre-syncope from vasovagal stimulation, orthostatic hypotension, arrhythmia, or side effects from blood pressure and other medications” (Bickley, et. al., 2017). Another study wanted to know if there are side effects from medications. Their conclusion was that “general practitioners, otolaryngology, neurology, and audiology specialists should be aware of possible audio-vestibular side effects of drugs such as hearing loss, tinnitus, dizziness and vertigo” (Altissimi, et.al., 2020). Another question I would want to ask would be is she pregnant? If she is pregnant, has she been on prolonged bedrest? One of the predisposing factors of orthostatic hypotension is prolonged bedrest (Bickley, et.al., 2017). Does the patient have any substance abuse problems? What is her psychiatric history? “Dizziness caused by vestibular dysfunction involves psychological reactions. These reactions can vary considerably depending on whether or not psychiatric patients are involved. Vertigo may also be a symptom of a psychiatric disorder with no objective symptoms of a disorder of the vestibular system or of other neurological pathologies. This dichotomy in which psychological issues are the cause or the consequence of dizziness represents a possible incomplete view of the disorder, leading to sub-optimal care. Typically, otoneurologic disorders and psychiatric disorders coexist and interact, probably as a result of central-neurologic links between the vestibular and the autonomic systems” (Kanzaki, et. al, 2015).
Assessments of the ears, looking for any signs of infections that could cause vertigo would be necessary to rule out that primary etiology.
I would protect this patient’s safety by assisting the patient when walking, making sure to watch the patient’s gait for unsteadiness. “Dizziness/balance problems are strongly associated with both an increased tendency to fall and increased injury rate from falls among adults” (Lin, et.al., 2014). Since this patient is at an increased risk for falls, extra precaution is of upmost importance.
Discussion 2: Emanuela
When a 36 year old woman would come into the hospital and complain of dizziness the first thing I would do is ask her if she’s able to ambulate or if she needs a wheelchair into a room where I can assess her. Depending on her answer I would help her into a private room, insuring she is safe. If she was ambulatory while helping her into privacy I would begin assessing her walk. In a recent article it also states that “the patient’s gait should be observed and a Romberg test performed. Patients with an unsteady gait should be assessed for peripheral neurophaty. A positive Romber test suggests an abnormality with proprioception receptors or their pathway.” (Herbert L. Muncie et al., 2017) In the room I would begin asking her some simple questions like if she knows where she is, if she can tell me her name and date of birth, and if she can tell me what day it is. From that point forward I would ask her if she has a headache that accompanies her dizziness. If yes, I would ask about location, severity, and duration. After that I would start asking more questions about her dizziness. According to Bickley(2021), “dizziness or vertigo can have many meanings. Is the patient lightheaded or feeling faint (presyncope)? Is there unsteady gait from disequilibrium or ataxia, or true vertigo, a perception that the room is spinning or rotating? Are any medications contributing to dizziness?”(p.412) I would also like to find out from her if she ever fainted and if the dizziness has ever happen before.
At that point I if she has previous experiences I would like to talk to her more about the where it happen, what she was doing at the time it happen, were there any warning signs, were there any triggers that lead to the episode, and if she remembers the duration of the episode. Even though this patient is still quite young I would want to make sure she doesn’t have any underlying conditions that could be causing the dizziness. According to Eske(2019) “conditions that affect the cardiovascular system, such as the buildup of plaque in the arteries and congestive heart failure, can cause dizziness. People may experience dizziness or feel lightheaded before or after a heart attack or stroke.” (Eske, 2019) Therefore I would want to ask her if she has any heart issues or anybody in close family that might as well. Along with this I would want to run some basic tests like EKG and labs for tropinin.
Another form of examination I would want to perform would be neurological assessment with attention to the head, eye, ear, nose and throat examination. Checking all of her cranial nerves to make sure nothing seemed to be out of the ordinary. The article by Herbert L. Muncie et al. (2017) also talks about a test called HINTS which stands for head-impulse, nystagmus, test of skew. This examination can help to distinguish a possible stroke. (Herbert L. Muncie et al., 2017) If any abnormalities would be found from the assessment I would want to consult neurology. According to Kerber and Baloh (2011) “neurologists play an important role in the evaluation and management of patients with dizziness. The possibility of a serious neurologic disorder is unnerving to front-line physicians who have ranked decision support for identifying central causes of vertigo as a top priority.” (Kerber & Baloh, 2011) Working as a team always leads to better patient care and possibility of finding the solution to the problem quicker and more efficiently. As the say two brains are better than one.
Below is the case study question they responded to:
A 36-year-old woman comes into the hospital with the chief complaint of dizziness. What history questions would be pertinent to ask this patient given her age and gender? What aspects of the neuro exam would you include to evaluate this patient? Would you include assessments of any other system? How would you provide for her safety during the exam?
Dont respond to the case study question. Only respond to the discussion posts.
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