NR 601 Week 7 Discussion; Client Assessment & Management Plan for BPPV

Pharmacological interventions Clinical practice guidelines recommend against routine pharmacological treatment (Bhattacharyya et al., 2017). However, patient is experiencing intense vertigo accompanied by nausea and vomiting. It significantly interferes with daily functioning and tolerance of repositing maneuvers. Therefore, limited and closely monitored medication use with clear plan is necessary. • Meclizine 25 mg PO TID PRN for vertigo • Ondansetron 4 mg PO BID PRN for nausea during vertigo episodes. Reference Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., Holmberg, J. M., Mahoney, K., Hollingsworth, D. B., Roberts, R., Seidman, M. D., Steiner, R. W. P., Tsai, B., Voelker, C. C. J., Waguespack, R. W., & Corrigan, M. D. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (update). Otolaryngology—Head and Neck Surgery, 156(3S), S1-S47. https://doi.org/10.1177/0194599816689667 Maarsingh, O. R., & van Vugt, V. A. (2021). Ten vestibular tools for primary Care. Frontiers in neurology, 12, 642137. https://doi.org/10.3389/fneur.2021.642137 so many cases about BPPV. I appreciate that you point out that medication is not recommended, since most of the cases resolve with the Epley maneuver. Are there any other diagnostic tests you can think of that can either rule BPPV in or out? Would you consider checking her TSH? Hello Professor, Dix-Hallpike maneuver is gold standard for posterior canal BBPV. In addition, we can do supine roll test for horizontal canal BPPV. However, it is important to consider all possible differential diagnosis when patient comes with complaint of dizziness. If maneuvers are inconclusive or if symptoms persist atypically, additional test such as electronystagmography (ENG) or videonystagmography (VNG) can be useful to assess and differentiate peripheral from central cause of vertigo (Swain, S., 2023). Imaging such as MRI or CT scan is recommended when central etiologies are suspected, especially in the presence of red flag symptoms such as confusion, sudden severe headache, seizures, etc. (Swain, S., 2023). Since this patient has history of hypothyroidism, assessing thyroid function is clinically relevant. Thyroid dysfunction, particularly hypothyroidism, is associated with impair vestibular function by reducing cerebral blood flow • Educated patient on side effects of sertraline such as GI side effects, sexual dysfunction and potential suicidal thoughts and behaviors. • Educate patient on exercise and maintaining healthy lifestyle (Qaseem et al., 2023). • Referrals (List at least two priority referrals for this client.) • Mental health therapies who can provide CBT to target depressive and anxiety symptoms. • Nutritionist to support weight management, glycemic control and improve overall mood through nutrition. • Follow-up (List the client’s next recommended follow-up appointment and rationale for your recommendation) • Follow-up: follow up in 2-4 weeks after initiating sertraline. • Rationale: Early follow up for assessment of medication tolerance, side effects, and adherence to medication (Qaseem et al., 2023). Beverly, E. A., & Gonzalez, J. S. (2025). The interconnected complexity of diabetes and depression. Diabetes Spectrum, 38(1), 23–31. https://doi.org/10.2337/dsi24-0014 Qaseem, A., Owens, D. K., Etxeandia-Ikobaltzeta, I., Tufte, J., Cross, J. T., & Wilt, T. J. (2023). Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute