Etiology According to (Burton, 1990: 170), namely: a) vestibular lesions physiologic Labirinitis Meniere Drugs; such as quinine, salicylates. otitis media "Motion sickness" "post-traumatic Benign positional vertigo" b) the vestibular nerve lesions acoustic neuroma Drugs; eg streptomycin vestibular neuronitis c) Lesions of the brain stem, cerebellum or temporal lobe infarction or hemorrhage pons vertebro-basilar insufficiency Migraine basilar artery Sklerosi disseminated Tumor Siringobulbia temporal lobe Epilepsy According to (http://www.kalbefarma.com) 1. Peripheral vestibular system disease: a. Outer ear: wax, foreign objects. b. Middle ear: tympanic membrane retraction, akuta purulent otitis media, otitis media with effusion, Labirintitis, cholesteatomas, involuntary with bleeding. c. Inner ear: Labirintitis akuta toksika, trauma, vascular attack, allergies, labyrinth hydrops (Morbus Meniere), drunken movements, postural vertigo. d. Nerve VIII. : Infection, trauma, tumor. e. Core Vestibular: infection, trauma, bleeding, serebeli posterior inferior artery thrombosis, tumors, sclerosis multiplex. 2. CNS disease: a. Hypoxia ischemia brain. : Chronic hypertension, atherosclerosis, anemia, cardiovascular hypertension, paroxysmal atrial fibrillation, aortic stenosis and insufficiency, carotid sinus syndrome, syncope, orthostatic hypotension, heart block. b. Infection: meningitis, encephalitis, abscess, lues. c. Head trauma / maze. d. Tumors. e. Migraines. f. Epilepsy. 3. Endocrine disorders: hypothyroidism, hypoglycemia, hipoparatiroid, tumor adrenal medulla, a state-pregnant-menopausal period. 4. Psychiatric disorders: depression, anxiety neurosa, hyperventilation syndrome, phobias. 5. Eye disorders: abnormalities proprioseptik. 6. Intoxication.
Pathophysiology Vertigo occurs if there is a mismatch of afferent information delivered to the center of consciousness. Afferent arrangement is important in this system is the arrangement of vestibular or balance, which is continuously deliver impulses to the center of balance. Another arrangement is the role of optical systems and pro-prioseptik, pathway-pathway linking the vestibular nuclei with the nuclei N. III, IV and VI, vestibuloretikularis arrangement, and vestibulospinalis. Useful information for the balance of the body will be captured by receptors vestibular, visual, and proprioseptik; vestibular receptors contribute the most, ie more than 50% followed later visual receptors and the smallest contribution is proprioseptik. Under physiological conditions / normal, which arrived at the central information integration tool body balance derived from receptors vestibular, visual and proprioseptik left and right will be compared, if everything is in a state of synchronous and reasonable, will be processed further. Responses that emerged in the form of adjustment and eye muscles in the body driving state of motion. In addition, people are aware of the position of the head and body to the surrounding environment. If the function of balancing tool in peripheral or central body in abnormal conditions / not physiological, or there is a strange movement stimuli or excessive, then the information processing is impaired, resulting in symptoms of vertigo and autonomic symptoms; beside it, the response becomes muscle adjustment adequate so that it appears abnormal movements that can be nystagmus, unsteadiness, ataxia when standing / walking and other symptoms (http://www.kalbefarma.com).
Classification of Vertigo Based on clinical symptoms, vertigo can be divided into several groups: 1. Paroxysmal vertigo Ie vertigo attacks come suddenly, last a few minutes or days, then disappeared perfect: but once the attack may appear again. In between attacks, patients completely free complaint. This type of vertigo can be divided into: 1) Those with ear complaints: Included in this group are: Morbus Meniere, Arakhnoiditis pontoserebelaris, Lermoyes Syndrome, Cogan's Syndrome, cranii posterior fossa tumors, abnormalities of teeth / odontogen. 2) The complaint without ears; included here are: Ischemic Attack cursory vertebrobasilaris artery, Epilepsy, Migraine equivalent, Vertigo in children (Vertigo de L'enfance), Maze trigger (trigger labyrinth). 3) The onset is affected by changes in position, included here are: latent paroxysmal positional vertigo, benign paroxysmal positional vertigo. 2. Chronic Vertigo Namely persistent vertigo, constant complaint without (intangible. 144, 2004: 47) acute attacks, can be divided into: 1) The complaint accompanied by ear: Otitis media chronica, Tb meningitis, chronic Labirintitis, Cerebral Lues, maze lesions caused by ototoxic materials, serebelopontin tumor. 2) Without complaint ear: Cerebral contusions, Pontis encephalitis, post-Komosio syndrome, pellagra, siringobulbi, hypoglycemia, multiple sclerosis, ocular abnormalities, drug intoxication, psychological disorders, cardiovascular disorders, endocrine disorders. 3) Vertigo-influenced position: Orthostatic hypotension, cervical vertigo. 3. Sudden attacks of vertigo / acute, then gradually reduce, divided into: 1) Accompanied ear complaints: Trauma maze, herpes zoster otikus, Labirintitis akuta, bleeding maze, neuritis n.VIII, injury to the internal auditory / vestibulocochlear artery. 2) Without complaint ear: vestibular neuronitis, anterior vestibular artery syndrome, encephalitis vestibular, vertigo epidemika, sclerosis multiplex, hematobulbi, serebeli posterior inferior artery blockage. There is also a vertigo split into: 1. Vestibular vertigo: due to abnormalities of the vestibular system. 2. Non vestibular vertigo: a disorder somatosensory and visual systems.
Clinical manifestations A whirling sensation that is sometimes accompanied by symptoms related to reak and humid that nausea, vomiting, severe headache taste, appetite down, tired, pale tongue with sticky white membrane, weak pulse, headache (dizziness), headache, blurred vision, tinnitus , bitter mouth, red eyes, irritability, restlessness, red tongue with thin membrane.
Supporting examination 1) Physical examination: The eye examination The perusal of the balance of the body Neurologic examination Inspection otologik A general physical examination. 2) Special examination: ENG audiometry and BAEP Psychiatric 3) Additional examination: Laboratory radiological and Imaging EEG, EMG, and ECG.
Medical management. Therapy according to (intangible. 144, 2004: 48): Consists of: 1. Causal therapy 2. Symptomatic therapy 3. Rehabilitative therapy
Nursing Management 1. Assessment a. Activity / Rest • Fatigue, weakness, malaise • Limitations of motion • Tension eyes, difficulty reading • Insomnia, waking up in the morning with a head ache • severe headache when changes in posture, activity (work) or because of changes in weather. b. Circulation • History of hypertension • vascular pulsations, eg temporal region • Pale, the face looks rosy. c. Ego Integrity • Emotional stress factors / environment specific • Changes in disability, despair, hopelessness depression • Fears, anxiety, headaches receptors during • Mechanisms refresif / dekensif (chronic headaches) d. Food and fluid • Foods that are high vasorektiknya eg caffeine, chocolate, onions, cheese, alcohol, wine, meat, tomatoes, fatty foods, citrus, sauces, hotdogs, MSG (the migraine). • Nausea / vomiting, anorexia (for pain) • Weight loss e. Neurosensoris • Dizziness, disorientation (for headaches) • History of seizures, a recent head injury, trauma, stroke. • Aura; facial, olfactory, tinnitus. • visual changes, sensitivity to light / sound harsh, Epitaksis. • Parastesia, progressive weakness / paralysis of the hand tempore • Changes in speech patterns / thought patterns • Easily aroused, sensitive to stimulus. • Decreased deep tendon reflexes • papilledema. f. Pain / comfort • Characteristics of pain depends on the type of headache, eg, migraine, tension, cluster, brain tumors, post-traumatic, sinusitis. • Pain, redness, pale in the face • Focus narrows • Focus on self sndiri • Emotional Response / undirected behavior such as crying, restless. • The muscles also tighten the neck area, frigidity vocals. g. Security • History of allergies or allergic reactions • Fever (headache) • Impaired gait, parastesia, paralysis • purulent nasal drainage (on the sinus headache) h. Social interaction • The change in responsibility / role of social interaction associated with the disease. i. Counseling / learning • History of hypertension, migraine, stroke, illness in the family • Use of alcohol / other drugs, including caffeine. Oral contraceptives / hormone, menopause.
2. Nursing Diagnosis (Doengoes, 1999:2021) 1) pain (acute / chronic) associated with stress and tension, irritation / nerve pressure, vasospressor, characterized by increased intracranial stating that pain is influenced by such factors, changes in position, changes in sleep patterns, anxiety. 2) ineffective individual coping related to non-adekuatan relaxation, coping methods are not adequate, excess workload. 3) Lack of knowledge (learning need) regarding condition and needs medication associated with cognitive limitations, do not know given the lack of information and characterized by asking information, non-adekuatannya follow instructions.
3. Nursing Interventions a) pain (acute / chronic) associated with stress and tension, irritation / nerve pressure, vasospasm, increased intracranial states characterized by pain that is influenced by such factors, changes in position, changes in sleep patterns, anxiety. Purpose: Pain is lost or reduced Criteria results: - client revealed reduced pain - Normal vital signs - The patient was calm and relaxed Intervention / Implementation Monitor vital signs, the intensity / pain scale Rationale: Identify and facilitate the conduct of nursing actions. Encourage clients to rest in bed Rationale: The break to reduce the intensity of pain Position the patient as comfortable as possible Rationale: The correct position reducing stress and prevent muscle tension and reduce pain.
Teach relaxation techniques and breathing in Rational: relaxation reduces tension and create a feeling more comfortable Collaboration for providing analgesic. Rationale: useful analgesic to reduce pain so that patients become more comfortable.
b) ineffective individual coping related to non-adekuatan relaxation, coping methods are not adequate, excess workload. Goals: be more adequate individual coping Results Criteria: - identify the behaviors that are not effective - Reveal awareness about coping abilities which is owned - Megkaji accurate current situation - Shows the lifestyle changes necessary or appropriate situations. Intervention / Implementation Assess the physiological capacity of a general nature. Rationale: Knowing the extent and identify deviations physiological functions of the body and ease the nursing action Advise the client to express his feelings. Rationale: The client will feel relief after revealing all his feelings and become calmer Provide information about the cause of headache, sedation and expected results. Rational: that the client knows the condition and medication, and provide hope and encouragement to the client recovers.
Approach the patient with friendly and attentive, taking advantage of the activities that can be taught. Rational: make clients feel more meaningful and appreciated.
a) Lack of knowledge (learning need) regarding condition and needs medication associated with cognitive limitations, do not know given the lack of information and characterized by asking information, non-adekuatannya follow instructions. Purpose: The patient expressed understanding of the conditions, procedures and effects of the treatment process. Results Criteria: - perform the necessary procedures and explain the rationale of an action. - Initiate the necessary lifestyle changes and participate in treatment regimen. Intervention / Implementation: Assess the level of knowledge of the client and family about the disease. Rational: megetahui how much experience and knowledge of the client and family about the disease. Provide a description of the client about his illness and his condition now. Rational: to know the diseases and conditions are present, the client and his family will feel calm and reduce anxiety. Discuss the individual causes of headaches if known. Rational: to reduce the client's anxiety and increase client knowledge neighbor illness. Ask the client and reiterated family of materials that have been given. Rational: knowing how far the client and family understanding and assessing the success of the action taken.
Discuss the importance of the position or location of the body's normal Rational: that the client is able to do and change the position / location of the body is not good. Instruct patient to always pay attention to that experienced headaches and related factors. Rational: to pay attention to factors related clients can reduce their own headaches with simple actions, such as lying down, resting on the time of the attack.
4. Evaluation Evaluation is the systematic comparison of the patient's health or well-planned with its intended purpose, is done by continuous, involving patients, families and other health professionals. (Carpenito, 1999:28) Return on vertigo goals are: a. Pain can be eliminated or overcome. b. Lifestyle or behavioral changes to control or prevent recurrence. c. Understanding the needs or conditions of disease processes and therapeutic needs.
Refference
1. Lynda Juall carpernito, Rencana Asuhan keperawatan dan dokumentasi keperawatan, Diagnosis Keperawatan dan Masalah Kolaboratif, ed. 2, EGC, Jakarta, 1999.
2. Marilynn E. Doenges, Rencana Asuhan Keperawatan pedoman untuk perencanaan dan pendokumentasian pasien, ed.3, EGC, Jakarta, 1999.
3. http://www.kalbefarma.com/files/cdk/files/14415TerapiAkupunkturuntukVertigo.pdf/144_15TerapiAkupunkturuntukVertigo.html
4. Kang L S,. Pengobatan Vertigo dengan Akupunktur, Cermin Dunia Kedokteran No. 144, Jakarta, 2004.
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