Nursing Care Plan

MENIERE’S DISEASE

In Partial Fulfilment of the

Requirements in NCM-212 RLE

METABOLISM ROTATION

Submitted to:
Gemshe M. Santos, RN,
Clinical Instructor

Submitted by:
Janiel Kayyi D. Torralba, St.N.
BSN 3E GROUP 1

MAY 21, 2022

Lenlen Marcos a 46 year-old female was admitted due to severe dizziness, sudden loss of balance, ringing in the ear, blurring of the eyes upon the
attack, and nausea & vomiting. She verbalized experiencing mild dizziness, headaches, and loss of balance episodes for quite some time, but refused
to be taken to the hospital since “abi nakog normal ra ni kung kapuyon ko…pero tung ni grabi najud nagpahospital najud ko”, “kanang lain kaayo ako
paminaw murag galabo akoang pananaw niya nikalit rajud kog kahilo pagkahuman nilabad ako ulo”, “nakadungog kog saba na tingog diri sa akong
wala na dalunggan niya nawadan kog balanse…may nalang naa ako anak nakakita sa akoang kahimtang na gunitan ko niya dayon”, “naka suka kog
gamay kay lain kaayo ako paminaw”. When she was asked how she was feeling right now she responded “karon kay murag bugat akoang wala na
dalunggan”. After tests she was diagnosed with Meniere’s disease due to presence of fluid in the left ear based on electrocochleography and loss of
balance during electronystagmogram.

CLUSTERING OF CUES:

CLUSTERED DATA NURSING DIAGNOSIS PRIORITY

(Diagnostic Label)
HEALTH PERCEPTION/ HEALTH MANAGEMENT
 Severe dizziness Risk for Falls High Priority (1)
 Sudden Loss of balance Risk for Injury High Priority (2)
 Blurring of eyes
 Ringing in the left ear
 Feeling of fullness in left ear
 Nausea & vomiting
 History of dizziness, headache, and loss of
balance episodes
 Presence of fluid in the left ear based on
 Electrocochleography
 Loss of balance during Electronystagmogram

NUTRITIONAL-METABOLIC
 Nausea & vomiting Nausea Medium Priority (1)
 Severe dizziness
 Sudden Loss of balance

ELIMINATION
N/A N/A
ACTIVITY - EXERCISE
 History of dizziness, headache, and loss of Impaired physical mobility Medium Priority (2)
balance episodes
 Disturbed gait
COGNITIVE – PERCEPTUAL
N/A N/A N/A
SLEEP - REST
N/A N/A N/A
SELF-PERCEPTION/ SELF-CONCEPT
N/A N/A N/A
ROLE - RELATIONSHIP
N/A N/A N/A
SEXUALITY - REPRODUCTIVE
 N/A N/A N/A
COPING/ STRESS-TOLERANCE
N/A N/A N/A
VALUE - BELIEF
N/A N/A N/A

Name of Patient: Marcos, Lenlen Age: 46 years old Sex: Female Attending Physician: Dr. Chua Ward: San Lorenzo

Chief Complaint: Severe dizziness, loss of balance, ringing in the ear, headache, nausea & vomiting Diagnosis: Meniere’s disease

DATE
& CUES NEEDS NURSING DIAGNOSIS PATIENTS INTERVENTIONS IMPLE EVALUATION
TIME OUTCOME MENTA
TIONS
M  “Kanang lain Risk for falls as evidenced Within the 8-hour  Establish rapport. May 21, 2022
A kaayo ako H by severe dizziness, span of care the R: Facilitates better influence, 1 @ 3PM
Y paminaw E sudden loss of balance, patient will be able understanding, and learning GOAL PARTIALLY MET
murag galabo A blurring of eyes, ringing to: since the disease may cause
2 akoang L and feeling of fullness in a. Integrate medical hearing difficulty, and MD At the end of the 8-hour
1, pananaw niya T the left ear, and nausea & compliance to patients are prone to develop span of care the patient
nikalit rajud H vomiting associated with relieve symptoms distress, anxiety, and was be able to:
2 kog kahilo Meniere’s disease. of vertigo. depression (Newman, 2020). a. Integrate medical
 0 pagkahuman P b. Determine  Administer Diuretics, compliance to
2 nilabad ako E Rationale: Meniere’s environmental Steroids, 2 relieve symptoms of
2 ulo” R disease causes factors that will Vestibulosuppressants, vertigo by taking
 “Nakadungog C endolymph buildup in the lead to falls. Motion sickness, and prescribed
7AM kog saba na E labyrinth, which interferes Anti-nausea medications on
tingog diri sa P and distorts the vestibular c. Implement medications, as ordered. schedule, adhering
akong wala na T system causing non- management to medicine
R: Help alleviate symptoms.
dalunggan niya I rotational vestibular techniques to treatment, and made
o Diuretics reduce fluid in
nawadan kog O symptoms, hearing loss, avoid falls. a medicine chart
your ear.
balanse…may N and tinnitus (Li, 2020). with significant
o Steroids treat
nalang naa ako - Extreme symptoms, others.
especially vertigo, during endolymphatic hydrops
anak nakakita H o “maayo na
sudden drop attacks, lead because of their anti-
sa akoang E ako paminaw
to loss of balance, blurring inflammatory
kahimtang na A karon, wa
of vision, falling, and properties.
gunitan ko niya L nako
nausea & vomiting o Vestibulosuppressants
dayon” T nahilo…lipay
(American Medical mask vertigo by dulling
 “naka suka kog H k okay
Association, 2020). the brain’s response to
gamay kay lain nitabang ako
M signals from the inner
kaayo ako pamilya mag
A ear.
paminaw” buhat ug
N o Motion sickness
 “karon kay schedule
A medications reduce the
murag bugat para sa
spinning sensation and
 akoang wala G help control nausea akong mga
na dalunggan” E and vomiting. tambal”
(As verbalized by M o Anti-nausea o “dapat
the patient) E medications control mutuman ko
N nausea and vomiting sa mga
Objective: T during an episode of gipang ingon
 Severe vertigo. sa doctor
dizziness P aron dili
(Li, 2020) 3
 Sudden loss of A kaayo lala
balance T mga
 Educate the patient and
 Blurring of T simtomas”
the family members on
eyes E
the treatment regimen
 Ringing in the R b. Determine
that the patient will
left ear N environmental
undergo.
 Feeling of factors that will lead

fullness in left R: Increases awareness to falls by identifying

ear about the importance of hazards in the care

 History of completing the prescribed setting.

dizziness, treatment and provides o “kahibaw

4
headache, increased compliance to such nako unsa

and loss of treatment (Wayne, 2022). ako dapat

balance hiposon ug
 episodes  Supervise patient and tarongon aron
 Presence of significant others in di ko mahulog
fluid in the left creating a medicine inig mubalik
ear based on schedule or chart. ako hilo”
Electrocochleo
R: Improves discipline,
graphy c. Implement
cooperation, and represents
 Loss of management
an additional reminder aid to 5
balance during techniques to avoid
provide communication with
Electronystag falls by learning
healthcare providers (Dietrich
mogram more about the
et. al., 2020).
disease, familiarizing

 Conduct safety with trigger factors,

assessment in home or promoting safety

care setting. measures by placing

call light and emesis
R: Performing an bucket near bedside,
environmental hazard raising side rails,
assessment determines the and lowering bed,
presence of objects or items implementing a non-
that could potentially cause triggering
injury and harm. Thus, it 6 environment,
should be removed or placed acknowledges the
into a safer space to ensure importance of
safety during unexpected attending treatment
attacks (Wayne, 2022). and therapies and
doing moderate
 Educate to identify balance exercises,
potential hazards and moves slowly,
risks in the encourages family's
surroundings to assistance.
facilitate a hazard-proof o “kasabot ko
home. ngano nay
posibilidad na
R: Prevent falls by:
magbalik-
o Getting rid of throw
balik ako hilo”
rugs, and use non-skid
o “pag-uli
mats.
nakog balay
o Install and use grab
magtabang
bars near the bathtub
kos ako
and toilet.
pamilya na
o Use night-lights.
magtarong sa
o Wear shoes with low
mga gamit
heels and non-slip
para iwas
soles.
o Keep floors dry to
 prevent slipping. aksidente”
o Store items you use o “ di dapat ko
often on low shelves to sigeg lihok
decrease climbing or lihok, ma
reaching high. minaw ug
o Use a step stool with saba kaayo,
handrails if need to ug magtanaw
climb, 7 sa mga
o Keep pathways at galihok na
home, driveways, suga kay
sidewalks, and other mutukar ako
walkways clear of hilo”
things that might cause
falls.

(Healthwise, 2020) Janiel Kayyi D. Torralba,

St,N.

 Enforce the need for

education and 8
understanding of the
disease.

R: Provides adequate
information to help the patient
and family manage the
disease effectively (Wayne,
2022).

9
 Discuss trigger factors
of vertigo.

R: Vertigo can be triggered by

various reasons, including
stress, overwork, fatigue,
sharp changes in weather and
air pressure, underlying
illness, bright lights, and loud
noises (WebMD, 2020).
10

 Educate about the

possibility of “drop
attacks”

R: Drop attacks is a rare

manifestation of MD, occurs
by sudden falls that occur
without an external physical
trigger (Whelan, 2019).
11
 Place call light within
reach and teach how to
call for assistance.

R: Being familiar with the

layout of the environment to
prevent accidents as too far
items may cause hazards
(Wayne, 2022).

12
 Promote safety
measures for sudden
attacks while in
admission by raising
side rails and lowering
bed.

R: Prevent injury from falls

due to sudden vertigo or drop
13
attacks that may cause harm
(Whelan, 2019).
 Place a bucket or any
container for vomitus
near bedside.

R: MD may result to nausea

and vomiting due to dizziness
(National Health Service,
2020) 14

 Teach to provide a non-

triggering environment
by dimming lights,
lowering blinds, and
decreasing volume of
any entertainment
system c.

15
R: A dark room lessens
vertigo triggers by decreasing
stimuli (WebMD, 2020).

 Sit down and rest during

a vertigo attack, if
 possible.

R: To avoid falls lying down in

a quiet, dark room, eyes
closed while taking deep
breaths reduces the sensation
of spinning (WebMD, 2020).
16
 Uphold strict bed rest if
an aura or prodromal
signs of an attack is
experienced.

R: Patients may feel restless

and need to ambulate,
defecate, or vomit during the
aural phase, which
inadvertently removes 17

themselves from a safe area

and direct observation
(Wayne, 2022).

 Encourage to promptly
report discomfort or
 when sensing an arising
attack.

R: For immediate medical

intervention since these
problems can also be caused
by other conditions (Mayo
Clinic, 2020)

 Explain the importance

of attending treatment
sessions and therapies.

R: Therapies help with

balance issues.
o Physical therapy is a
series of exercises that
can help with
imbalance, dizziness,
and other issues.
o Vestibular 18
rehabilitation therapy
is an exercise program
 that retrains brain to
use other senses, like
vision, to help with your
balance.
o Positive pressure
therapy uses a Meniett
device to apply
pressure to the ear
canal through a tube.
This improves fluid
movement through
your ear.

(Bhargava, 2020)

 Encourage performing
moderate exercises to
improve balance.

R: Help ease vertigo.

Exercises like:
o Holding a standing 19
position with feet
 together and arms at
sides for 30 seconds
then progressing to do
it while slowly moving
the head up and down
and side to side.
o Walk 5 steps and then
20
stop abruptly or turn
and walk backwards.
Wait for any dizzy
feeling to go away,
and do it again.
Repeat until you have
walked about 15
metres (50 feet). 21

(Healthwise, 2020)

 Teach the patient to

move slowly, like sitting
up slowly and taking a
few minutes before
standing up.
R: Sudden movements can
trigger dizziness (Mayo Clinic,
2020).

 Encourage family and

significant others to
accompany the patient.

R: Prevent debilitating injuries

that may cause further
complications (Wayne, 2022).

 Evaluate patient’s
understanding and
knowledge about the
disease.

R: Assesses the ability to

keep oneself away from harm,
adhere to treatment, and
reactiveness in management
(Wayne, 2022).
REFERENCES:

American Medical Association. (2020). Drop Attack in Meniere Disease. Retrieved on May 13, 2022, from https://edhub.ama-assn.org/jn-learning/video-

player/18471263#:~:text=Drop%20attacks%20are%20sudden%20falls,environmental%20tilt%20causing%20the%20fall.

Bhargava, H. (2020). Meniere’s Disease. Retrieved on May 13, 2022, from, https://www.webmd.com/brain/what-is-meniere-disease

Dietrich FM, Hersberger KE, Arnet IBenefits of medication charts provided at transitions of care: a narrative systematic reviewBMJ Open
2020;10:e037668. doi: 10.1136/bmjopen-2020-037668

Healthwise. (2020). Ménière's Disease: Care Instructions. Retrieved on May 13, 2022, from,

https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ut3011

Li, J. (2020). Meniere Disease (Idiopathic Endolymphatic Hydrops). Retrieved on May 13, 2022, from, https://emedicine.medscape.com/article/1159069-
overview#a2

Li, J. (2020). Meniere Disease (Idiopathic Endolymphatic Hydrops) Treatment & Management. Retrieved on May 13, 2022, from,

https://emedicine.medscape.com/article/1159069-treatment#d19

National Health Service. (2020). Ménière's disease. Retrieved on May 14, 2022, from, https://www.nhs.uk/conditions/menieres-

disease/#:~:text=Prevention-,Medicines,hearing%20loss%2C%20tinnitus%20and%20vertigo.

National Institute on Deafness and Other Communication Disorders. (2017). Ménière's Disease Retrieved on May 13, 2022, from,

https://www.nidcd.nih.gov/health/menieres-disease
Newman, T. (2020). What you need to know about Ménière's disease. Retrieved on May 14, 2022, from,

https://www.medicalnewstoday.com/articles/163888

Mayo Clinic. (2020). Meniere's disease. Retrieved on May 13, 2022, from, https://www.mayoclinic.org/diseases-conditions/menieres-disease/symptoms-

causes/syc-20374910#:~:text=Meniere's%20disease%20is%20a%20disorder,young%20and%20middle%2Daged%20adulthood.

Wayne, G. (2022). Noncompliance Nursing Care Plan. Retrieved on May 13, 2022, from, https://nurseslabs.com/noncompliance/

Wayne, G. (2022). Risk for Injury Nursing Care Plan. Retrieved on May 13, 2022, from, https://nurseslabs.com/risk-for-injury/

WebMD. (2020). Remedies for Vertigo. Retrieved on May 13, 2022, from, https://www.webmd.com/brain/remedies-vertigo

Whelan, C. (2019). What Is a Drop Attack? Retrieved on May 14, 2022, from, https://www.healthline.com/health/what-is-a-drop-attack