Instructions for the Learner

Transcription

1 Developing Top-Notch CNAs, One Inservice at a Time A Client Safety Module: DEALING WITH DIZZINESS We hope you enjoy this inservice, prepared by registered nurses especially for nursing assistants like you! Instructions for the Learner If you are studying the inservice on your own, please do the following: Read through all the material. You may find it useful to have a highlighting marker nearby as you read. Highlight any information that is new to you or that you feel is especially important. If you have questions about anything you read, please ask. Take the quiz. Think about each statement and pick the best answer. Check with your supervisor for the right answers. You need 8 correct to pass! Print your name, write in the date, and then sign your name. Keep the inservice information for yourself and turn in the quiz page to _ no later than. Show your Inservice Club Membership Card to so that it can be initialed. In the Know at feedback@knowingmore.com with your comments and/or suggestions for improving this inservice. After finishing this inservice, you will be able to: Describe the four sensory systems that help maintain balance. Compare the symptoms of light headedness, vertigo and syncope. List at least ten possible causes of dizziness. Discuss at least three ways to treat dizziness. Discuss how dizziness affects client safety. THANK YOU!

2 Developing Top-Notch CNAs, One Inservice at a Time Inside This Inservice: Staying Balanced 2 What Dizzy Really Means Vertigo 4 Syncope 5 Other Causes of Dizziness Treating Dizziness 7 Working with Dizzy Clients Safety Precautions In the Know, Inc. May be copied for use within each physical location that purchases this inservice from In the Know. All other copying or distribution is strictly prohibited A Client Safety Module: Dealing with Dizziness WOOZY, WOBBLY & GROGGY, OH MY! Dizziness is a common symptom in people of all ages. At least one third of all adults have experienced at least one episode of dizziness. But dizziness is particularly common in the older adult. Around 65 percent of people over the age of 60 experience dizziness or loss of balance, often on a daily basis. Dizziness is a "catch all" term used to describe many different feelings including lightheadedness, faintness, spinning, and unsteadiness. The cause of dizziness is often difficult to find. It may be the result of an ear infection, a side effect of medication, a heart problem, or even stress. Sadly, many older adults accept feeling dizzy as a normal part of aging and will delay or even fail to seek treatment. Unfortunately, untreated dizziness can severely impact a person's quality of life. Think about it. It would be hard to find joy in playing cards, watching TV or doing needlework if you were dizzy, right? Aside from being inconvenient, the consequences of being dizzy can be very serious. Most people who are dizzy are unsteady on their feet. As a result, dizziness is one of the major reasons that people fall down. Part of your job is to guard your client s safety and prevent falls and other injuries. In order to meet this responsibility, it s important to learn all you can about dizziness. After reading this inservice, you will know how to help keep clients with dizziness safe from falls and injuries, and even help relieve the symptoms of dizziness.

3 2012 In the Know, Inc. Page 2 STAYING BALANCED The brain uses input from four sensory systems to maintain a sense of balance and to keep the body orientated to the surroundings. The body can be thrown out of balance by a problem in any area of four areas. At least two of the systems must be properly functioning to maintain balance. VISION: The eyes provide information to the brain about the environment. For example, when we ride in a car, the eyes tell the brain that the world is rushing past, but our bodies are not moving. SKIN PRESSURE (TACTILE SYSTEM): There are pressure receptors all over the body that send messages about balance to the brain. For example, the receptors on the feet and buttocks inform the brain what part of the body is down and touching the ground. THE INNER EAR (VESTIBULAR SYSTEM): The inner ear contains fluid that helps the body keep its balance. As the body changes position, the fluid in the ear shifts. The inner ear also has tiny, little nerve cells that send messages to the brain to let it know which way the head is moving and to let the body know which way is up and which way is down. SENSORY NERVES (PROPRIOCEPTIVE SYSTEM): Sensory nerves in the joints help the brain keep track of where the legs, arms, and torso are situated. The brain uses this information to make tiny adjustments in posture to help maintain balance. DIFFERENT DEGREES OF DIZZINESS LIGHT HEADEDNESS Lightheadedness is when a person feels about to faint or "pass out." It usually goes away if the person lies down. VERTIGO Vertigo is when it feels like the room is moving. There may be a feeling of spinning or tilting. The person may have trouble walking or standing, and may even lose balance and fall. SYNCOPE Syncope (also known as fainting) is a type of balance disorder that results in a temporary loss of consciousness. Grab your favorite highlighter! As you read through this inservice, highlight five things you learn that you didn t know before. Share this new information with your supervisor and co-workers!

4 2012 In the Know, Inc. Page 3 WHAT DOES DIZZY REALLY MEAN? Dizziness is a vague term that people use to describe a variety of sensations including: lightheadedness, vertigo and syncope. Just think about all the ways there are to describe dizziness: I m a little unsteady on my feet. The room seems to spin when I stand up. I feel sort of woozy. It seems like I m floating. I get lightheaded if I don t eat every few hours. Remember that the brain collects information from the body in order to keep it balanced. The brain uses this information to create a kind of map to keep track of which way is up. The brain uses this map to tell the body how to keep balanced. Usually, this complex process happens without us thinking about it. However, sometimes, the brain receives mixed messages from the body... and dizziness occurs. For example: Tim is riding in the back seat of a car, reading a book. His inner ears and nerves are sending his brain the message that he is moving. But, his eyes see only the pages of his book. These mixed messages cause Tim to become car sick. Mr. Baker has an inner ear infection in his left ear. Because of the infection, his left ear does not send the same messages to his brain as his right ear. This causes Mr. Baker to feel like he is spinning. Most often, feelings of dizziness stem from the vestibular system which consists of the brain and the motion sensors located in the inner ear. Around 65 percent of people over the age of 60 experience dizziness or loss of balance, often on a daily basis. Family physicians report that 70 percent of their elderly patients complain of dizziness and that dizziness is the reason for 1/3 of all new patient visits each year. There are an estimated 5 to 8 million physician visits for dizziness in the United States each year. At least one third of all adults have experienced at least one episode of dizziness. Approximately 12.5 million Americans over the age of 65 have a dizziness or balance problem that significantly interferes with their lives. In the US, the estimated cost of medical care for patients with balance disorders exceeds $1 billion annually. Dizziness can be difficult to diagnose, particularly in elderly clients because often, more than one body system is involved.

5 2012 In the Know, Inc. Page 4 MORE ABOUT VERTIGO One common type of balance disorder is called vertigo. It is often associated with inner ear problems. In most cases of vertigo, the nerve cells in the inner ear send confusing information about body movement to the brain. The word vertigo comes from the Latin verb to turn. People who have a single episode of vertigo are likely to get better without treatments. More than two million people visit the doctor every year because vertigo is seriously interfering with their work or personal activities. The symptoms of vertigo can be brief and infrequent or they can last for days or even weeks. The symptoms of vertigo are similar to the feeling caused by getting off a spinning merry-go-round. They may include: True vertigo is almost always related to an inner ear disorder such as: Inflammation or infection. Fluid or wax build-up inside the ear. Tumors. A sensation of spinning or turning that is made worse by moving the head. Nausea. Vomiting. Another common inner ear disorder that causes vertigo is Meniere s disease. This condition usually appears in young adulthood. There are 100,000 new cases every year in the U.S. A common cause of vertigo among the elderly is benign positional vertigo. Generally, this condition appears suddenly when a person changes position such as getting up from bed or bending the head back to look up high. This type of vertigo can often be detected during a simple physical examination and is treatable. Vertigo can also be a symptom of MS or a stroke. Ringing in the ears. Jerky eye movements. Headache. Fatigue. Difficulty walking. WHEN YOUR CLIENT COMPLAINS OF DIZZINESS If your client complains of feeling dizzy... you ll want to report it right away to your supervisor. BUT WAIT! Before you report it, you can talk about it with your client to find out how serious the situation is. You can ask these questions: Do you have any chest pain, weakness in your arms or legs, or confusion? If yes, this is an emergency. Call 911 or start your workplace emergency procedure protocol. How long have you felt dizzy? Do you have an earache? (Check for fever). If your client has been feeling dizzy for more than three days, has an earache and/or a fever, report the symptoms to the nurse. Treatment should be started within 24 hours. Have you eaten? Started a new medication? Are you under any new stress? If the client has not eaten, provide a high protein, high carb snack. If a new medication was started, talk to the nurse about side effects. If stress is the problem talk to the nurse about stress reducing activities.

6 2012 In the Know, Inc. Page 5 MORE ABOUT SYNCOPE Syncope is a type of balance disorder that is often associated with low blood pressure and/or heart problems. During a syncope episode, there is a sudden, temporary loss of consciousness due to poor circulation to the brain. As many as one million Americans are treated for syncope every year. Syncope can lead to serious accidents. Every year, thousands of people are injured during an episode because of dizziness and loss of consciousness. This balance disorder occurs both with or without warning. Syncope can be a chronic problem, affecting people at any time during the day or night. The symptoms of syncope are related to a reduced flow of blood to the brain. They include: Syncope often results from a lack of blood circulating to the brain. This can be a sudden, temporary problem caused by coughing forcefully or straining to have a bowel movement. Dimmed vision. Loss of coordination. Confusion. Anxiety. Syncope can also be caused by a chronic circulation problem such as a heart problem or a partially blocked blood vessel in the neck or brain. (Even wearing a tight shirt collar can lead to syncope!) Some people experience this type of dizziness because of severe pain, emotional distress or as a reaction to stress. Syncope can also be caused by seizures. Doctors are unable to figure out the cause for up to 30% of syncope cases. Lightheadedness. Sweating. A brief loss of consciousness (fainting). Syncope is pronounced sink-o-pee. Three out of every one hundred emergency room visits are due to syncope. WHAT WILL YOU DO IF YOUR CLIENT FAINTS? 1. Have you ever had a client faint while your were on duty? If so, what did you do? 2. If you ve never experienced a client faint... what do you think you would or should do? 3. What is the difference between fainting and a life threatening emergency? (See page 6 for answers)

7 2012 In the Know, Inc. Page 6 WHAT ELSE CAN CAUSE DIZZINESS? There is no single cause for dizziness. In fact, there are many possible causes and people may be affected by several conditions at the same time. The causes of dizziness include both minor and serious conditions, such as: Problems with the inner ear including inflammation and infections. Meniere s disease. High or low blood pressure. A very slow, very fast or irregular heart rate. Heart disease. Low blood sugar. Head injuries. Migraine headache. Brain tumors. Multiple sclerosis. Epilepsy and/or seizures. With all these possible causes, you can see why doctors often have a hard time figuring out what is making a person dizzy. (Just thinking about all the possibilities can make a person dizzy!) However, there are a number of medical tests that may help pinpoint the problem, including: An EKG (to check how well the heart is pumping blood). A hearing test. An eye exam. A caloric test in which the doctor deliberately tries to make the patient dizzy. Blood tests to check for a variety of disorders and deficiencies. CT or MRI scans. Stroke. Allergies. Anemia. Alcohol consumption. Drug abuse. Medications. Drug allergies. Cataracts or eye muscle problems. A new pair of glasses. Anxiety. Panic attacks. Untreated syphilis. A high fever. Herpes zoster ( Shingles ) Infections of the brain such as meningitis or encephalitis. Arthritis because the joints and muscles may send the wrong message to the brain. Thyroid disorders. Severe pain. Traveling in a moving vehicle such as a car, boat or airplane. Caffeine. Malnutrition. Sunstroke. WHAT TO DO IF YOUR CLIENT FAINTS (Answers to Apply What You Know ) When someone is about to faint: Have the person lie down or sit down before the fainting happens. If the person is sitting, have him lean forward and place his head between his knees. If the person is lying down, place him on his back and raise his legs. Keep the person in this position for at least 5 minutes after the symptoms end. Help the person up slowly, continue to monitor and document properly. When a client actually faints: Lower the person to the floor and position her on her back. Elevate the legs and check for breathing and pulse. Report to the nurse right away! Is it fainting or an emergency: Loss of consciousness from fainting should only last for a few seconds. Going unconscious any longer or having no breathing or no pulse is an emergency!

8 2012 In the Know, Inc. Page 7 HOW IS DIZZINESS TREATED? The best way to treat dizziness is to fix the real root of the problem. For example, if Mr. Brown is dizzy because of an inner ear infection, he ll probably feel better after taking antibiotics. If Mrs. Wilson is dizzy because of an inner ear tumor, she ll need surgery to remove the tumor. In many cases, the cause of dizziness is not so easy to figure out... or to treat. Treatment may include a combination of the following methods. MEDICATIONS: There are a number of medications used to treat dizziness, including: Anti-dizziness drugs such as Antivert. Antihistamines such as Benadryl. Antinausea medications such as Phenergan. Motion sickness drugs such as scopolamine. Steroids such as prednisone. Antianxiety drugs such as Valium. DIET: Studies have shown that dizziness may be reduced by avoiding fluid build-up in the inner ear. There are some dietary suggestions that may help keep inner ear fluid under control. These include: LIFESTYLE CHANGES: The following actions may help reduce the frequency and/or severity of dizzy spells: Avoiding triggers like reading while riding in a car. Eating meals at regular times each day. Drinking plenty of fluids throughout the day. Learning exercises (from a physical or occupational therapist) to increase strength and improve balance. SURGERY: There are a number of surgical procedures that are performed to treat dizziness. They include: Eating a low-salt diet. Avoiding caffeine. Inserting a drain to prevent fluid build-up in the inner ear. Cutting back on sugar. Staying away from MSG. Repairing a leak in the inner ear by plugging it with a piece of fat or other body tissue. Drilling the bones of the inner ear. Inserting a pacemaker to maintain a steady heart rate. Working with clients in the home often requires coming up with creative solutions to uncommon problems. THE PROBLEM: You are caring for a 72 year old woman who lives alone. She suffers from dizziness every day when she gets out of bed. The dizziness lasts several hours and gets worse if she moves her head around. She has spoken to the doctor about it but has not yet found a solution to the problem. Now, she is worried about attending a family party next week. She fears fainting and falling. WHAT YOU KNOW: You know that dizziness is a leading cause of falls and injuries among the elderly. But, you also know your client would benefit emotionally from spending time with her family. GET CREATIVE: Think of 3 creative solutions you might suggest to your client to keep her safe and comfortable while attending the family party. TALK ABOUT IT: Share your ideas with your co-workers and supervisor and find out how they would solve the problem.

9 2012 In the Know, Inc. Page 8 HELPING CLIENTS DEAL WITH DIZZINESS Encourage your clients to get up slowly after eating, lying down or resting. Some people feel lightheaded when their body temperature drops. Help your clients maintain an even body temperature by dressing them appropriately for the weather and keeping them away from drafts. Remind your clients that drinking alcoholic beverages can affect their balance and reflexes. Encourage your clients to use any assistive devices such as a cane or a walker that will help them keep their balance. Make sure your clients wear supportive, rubber-soled shoes when they are moving around. Wearing only socks will increase their risk of falling. Let your supervisor know if a client reports poor vision or hearing. They may need to have their eyes and ears checked. If your clients have glasses and/or hearing aids, encourage them to wear them. They ll have better balance! If your client has a respiratory infection, such as a cold or the flu, watch carefully for signs of dizziness. The infection could spread to the inner ear. Keep your client s personal items within their reach so they don t have to stretch too far to get them. Encourage your clients to get some type of regular exercise. Having strong bones and muscles will help them keep their balance. If your clients have a special exercise plan that has been developed by a physical or occupational therapist, be sure to help them perform these exercises as ordered. Ask the therapist to teach you the exercises, if necessary. TRY THE ROMBERG TEST The Romberg Test is a simple test doctors can do to check how well a person can balance. This is also part of the field sobriety test police officers perform on drunk drivers. Try it with a friend or co-worker. Have the person stand straight with feet together and eyes open. The person should be able to maintain balance in this position. Now, have the person close her eyes. Stand close by just in case she loses her balance. If major swaying is noted, or if the person stumbles or falls... the Romberg Test is positive and there is a problem with balance. BUT, WHY? You learned on page 2 that the brain uses input from four sensory systems to maintain a sense of balance. When one is removed (in this case, vision), the body can make up for it by using the other systems. At least two of the systems must be intact to maintain balance. A positive Romberg Test indicates there is a problem in one or more of the other systems.

10 2012 In the Know, Inc. Page 9 EXTRA FALL PRECAUTIONS FOR DIZZY CLIENTS Clients who are dizzy are at an increased risk for falling. Help your clients manage the risk by making changes to the environment to reduce the risk of falls. Keep stairways and hallways well lit. Use night lights in hallways and bathrooms for night time trips to the bathroom. Wipe up spills immediately, especially on ceramic tile floors. If you clean your clients' homes, avoid waxing floors after mopping. Use a non-skid floor wax - if waxing is absolutely necessary. Use double sided carpet tape on area rugs or remove the rugs completely. Ask the family to repair or replace loose carpet or raised areas in the floor that may cause a fall. Keep all walkways clean and clutter-free. Rearrange furniture and electrical cords to keep them out of walking paths. Recommend the family have handrails and grab handles installed in the bathroom, hallways and on staircases. In the bathroom, use a shower chair or bath bench and nonskid mats inside and outside the shower or tub and near the toilet. Use remote switches (such as clap-on switches) or timers on lights so that clients will not have to walk across the room in the dark to turn on lights. Put things within easy reach so your client does not need to reach overhead for them. Keep a cordless phone and a flashlight with new batteries by your client's bed for emergencies. 1. Dizziness is common symptom in people of all ages but, it is particularly common and potentially dangerous in the older adult population. 2. The brain uses input from four sensory systems to maintain a sense of balance and to keep the body orientated to the surroundings. The four sensory systems are: vision, the vestibular, proprioceptive and tactile systems. 3. Dizziness is a vague term that people use to describe a variety of sensations including: lightheadedness, vertigo and syncope. 4. Most people who are dizzy are unsteady on their feet. As a result, dizziness is one of the major reasons that people fall down. 5. Keeping clients with dizziness safe from falls and other injuries should be your top priority.

11 2012 In the Know, Inc. Page 10 WATCH YOUR CLIENTS CLOSELY! As you work with clients who may suffer from dizziness, take note of the following: Ask the client what the dizzy spell feels like. Write down the answer in the client s own words. Watch for any kind of pattern for when the dizziness occurs. Is it always when the client is standing? Is it after taking medication? Is it at a certain time of day? If you see your client take an over-the-counter medication or supplement, let your supervisor know. Just like prescription drugs, these substances may also cause dizziness especially when mixed with other medications. Did the client eat or drink a particular food prior to becoming dizzy? Ask the client if there is anything that makes the dizziness go away. For example, does it help to lie down? Look for other changes in the client s condition that seem to come along with the dizziness. Watch for signs that your client s sight or hearing has changed. Remember that vision and hearing problems can lead to dizziness. Watch for changes in the way a client walks. For example, you may notice a client holding on to the wall while walking or being unable to walk in a straight line. These gait problems may stem from dizziness. Keep an eye out for signs that a client may have an episode of syncope. These signs include yawning, sweating, weakness and loss of color in the face. If you notice these signs, have your client lie down as soon as possible. REPORT THESE PROBLEMS RIGHT AWAY! Your client complains of dizziness PLUS double vision, blindness, difficulty with speech or swallowing, mental confusion, chest pain and/or numbness, tingling or weakness of an arm or leg. There is a significant change in your client s blood pressure reading. Your client loses consciousness and blacks out. Dizziness seems to be affecting your client s quality of life. Now that you ve read this inservice on dizziness, take a moment to jot down a couple of things you learned that you didn t know before.

12 Developing Top-Notch CNAs, One Inservice at a Time EMPLOYEE NAME (Please print): DATE: I understand the information presented in this inservice. I have completed this inservice and answered at least eight of the test questions correctly. EMPLOYEE SIGNATURE: SUPERVISOR SIGNATURE: A Client Safety Module: Dealing with Dizziness Are you In the Know about dizziness? Circle the best choice. Then check your answers with your supervisor! 1. Feeling as if the room is moving is known as: A. Lightheadedness C. Syncope B. Vertigo D. Drunkenness 2. The most common reason for dizziness comes from a problem with the: A. Skin receptors C. Inner ear B. Sensory nerves D. Vision 3. A sudden, temporary loss of consciousness due to poor circulation to the brain is known as: A. Lightheadedness C. Syncope B. Vertigo D. Fainting 4. The most important thing you can do for clients with dizziness is: A. Limit physical activities. B. Keep them safe from falls. C. Serve nutritious meals and snacks. D. Eliminate medications that cause dizziness. Inservice Credit: Self Study Group Study 1 hour 1 hour 5. True or False It s easy for doctors to diagnose and treat dizziness. 6. True or False Loss of consciousness from fainting should only last a few seconds. 7. True or False Wearing glasses and hearing aids as ordered can improve balance. 8. True or False Dizziness can severely impact a person s quality of life. File completed test in employee s personnel file. 9. True or False Dizziness is rare among the elderly. 10. True or False Dizziness with chest pain, weakness or confusion is a medical emergency.