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UNCIANO COLLEGES, INC.

Antipolo City
S COLLEGE OF NURSING
In Partial Fulfillment of the Requirements
For the Actual Clinical Hospital: Related Learning Experience
Affiliating Institution: Unciano Medical Center

HYPERTENSIVE T/C BENIGN PAROXYSMAL


POSITIONAL VERTIGO

SUBMITTED BY:
Camille Marasigan Daracan
(Student)

SUBMITTED TO:
MILAGROS JAVIER - NUEZ, RN, MAN
(Clinical Instructor)

INTRODUCTION
Benign Paroxysmal Positional Vertigo is listed as a "rare disease" by the Office of Rare
Diseases (ORD) of the National Institutes of Health (NIH). This means that Benign
Paroxysmal Positional Vertigo, or a subtype of Benign Paroxysmal Positional Vertigo,
affects less than 200,000 people in the US population. Prognosis of Benign Paroxysmal
Positional Vertigo: may last for weeks or months and then spontaneously disappear.
Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of
vertigo the sudden sensation that you're spinning or that the inside of your head is
spinning.

Benign paroxysmal positional vertigo causes brief episodes of mild to intense dizziness.
Benign paroxysmal positional vertigo is usually triggered by specific changes in the
position of your head. This might occur when you tip your head up or down, when you
lie down, or when you turn over or sit up in bed.

Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely
serious except when it increases the chance of falls.

GENERAL OBJECTIVES
To be able to come up with an understanding of the disease process and
formulate a comprehensive nursing care plan using the specific objectives nursing
process.

SPECIFIC OBJECTIVES
1. To review the anatomy and physiology of the disease.
2. To practice nursing assessment during data gathering.
3. To prioritize identified health problems of the patient.
4. To understand the pathophysiology of it.
5. To know the medical treatment such as the medications and laboratory works
involved.
6. To know the importance of laboratory and diagnostic procedure.
7. To know the nursing management of the disease.

I.

PATIENTS PROFILE

Name

: Mercedita Del Rosario

Address

: Tanay,Rizal

Age

: 57 years old

Birthday

: August 31, 1959

Gender

: Female

Civil Status

: Single

Religion

: Roman Catholic

Nationality

: Filipino

Chief Complaint

: Dizziness

Impression

: Hypertensive T/C Benign Paroxysmal Positional Vertigo

Admission Date

: September 12, 2016

Admission Time

: 2:18 pm

II.

NURSING HISTORY

III.

History of Present Illness:


1 day prior to admission, in the morning the patient vomits 3 times in their house. as
she schedule to go to Antipolo to meet a friend she lend money to pay her back that
very day but suddenly patient was feel very dizzy and she fainted that time. Her
friend brings her to Unciano Medical Center and vomits again 2 times.

IV.

History of Past Health Illness


Miss Del Rosario known hypertensive since she was pregnant at her first baby that
was 1988 way back her husband died last 2012 it is very difficult to her she took a
big responsibility , the patient was always stress thinking how to pay their bills.

V.

Social/Environmental/Personal History
The patient is not a smoker even the other family member in their house do not
smoke also she did not drinking liquor. They live in a village with no open drainage
surrounded with trees and houses. Patient owns a sari-sari store.

VI.

Family Health History


Patient family had no history of any diseases. Both sides of her parents have a strong

immune system.

GORDONs FUNCTIONAL HEALTH PROBLEMS


Functional Health
Problem
Health Perception-

Before
Hospitalization
Patient Health

During

Analysis

Hospitalization
She is aware of her

As she felt the

Health Management perception is out of

situation she

weakness prior to

Problem

the disease .As a

wanted to heal as

admission her

normal people she

soon as possible.

feeling of being

took a medicine

healthy unsatisfied.

when she didnt feel


good. She didnt go
to clinic for checkup because she is

Nutritional-

afraid.
The patient usually

The patient is in the

There is a change

Metabolic Pattern

eat 3 times a day 1

low salt low fat diet

in eating pattern of

cup of rice every

she eats only eats

the patient.

meal more likely to

2-3 tbsp of her

eat vegetables than

meal.

meat.
Patient usually

Still before, patient

Elimination Problem

Her elimination

defecate once a day can defecate once a pattern did ot

Activity and

after finishing eating

day and can urinate

breakfast 4 to 5

4 to 5 times a day

times.
Patient habit of

Patient is always

affected.

She is only

Exercises Pattern

Sleep- Rest Pattern

exercise is walking

lying on her bed.

every day.

Did not do any

He has a regular

exercises at all.
The patient is

sleeping pattern.he

always sleeping and to time of

sleeps 7:00 in the

lying on her bed.

evening and wakes

sleeping.

Due to adherence

medication and vital


signs medication.

up at 10:00pm,
12:00nm,and
3:00am then she

Cognitive and

sleep again.
The patient is aware The patient is aware The patient is aware

Perceptual Pattern

of the

of the time,

on his health

time,place,whre she

place,where she is

condition and

is and know her

and know her

follows doctors

name.

name.

advice and
condition. He
realizes the
importance of
maintaining health

Self- Perception/

The patient is able

Her family was

lifestyle.
Persons self

Self- Concept

to express his

always on her side

concept affected by

feelings. He is

to help her in her

some factors such

contented seeing

needs. she always

as illness, stressors,

his family, their

expresses what she

support, love and

feeds on her family.

Role- Relationship

care.
She was able to do

Due to her condition

Due to his condition

Pattern

her responsibilities

being a mother to

he is not aware of

as a mother.

her child not fully

performing his real

The patient was

met.
The patients always

role in his field.


Coping strategy is a

cope her stress by

sleep and not

natural learned way

eating and watching

thinking about her

of responding to a

television.

problem.

changing

The patient is not

The patient doesnt

environment.
He is not sexually

sexually active.

have any sexual

active.

Coping Stress

Sexual

etc.

avtivity.

Reproductive
Pattern
Values- Belief

The patients

The patients never

Spiritual and

Pattern

religious affiliation is

blame GOD for his

religious belief plays

a Roman

condition. The

a significant role in

Catholic.She always patients relationship


Pray that Gdo heal

with GOD remains

her.

unchanged.

their major life.

PHYSICAL EXAMINATION
Date assessed: September 14, 2016
Initial vital signs: T= 36.0 C, PR= 76 bpm, RR= 15 cpm, BP= 140/90 mmHg.
Physical

Methods use Normal finding

Actual finding

Analysis

assessment
I.
Head

Palpation

Head is

Symmetric in

Normal

symmetric,

shape, round and

round, erect and

in the midline. No

in midline. no

Visible lesions.

lesions are

A. Hair

Inspection,

visible.
Black evenly

Black to grey color. Normal

palpation

distributed and

evenly distributed

covers the whole

that covers the

scalp, thick and

whole scalp.

shiny free from

B. Face

C. Eyes

Inspection

Inspection

split ends.
Oval, square or

Round in shape.

Pale

heart shape.

Absence of

appearance

Symmetry and

involuntary

Facial

no involuntary

muscle. Face is

expression

muscle.

slightly pale. Facial shows anxiety


expression shows

and irritable

anxiety and

due to his

Parallel and

irritable
Eyes are black in

condition.
Normal

evenly placed,

color, Parallel

symmetrical.

inposition and

none protruding

equal in size and

with scant

shape.

amount of
secretions, both
eyes black and

D. Ears

Inspection

clear.
Position of the

Ears are align with

Normal

ears is line up

the eyes, color is

with the eyes.

similar to the face,

The color is

shape is

similar with the

proportional to the

facial color.

face

Shape is
proportion to the
face; no
drainage,
nodules or

E. Nose

F. Mouth

Inspection/

lesions.
Midline and

Palpation

symmetric. Equal midline. Equal

Inspection

Nose is in the

normal

nasal opening.

nasal opening and

Presence of

there is no nasal

nasal folds.

discharges.

Lips are pink,

Lips is light pink in

Dry lips

smooth and

color in color and

caused by

moist. Gums are

dry.

dehydration.

any discharges.
3 molar, 2

Complete teeth

Patient is

premolar, 1

with dentures use.

using fake

moist and
pinkish without

G. Teeth

Inspection

canine and 1

H. Inspectio Inspection/
n

II.

palpation

Align well.

central incisor.

her teeth has

Align well and no

broken year

foul odor

passed by.

Proportion to the

Proportion to the

size of the body,

size of the body.

symmetrical in

No tenderness

shape, palpable

present.

Scapula are

Thor

Inspection,

masses.
Scapula are

ax

palpation,

symmetric and

symmetric and no

and

percussion,

no protruding.

protrusion. No

lungs

auscultation

Does not use

accessory muscle

accessory

use during

muscle in

breathing. no

breathing. No

tenderness, pain.

:
A. Posterior
thorax

tenderness, pain.
has a normal
breath sound

B. Anterior
thorax

teeth due to

Inspection,

and pattern.
Sternum is

Sternum located at

palpation,

positioned at the

the midline and

Normal

Normal

percussion,

midline and

straight. Relaxed,

auscultation

straight.

effortless and quite

respiration is

during respiration.

relaxed,

No use of

effortless and

accessory muscle.

quite. Use of
accessory
muscle is not
seen with normal
respiratory effort.
No tenderness or
pain palpated.

C. Breathin
g

Inspection,

Respiratory rate

Respiratory rate of

Patient

Auscultation

of 12 to 20

19 per minute

breathing

counts per

pattern is

minute. Lung

normal.

sounds are clear


to auscultation

D. Heart
Rate

Palpation

bilaterally.
Heart rate of 60

Heart rate of 78

Patient known

to 100 beats per

beats per minute.

hypertensive

minute. Blood

And blood

bp of 140/90

pressure is

pressure of 140/90

is normal to

within 90-120/

E. Breast

F. Abdome
n

her.

Inspection,

60-90 mmhg
Texture is

Breast are equally

palpation

smooth with no

in size and smooth

edema. Areolas

in texture. Areolas

vary from pink to

are dark brown in

dark brown.

color. there is no

nipples are

tenderness upon

equally bilateral

palpation.

Inspection,

in size
Abdomen is free

Abdomen has

palpation,

from lesions,

same color with

auscultation,

tenderness or

the face. Bowel

percussion

pain and

sound are slightly

palpable

heard on

masses.

auscultation.

Normal.

Normal

Umbilicus is free
from swelling
bulge and

G. Lower
extremiti
es:
A. Legs

Inspection,

masses.
Skin color varies

He has brown

palpation

within the normal

complexion,no

range, skin is

lesions, absence

smooth no

of varicose veins

lesions, absence

and there is

Normal

of varicose

presence of good

veins. And there

muscle tone.

is presence of
good muscle

H. Mental
Status

Listening,

tone.
The patient

Patient is awake

Observation

should be

and cooperative

conscious and

upon assessment.

aware in her
surroundings.

Normal

Anatomy and Physiology

The inner ear (internal ear, auris interna) is the innermost part of the vertebrate ear. In
vertebrates, the inner ear is mainly responsible for sound detection and balance. [1] In
mammals, it consists of the bony labyrinth, a hollow cavity in the temporal bone of the
skull with a system of passages comprising two main functional parts:[2]
The cochlea, dedicated to hearing; converting sound pressure patterns from the outer
ear into electrochemical impulses which are passed on to the brain via the auditory
nerve.
The vestibular system, dedicated to balance

The inner ear is found in all vertebrates, with substantial variations in form and function.
The inner ear is innervated by the eighth cranial nerve in all vertebrates.

PATHOPHYSIOLOGY OF OTOCONIA
Precipitating factor:
Predisposing
factor:
8

Age (57)
Female

Behavior
Environment
Life style

Otoconia

Dislodged from labyrith


within the urticle and migrate
to semicircular canal.
Triggering Actions:

When head is reoriented


relative to gravity.

Signs and
symptoms:
-

Spinning
dizziness
Can be
induced by a
change
position.
Nausea
Feeling faint
or fainting.

DRUG STUDY

Movement of the heavier


otoconial debris within the
affected semicircular canal.
Fluid endolymph
displacement. fluid in the
direction of flow

Sensation of vertigo.

Tilting of the head


Rolling over in bed
Looking up or under
Sudden head motion.

PhARMACOKINETICS

PHARMACODYNAMICS

PHARMACOTHERAPEUTICC

Generic Name:

Indication

Nursing responsibilities

Serc

Menieres Disease Vertigo

assess patients fever or

Classification:

Tinnitus sensory neural

pain: type of pain, location,

Antiemetic and Anti vertigo

deafness

intensity, duration,

Tablet:

Contraindication

8mg,16mg,24mg

Previoushypersensitive

Mechanism of action:

reaction tothe drugcomponents

It has ahistamine-like action.

Adverse Effect

Itis readilyabsorbedfrom

-Urticarial

thegastrointestinal tract. It

-Pruritus

isconverted

-Mildgastriccomplaints

totwometabolitesand

-False heartbeat

peakconcentrations in blood

-Insomnia

of the twometabolitesare
achievedwithin 3 to 5hours.
Mostof a dose isexcreted
inthe urine, inthe form of
themetabolites,in about
3days.Themechanismof
action of betahistine isnot
known.Pharmacological

temperature and diaphoresis.


assess allergic reactions
such as: urticaria, if this
occurs, drug may have to be

discontinued.
teach patient to recognized
signs of chronic overdose:
bleeding, bruising, malaise,

fever, sore throat.


tell patient to notify prescriber
for pain/ fever lasting for
more than 3 days..

testing inanimals hasshown


thatthe bloodcirculation inthe
striaevascularis of the inner
earimproves,probably
bymeans of arelaxation of the

PHARMACOKINETICS
Generic Name:
Stugeron

PHARMACODYNAMICS
Indication
Control of vestibular

PHARMACOTHERAPEUTIC
Nursing responsibilities:
-

Administer medication

Brand Name:

symptoms of both

three times a day after

Cinnarizine

peripheral and central

meal.
Provide quite room.

Classification:

origin and of labyrinthine

Antihistaminics, antiemetics and antivertigo


preparations.

disorders including vertigo,


dizziness, tinnitus,
nystagmus, nausea and

Warning: This medicine may


lead to drowsiness and
impaired concentration, which
may be aggravated by

Dosage:

vomiting.

simultaneous intake of

25mg

Prophylaxis of motion

alcohol or other central

Frequency:

sickness.

nervous system depressants.

TID

Adjunct therapy for

Patients should not operate

Mechanism Of Action:

symptoms of peripheral

hazardous machinery or drive

Cinnarizine inhibits

arterial disease.

motor vehicles or perform


potentially hazardous tasks

contractions of vascular
smooth muscle cells by
blocking calcium

Contraindication
In patients with known

channels. Cinnarizine

hypersensitivity to

increases erythrocyte

cinnarizine.

deformability and

The safety of STUGERON

decreases blood viscosity

tablets in pregnant and

in vitro. Cinnarizine

lactating women has not

inhibits stimulation of the

been established.

vestibular system.

Parkinson's disease.

Adverse Effect
drowsiness, sweating,
dry mouth, headache, skin
problems, lethargy,
gastrointestinal irritation,
hypersensitivity reactions,

where loss of concentration


may lead to accidents

as well as movement
problems/muscle rigidity,
and tremor.

NURSING CARE PLAN


Assessment
Subjective:

Diagnosis
Disturbed

Planning
After several

Nahihilo ako.

sensory

hours of

relaxation

hours of

As verbalized

perception

nursing

techniques,

nursing

by the patient.

related to

intervention

music

intervention the

otoconia As

the patient will

therapy, and

patient will be

manifested

be able to

meditation to

able to report

by dizziness.

report

prepare for

improvement

improvement

rest/sleep.
Provide calm,

and decreases

Objective:
- Pallor
- Fatigue

Intervention
Instruct in

Evaluation
After several

- Body

and

quiet

level of

weakness

decreases

environment

dizziness.

level of

and manage

dizziness.

controllable
sleepdisrupting

factors.
Administer
medication as
ordered by

her physician.
Listen to
clients /SOs
subjective
reports of any
abnormality
feeling.