C/O feeling dizzy

[ContraryMary]

I'm a new school nurse (with no orientation) at our local high school. What do you do when a student comes in and complains of feeling dizzy but everything checks out? I'm assessing vitals, lung sounds, heart, ears...just about every time I'll go ahead and check their sugar...ask about hydration. I'm sure some of them are faking because they know this ends up being a longer visit, but ya never know.

[kayakqueen]

Good assessment ideas in some previous posts....if everything checks out well and they're still complaining, I usually start with "boredom therapy" which is laying quiet on the cot in my office. Amazingly enough, that's usually just the cure. If after 10-15 they truly seem uncomfortable and/or have additional symptoms, I call a parent and they will likely go home. Mind you, I work with a K-8 crowd. That might not work with high schoolers.

[mc3, ASN, RN]

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...

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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!

In my case, the kid would answer 'yes' to every question, figuring one of the answers would be the golden ticket home

(I'm pretty good on determining who is really not feeling well, and who is looking for a way out of class for the day)

[JenTheSchoolRN, BSN, RN]

In my case, the kid would answer 'yes' to every question, figuring one of the answers would be the golden ticket home

For a lot of kids, yep. Which is why I observe myself for a minute without any questions. That observation is very telling.

Kids - especially those in MS and HS - learn quick that saying "yes" to anything on a checklist might get them that ticket home. The good thing about school nursing is that I really do get to know a lot of the kids and that means I can often tell within a minute if their behavior if "off" from the norm. *That* is when I get worried :).

[chasinRT]

In my case, the kid would answer 'yes' to every question, figuring one of the answers would be the golden ticket home

This.

[bebbercorn]

Yes, very true for this age group (and the melodramatic of all ages). Don't ask the pt each of these, ask them to describe it to you. "What do you mean by, 'feeling dizzy?'" That's how I get around it. The more vague the description, the more likely it's nothing to worry about, imho.