Sudden complete hearing loss or new neurologic deficits should be reported to rule out other causes.
Before you read
Test yourself first: 3 questions
Question 1 of 3
The nurse is assessing a newborn for Hirschsprung disease. Which finding in the first 48 hours of life is most suggestive of this disorder?
Answer: A. Failure to pass meconium within 24 to 48 hours of birth is a hallmark of Hirschsprung disease, caused by absence of ganglion cells in a segment of the distal colon. Frequent loose stools, projectile vomiting, and excessive meconium passage are not characteristic.
Question 2 of 3
A child is diagnosed with hand-foot-and-mouth disease. The nurse expects to find which characteristic lesions?
Answer: A. Hand-foot-and-mouth disease, caused by coxsackievirus, produces painful vesicular lesions in the mouth and on the palms and soles. It is usually self-limiting, and care focuses on hydration and comfort.
Question 3 of 3
A nurse is assessing a 78-year-old client. Which finding is a normal age-related change rather than a sign of disease?
Answer: A. Decreased skin elasticity and turgor is an expected aging change due to loss of subcutaneous tissue and collagen. Resting tachycardia, productive cough, and a new confusion onset are not normal aging and warrant evaluation.
Keep the streak going with more questions like these, each with a full rationale.
What is meniere disease?
Attacks come on suddenly, last minutes to hours, and often include a feeling of ear fullness, nausea, and vomiting. The cause is unknown but is linked to fluid imbalance. Management focuses on reducing fluid retention and ensuring safety during vertigo attacks.
Key points to remember
- The classic triad is severe rotational vertigo, tinnitus (ringing), and one-sided fluctuating hearing loss.
- A sensation of fullness or pressure in the affected ear often precedes an attack.
- Attacks are episodic, sudden, and incapacitating, frequently with nausea, vomiting, and nystagmus.
- It usually affects one ear, and repeated attacks can lead to permanent hearing loss.
- Excess endolymphatic fluid (hydrops) in the inner ear underlies the symptoms.
Nursing priorities
- During an acute attack, ensure safety: assist to a side-lying or comfortable position, raise side rails, and minimize head movement.
- Provide a quiet, dimly lit room and reduce sudden movements and bright lights that worsen vertigo.
- Administer prescribed antivertigo/antiemetic and diuretic medications to control symptoms and fluid.
- Teach a low-sodium diet and limiting caffeine, alcohol, and nicotine to reduce fluid retention.
- Implement fall precautions and instruct the patient to move slowly and avoid driving during symptoms.
Patient teaching
- Follow a low-sodium diet and limit caffeine, alcohol, and nicotine to lessen fluid buildup and attacks.
- Sit or lie down at the first sign of an attack and avoid driving or climbing until vertigo fully resolves.
- Move the head slowly, keep the environment free of clutter, and report worsening hearing loss.
Red flags: report now
- Sudden complete hearing loss or new neurologic deficits should be reported to rule out other causes.
- Severe vertigo creates a high fall and aspiration risk; keep the patient safe and avoid unattended ambulation.
- Persistent vomiting can cause dehydration and electrolyte imbalance; monitor and report.
- Do not leave the patient ambulating alone during an acute attack.
References
Clinical references for this topic
