NR 576 Week 7 Assignment; Clinical Practice Guidelines Presentation - Benign Paroxysmal Positional Vertigo Paper Transcript

medications, decrease the use of radiology testing, and increase the use of therapeutic repositioning maneuvers. This guideline provides key actions and recommendations for the provider to follow for adults over the age of 18. This does not apply to pediatrics. A strong recommendation is to refer the patient to a clinician, typically an otolaryngologist who can differentiate between lateral semicircular BPPV or posterior semicircular BPPV. A strong recommendation is for the clinician to perform the Dix-Hallpike maneuver first to test for posterior semicircular BPPV. This the gold standard in diagnosing it if it is positive. The strong recommendation for treatment is the Canalith repositioning procedure. This procedure's goal is to use gravity to move the free particles back into the vestibule to get rid of the stimulus that is causing the vertigo. If the Dix- Hallpike is negative on both sides, the specialist can perform a supine role test to assess for lateral semicircular canal BPPV. There is a recommendation against treating with vestibular suppressing medications such as antihistamines. Finally, a recommendation is educating the patient on being safe when dealing with BPPV to prevent falls and injuries. In clinicals, my preceptor and I saw a 65 year old female who reported having episodes of feeling like the room was spinning when she gets out of bed. She said that the episodes lasted about 10 to 20 seconds each. She reports that she felt like she was going to fall and had to sit back down. She has a past medical history of controlled hypertension and migraines. On physical examination, her blood pressure is normal at 116 /70. Her assessment of the HEENT is grossly normal, including a tinnitus screening, coordination, and cranial nerve examination. The patient denies any pain and says she feels well between episodes. She notes that there is no aggravating factors other than getting up from bed. She notes sitting down for a few minutes to let the episode resolve is the only relieving factor. Patient was ordered a head CT and was referred to otolaryngology for further work up. This patient was treated partially by the clinical practice guidelines. Referring the patient to the specialist to facilitate necessary testing to diagnose the patient is the appropriate recommendation. The provider should not have ordered imaging though, as non-radiologic testing could have been done to diagnose this patient. A way that this patient's treatment could have been improved to make sure that the patient was educated on safety precautions to prevent falls or injury. Another way is furthering the provider's education on the basic maneuvers that can help in diagnosing and treating this patient. This could have helped diagnose the patient quicker and even treat them and even maybe save the patient a specialist visit. Here are my references and thank you very much.