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Cleansweep RN

A. General Information:

  • Is also called endolymphatic hydrops, it refers to the dilation of endolymphatic system by over production or decreased absorption of endolymphatic fluid.
  • Disease of inner ear characterized by recurrent and usually progressive triad of symptoms: Vertigo, Tinnitus and Unilateral sensorineural hearing loss.
  • Symptoms occur in attacks and last for several days, and the client becomes totally incapacitated duringthe attacks.
  • Incidence highest between ages 30 and 60.
  • Initial hearing loss is reversible but as the frequency of attacks continues, hearing loss becomes permanent.
  • Cause unknown, theories include allergy, toxicity, localized ischemia, hemorrhage, viral infection or edema.
  • Repeated damage of cochlea caused by increased fluid pressure leads to permanent hearing loss.

B. Nursing Assessment

  • Feeling of fullness in the ear
  • Tinnitus, as continuous low pitched roar or humming sound, that is present much of the time but worsens just before and during severe attacks.
  • Sudden attacks of vertigo lasting hours or days; attacks occur several times a year.
  • Vomiting, nystagmus
  • Nausea and vomiting
  • Severe headache
  • Diagnostic test: Audiometry reveals sensoineural hearing loss; Vestibular tests: reveal decreased function.

C. Nursing Interventions

  • Maintain bed rest in a quite, darkened room in position of choice, elevate side rails as needed.
  • Provide kidney basin for vomiting.
  • Monitor intake and output.
  • Provide assistance with walking.
  • Instruct the client to move the head slowly to prevent worsening of the vertigo.
  • Instruct patient to stop smoking.
  • Administer nicotinic acid (niacin) as prescribed for its vasodilatory effect.
  • Administer antiemetics as prescribed.
  • Administer antihistamines as prescribed to reduce the production of histamine and inflammation.

D. Medical Management:

  • Acute Phase: atropine (decreases autonomic nervous system activity), diazepam (Valium), fentanyl, and droperidol (Innovar).
  • Chronic Phase: vasodilators (nicotinic acid), diuretics, mild sedatives and tranquilizers (Valium), Antihistamines (Benadryl), meclizine (Antivert)
  • Low sodium diet; restrict fluid intake, caffeine and nicotine.

E. Surgical Interventions:

  • Surgical destruction of labyrinth causing loss of vestibular and cochlear function
  • Endolymphatic sac decompression or shunt to equalize pressure in endolymphatic space

F. Post Operative Interventions:

  • Assess packing and dressing on the ear
  • Speak to the client on the side of the unaffected ear.
  • Perform neurological assessment
  • Maintain side rails and assist in ambulating.
  • Encourage patient to use bed side commode rather than ambulating to the bathroom

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