C/O feeling dizzy

MrNurse(x2), ADN · Nov 20, 2015

Another rabbit hole you can go down is a recent head injury. That could probably add another ten minutes to the visit. This is a difficult trail even in acute settings.

Flare, ASN, BSN · Nov 20, 2015

i won't check their sugar unless they are diabetic and already have those orders set up, but i do offer some juice, resting for a moment. These kids are chronically dehydrated. But honestly, if they come skipping into my office, laughing and smiling with a friend and tell me that they're dizzy then i usually chalk it up to good old fashioned malingering.

akulahawkRN, ADN, RN, EMT-P · Nov 20, 2015

i won't check their sugar unless they are diabetic and already have those orders set up, but i do offer some juice, resting for a moment. These kids are chronically dehydrated. But honestly, if they come skipping into my office, laughing and smiling with a friend and tell me that they're dizzy then i usually chalk it up to good old fashioned malingering.

I'm an ER nurse... every single patient I've seen to date that complained of dizziness or vertigo NEVER were laughing/smiling/drinking Starbucks... they always looked really uncomfortable and were too afraid to eat/drink anything because of nausea.

abc123RN · Nov 20, 2015

The times I covered the high school, after checking everything already mentioned, I would have them rest quietly for a few minutes to see if the dizziness went away. Usually resolved on it's own. I would also check to see where they might have come from i.e. gym, out doors. Usually it just turned out to be a break from class though.

JenTheSchoolRN, BSN, RN · Nov 20, 2015

I usually have them sit with a cup of water for a couple of minutes. In that time, I can do a visual assessment on pallor, respiration, demeanor. Most kiddos that just needed a break are actively talking, smiling, etc. The ones I break down to do a vitals check are pale, sweating, c/o nausea, hands shaking, look overall uncomfortable, etc. I will say that dehydration after gym is often when I see those types of kids. But I have also seen dizziness with ear infections - some of those kids seem a bit unsteady with their gait as well.

bebbercorn · Nov 21, 2015

Don't forget the anxiety component. Here are some things I check as an ER nurse...

1- is the room spinning? Are your ears ringing? Did your hearing change (check with a whisper test, for example). This could be vertigo or inner ear problem, menieres...

2) do you feel like you may pass out - r/o cardiovascular cause... orthostatic VS, heart sounds even, regular, peripheral pulses strong/weak, cap refill...

3) Disequilibrium - tripping over feet, problems "turning on a dime" etc to check for gait abnormalities or peripheral probe (unlikely in healthy teens, more with things like Parkinsons or peripheral neuropathy

4- "Lightheadedness" or vague complaints can be psych related.

Check for euro hx - migraines, etc. Do they take meds? Pregnant? A million causes for "dizziness," if nervous, get them to a doc! Good luck!

ContraryMary · Nov 23, 2015

Thank you all for the tips. I'm writing them down for next time.

The anxiety/panic attacks need to be another thread. It is unreal here. Last week I was having anywhere from 1-3 kids a day having anxiety attacks...

jhlpn · Nov 23, 2015

Find out if your school has a Therapeutic Day Treatment program. (counselors who are in the school through private agency). Some of the kids that come in with anxiety attacks and such I will let them vent or then I will send them to Guidance office.

RatherBHiking, BSN, RN · Nov 24, 2015

The most common cause of dizziness I see in the schools is fluid behind the ears. I did have one child tell me she had been spinning around in circles when it started. :roflmao: We cannot check blood sugar without a dr order. If all vitals normal, gait steady, neuro check fine, acting fine, etc I just have them rest and give a drink and it's usually resolves. If I'm worried I'll call the parent and suggest a dr visit if it continues.

toomuchbaloney · Nov 25, 2015

I would assess the ability to stand still with eyes closed.

Do they have nystagmus if you turn their head side to side when lying flat? (be prepared for emesis if they do)

Can they successfully touch their finger to their nose with eyes closed?

I would agree that the kid with actual dizzyness or vertigo is likely to have an unwell appearance as acute episodes are generally associated with nausea and vomiting.

kidzcare · Nov 30, 2015

The most common cause of dizziness I see in the schools is fluid behind the ears.

When a kid tells me they are dizzy, the first thing I ask is if they have a cold. Then if they stood up fast or were stretching.