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Scared Patient, "The World is Spinning!": Nurse in Action

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Specializes in ED,Tele,Med surg, ADN,outpatient,homecare,LTC,Peds. Has 32 years experience.

How does a triage nurse get to the root of the problem?

Seven ED visits in three months! Dizzy, nausea, sweaty, frequent falls, worried patient who is deaf and mute.

Scared Patient, "The World is Spinning!": Nurse in Action

I sighed!

I was not looking forward to making this call. I had 14 more triages to check online and I knew this call was going to take time. The patient was deaf and mute and was at home. I was calling from the clinic and it was really hard to get the sign language interpreter on the phone. As expected, I got the run around for 15 minutes before I was finally connected. The interpreter connected me to the patient.

"Hi, Sam. This is Dr. Annie. I am a registered nurse calling from your doctor's office. We got your message that you are feeling dizzy. How are you feeling now?"

Silence.

I waited patiently. The interpreter began answering for him.

"I am still feeling dizzy. The world is spinning!"

"Did you eat today?"

"Yes!"

"Any headache or blurry vision?"

"No."

I scanned his chart and saw that he had multiple visits to the ED for the same complaint. His last CAT scan of the head was negative.

"Sam, do you notice that your dizziness comes on when you change position from  say lying down to sitting?"

"Yes!"

"What about when you move your head or bend down?"

"Yes all the time. I have a problem at work!"

"Really? What kind of work do you do?"

"I wash dishes in a hospital cafeteria and in the kitchen. Been doing that for the last twenty years!"

"That is amazing. You sound like a loyal employee! Do you have to bend to pick up the dishes?"

"Yes!"

"Sam, do you get frequent colds, runny nose, or allergies?

"Yes, allergies all the time!"

"Sam, can I tell you what might be happening with you?"

"Yes please. I get scared and don't want this to happen."

"OK, I think this may be a problem with your balance. This is from a problem in your inner ear, which we can't see!"

"My ear? I don't have any pain in it!"

"You don't have to have pain. When you have allergies and your nose is stuffy, the inflammation travels to your inner ear and increases fluid production. The inner ear deals with balance and every time there is a sudden change in movement, it triggers the brain and you get signs and symptoms of imbalance like dizziness, nausea, unsteady gait, feeling like you are going to fall or pass out."

"What! I thought I was having a stroke and something was wrong like a tumor. How come nobody told me? I went so many times to the ER!"

"I see that you have been to the ER many times recently. Let me tell you what will help you at home!"

"Go ahead!"

"OK. The first thing is to remember to do everything slowly. Give yourself time when you get up. Sit for 2 minutes before you stand up!"

"I see! I always jump out of bed and get dizzy!"

"So, slowly like Justin Bieber says, "Pasito a pasito, suave suavecito!  I say Pokito Pokito!"

The interpreter states that Sam is laughing and nodding his head!

"Sam, you need to bend with your knees not head when picking up anything. Bending the head triggers the inner ear. It's like keeping each leg on a different boat!"

"That makes sense!"

"Sam, another thing that helps is to open your mouth when you blow your nose. It helps with too much pressure not going into your ear. It is a bit difficult but will come with practice!"

"I will try that!"

"Sam, do you have constipation?"

"Sometimes!"

"OK, increase drinking water, eat salad and fruits, and when you are in the bathroom, don't bear down but pant like this ... huh, huh, huh ... when pooping. Bearing down to poop will trigger the dizziness!"

"I wish I knew this before! I always felt dizzy in the bathroom! Now I know why!"

"So try it, Sam, and see if it helps you!"

"I will!"

"In case you tried everything but still feel dizzy, lie down for half-hour and don't move. Pretend you are a dead body, close your eyes but don't forget to breathe! The dizziness will subside!"

"I will do that!"

"How do you go to work? Do you drive?"

"No, I ride my bike! I need to slow down now. I used to weave in and out of traffic!"

(Ah! I finally get to meet a weaver! Drives me insane but that's another story ... !)

"Sam, when you look at things from the corner of your eye, it can trigger dizziness. You need to look directly and don't whip your hair, sorry, head back and forth!"

"That's a Jade Smith song! I whip my hair back and forth!"

"True, Sam. I see you know your singers!"

The interpreter informs me that patient is laughing!

"I think slowing down would be a very smart thing to do, Sam! You could also keep the dishes a little higher and closer to you so that you don't have to constantly bend!"

"I am going to try all this. Thank you so much!"

"You're welcome, Sam. I am going to give you a telephone visit with your doctor so that you can follow up."

I made him a telephone appointment with his Primary Care Provider and gave him the information.

"Thank you so much. I think this new year I won't need an ER visit!

"I hope so, Sam! Happy New Year!"

"Thank you! You, too!"

I thanked the interpreter and hung up and went back to triaging!

References

Labyrinthitis and Vestibular Neuritis

Labyrinthitis

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6 Comment(s)

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

Once again, spotangel, you have generated an interestingly entertaining article that was a joy to read and exhibited quality APIE!

However, I do have a critique: When I have worked with patients who are, as you noted, "deaf and mute", I have learned that they sometimes take umbrage at these terms and believe them to be archaic. 

I have been informed by some members of this group that they prefer to be referred to as being "hearing and speech impaired".

Any group can be attracted to political correctness.

I've heard that the dead would prefer to be called "living impaired".

An excellent article nonetheless!

spotangel, DNP, RN, NP

Specializes in ED,Tele,Med surg, ADN,outpatient,homecare,LTC,Peds. Has 32 years experience.

Thank you! I never get the right terms but am working on it! I am a
work in progress!

The living impaired! I can’t! LOL! 
Next to the walking dead!

It is surprising how many people have vertigo and don’t know simple remedies to prevent and treat it! 
I still recall an older gentleman who came with his wife in 2003 to the ED. I was his nurse. His vitals were stable and he was a classic vertigo case. I threw a line in, drew and send bloods, started saline and got him PO meclizine and  IV reglan  after speaking to an attending. I told him that his labs were going to be OK. He was going to sleep and would wake up in 4 hours feeling great! His wife sat quietly watching the extremely chaotic ED as he slept. We were having a crazy day with codes back to back. We had a great team and worked seamlessly despite the craziness! He woke up after four hours, labs perfect and waited for a bit for the discharge note from the attending who  was extremely busy. They thanked us politely and left. Got a letter from them that they were very impressed at how hard we worked and how professionally we treated the patients despite being extremely busy!

Turns out he was the Chief Financial Officer of our health system!! We were like darn we should have told him, put the money  for our old ED before we treated him! Anyway 2 years later they built us a brand new ED in addition to what  we had! I hope it was not a coincidence! I still have the letter! The work however got more with the same number of nurses——!!  Now the nurses are spinning!! LOL!

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

1 hour ago, spotangel said:

Thank you! I never get the right terms but am working on it! I am a
work in progress!

Aren't we all? As Kierkegaard said, and I'm probably paraphrasing, "The self is that which is in the process of becoming".

I have worked with numerous hearing impaired patients and clients over the years and took an Amslan- American sign language- course about 35 years ago. I learned not only the basics of sign language, but some of the culture's traits as well.

Like any other culture, they have their hierarchy and do's and don'ts as well.

1 hour ago, spotangel said:

It is surprising how many people have vertigo and don’t know simple remedies to prevent and treat it! 

Yeah! I gave out a lot of meclizine on the psych units when I worked at Wrongway.

I diagnosed myself with BPPV some years ago and do a variation of the Epley maneuver, which helps considerably.

1 hour ago, spotangel said:

 Anyway 2 years later they built us a brand new ED in addition to what  we had! I hope it was not a coincidence! 

Those administrators often take potshots from the sidelines until they have to be in the heat of the lunch hour rush!

Perhaps he saw a true need to invest in a lucrative business?

Great communicating with you, spotangel!

Edited by Davey Do
Kierkegaard said "self" and not "soul"

cynical-RN, BSN

Specializes in ICU. Has 11 years experience.

On 1/7/2021 at 10:45 AM, Davey Do said:

Once again, spotangel, you have generated an interestingly entertaining article that was a joy to read and exhibited quality APIE!

However, I do have a critique: When I have worked with patients who are, as you noted, "deaf and mute", I have learned that they sometimes take umbrage at these terms and believe them to be archaic. 

I have been informed by some members of this group that they prefer to be referred to as being "hearing and speech impaired".

Any group can be attracted to political correctness.

I've heard that the dead would prefer to be called "living impaired".

An excellent article nonetheless!

I heard instead of dead, the preferred term is permanent asystole. 

Davey Do

Specializes in around 25 years psych, 10 years medical. Has 42 years experience.

1 hour ago, cynical-RN said:

I heard instead of dead, the preferred term is permanent asystole. 

"Forever Flatline" sounds like a romantic song by Rod Stewart, doesn't it?

spotangel, DNP, RN, NP

Specializes in ED,Tele,Med surg, ADN,outpatient,homecare,LTC,Peds. Has 32 years experience.

57 minutes ago, cynical-RN said:

I heard instead of dead, the preferred term is permanent asystole. 

LOL! Some of the  ways doctors explain death, "Your mother is no more"

"We could  not get her back".

 Pt's son, "But where did she go?"