Pathophysiology of Meniere’s Disease

Etiology: Usually idiopathic.

S&S: Recurrent episodes (20 minutes to several hours) of spontaneous rotary vertigo, fluctuating hearing loss, tinnitus, and a feeling of fullness in the ear, often accompanied by nausea, vomiting, and sweating and sometimes loss of consciousness. After acute symptoms subside, balance is poor and client feels unwell for up to 24 hours

Rx: Low-salt diet, betahistine hydrochloride and a mild diuretic given to reduce number and severity of attacks; vestibular sedative such as prochlorperazine to abort acute attacks. Surgery may be done in refractory cases.

Nursing Process Elements
Help the client identify precipitating events or forewarning of attacks

Client teaching for self-care
• Aim to reduce severity of attacks by taking medication as prescribed when attack starts and lying down on the unaffected side in a quiet, darkened room and avoiding sudden movements and activities including reading
• Try to prevent attacks by avoiding exposure to loud sounds, bright light including sunlight, rapid jerky movements, bending at the waist, or twisting the head, all of which predispose to vertigo
• Encourage avoidance of nicotine, caffeine, and decongestants all of which have a vasoconstrictive effect
• Avoid fatigue and stress
• Use a white-noise machine to mask tinnitus PRN

Asthma and Reactive Airway Disease in Episode 135 of the Nursing Show

The Nursing Show

In this week’s episode of the Nursing Show, host Jamie Davis the podmedic features asthma and reactive airway disease. In this episode, nurses and nursing students will learn the mechanism as to how asthma comes about, the causes, symptoms and nursing care of this condition as well as treatment and preventive measures. The show also provides news for nurses and links for reference for this week’s feature.

Listen to episode.mp3

See episode shownotes and links

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The Nursing Show is a weekly podcast for nurses and nursing students offering news, articles, reviews, interviews, tips and more

The Devastating Effects Of Depression When It Accompanies A Chronic Disease

The damage that co-morbid depression has on a patient’s health is greater than that caused by such chronic illnesses as diabetes, angina, asthma and arthritis, according to an article published in The Lancet. In other words, depression with diabetes is more damaging than diabetes with angina or asthma or arthritis.

Dr Somnath Chatterji, World Health Organisation (WHO), Geneva, Switzerland and team looked at data on 245,404 people from the World Health Survey (WHO). They discovered that the prevalence of a depressive episode during the previous year was 3.2% – for diabetes this figure was 2%, for arthritis 4.1%, for angina 5.4% and for asthma 3.3%.

They found that a large number of people had one or more of these chronic diseases as well as depression – between 9% to 23% of them.

They found that depression has the largest effect on worsening health compared with the other listed chronic illnesses, even after adjustments were made for socioeconomic factors and health conditions. Depression, accompanied by one or more chronic disease(s) gave patients the worst health scores – these scores did not alter much from country to country around the globe.

“The co-morbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public health priority to reduce disease burden and disability, and to improve the overall health of populations,” the authors wrote.

An accompanying Comment pointed out that while 80% of patients with arthritis and 90% of patients with asthma receive an acceptable standard of care, the case is nowhere near the same for depression. “In Australia, less than 30% of patients receive good treatment with anti-depressants, cognitive behavioural therapy, and proactive maintenance care. Perhaps differential access to treatment is one reason why disability is less with the physical disorders. Treatment for depression should at least be on a par with that for other chronic diseases.” The Comment was written by Professor Gavin Andrews and Dr Nickolai Titov, Clinical Research Unit for Anxiety and Depression, University of New South Wales at St Vincent’s Hospital, Sydney, Australia.

thelancet