Transcript Meniere`s disease ppt

Meniere’s disease
ADAM MEZA CHANTELLE EDMONSON
TERESA RODRIGUEZ
GABRIELLA BURRIOLA
Meniere’s disease
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Meniere’s disease is a disorder of the inner ear that causes episodes
in which the patient may experience balance and hearing
impairment. The cause of the disease is not understood. One
popular theory is that is it due to abnormal amounts of fluid in the
inner ear.
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Other possible factors : improper fluid drainage, abnormal immune
response, allergies, viral infections, genetic predisposition, head
trauma, migraines
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Two types
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Unilateral (most common)
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bilateral
Pathophysiology
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Disease may result from over production of endolymph in the
labyrinth of the ear
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Accumulation of endolymph leads to pressure increase that may
break the membrane that separate the perilymph resulting in
vestibular nerve malfunction leading to vertigo
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Causes dilation of semicircular canal, utricle, and saccule causing
degeneration of vestibular and cochlear hair cells
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Overstimulation of the vestibular branch of cranial nerve VIII impairs
postural reflex and stimulates vomiting.
Antecedents
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Immune system
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Genetic factors
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Proper functioning neural system
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Autonomic nervous system
Attributes
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Hearing imbalance
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Psychosocial
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Physical imbalance
Interrelated Concepts
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Safety
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Coping
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Communication
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Interpersonal relationships
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Immunity
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Mobility
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comfort
Risk Factors
•Autonomic nervous system dysfunction
•Family history
•Head trauma
•Immune disorder
•Middle ear infection
•Migraine headaches
•Stress
•Allergy
•High salt intake
•Chronic exposure to loud noise
•Premenstrual edema
Consequences
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Positive
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Negative
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Patient education
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Impaired human development
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Proper coping
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Hearing impairment
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Decreased quality of life
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Communication and family
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Effective communications
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Balance impairment
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Maintain balance
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Psychosocial
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Less vertigo episodes
Signs and Symptoms of Meniere’s
disease
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Recurring episodes of vertigo
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Hearing loss
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Ringing in the ears (tinnitus)- ringing, buzzing, roaring, whistling, or
hissing sound in the ear
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Feeling of fullness in the ear- ( pressure in the affected ears (aural
fullness) or on the side of their heads
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Loss of balance
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Headaches
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Nausea, vomiting, and sweating caused by severe vertigo
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After an episode, signs and symptoms improve and might disappear
entirely. Episodes can occur weeks to years apart.
Diagnostic Screening/Tests
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Imaging
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•Computed tomography scanning (brain) and magnetic resonance imaging
are used to rule out acoustic neuroma or other neurological condition as a
cause of symptoms.
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Diagnostic Procedures
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•Audiometric test results show a sensorineural hearing loss and a loss of
discrimination; low-frequency sounds are commonly affected.
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•Electronystagmography results show normal or reduced vestibular response on
the affected side.
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•Cold caloric test results show impairment of the oculovestibular reflex.
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•Transtympanic electrocochleography results show an increased ratio of
summating potential to action potential, usually > 35%.
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•Brain stem evoked response audiometry test is used to rule out acoustic
neuroma, brain tumor, and vascular lesions in the brain stem.
Treatments
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No cure exists for Meniere’s disease, but a number of treatments can help
reduce the severity and frequency of vertigo episodes. There are no treatments
for the hearing loss that occurs with Meniere’s disease. All of the treatmentssome conservative, some aggressive-are to stop the spells of vertigo.
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General
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Hearing aids: a hearing aid in the ear affected by Meniere’s disease might
improve your hearing. Your doctor can refer you to an audiologist to discuss
what hearing aid options would be best for you
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Diet
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Avoidance of possible triggers, such as salt, caffeine, alcohol, nicotine, and
monosodium glutamate
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Activity
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Lying down to minimize head movement, and avoiding sudden movements
and glaring light to reduce dizziness (during an attack)
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As tolerated between attacks
Treatments
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Vestibular rehabilitation therapy: is an exercise based program for
reducing the symptoms of disequilibrium and dizziness associated
with vestibular pathology. The program may include exercises for:
coordinating eye and head movements, stimulating the symptoms
of dizziness in order to desensitize the vestibular system, improving
balance and walking ability, and improving fitness and endurance
(Exercises vary depending on the type of inner ear disorder and the
associated symptoms)
Treatments
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Surgery
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Pressure treatment with low pressure pulse generator device (Meniett Device): safe minimally
invasive method for managing Meniere’s disease symptoms. The device sends a series of
computer controlled, low pressure pulses to the middle ear. Scientist believe these micro pressure
pulses may reduce the inner ear fluid and swelling that are thought to cause Meniere’s disease
symptoms.
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Endolymphatic drainage and shunt procedures: is a surgical procedure in which a very small
silicone tube is placed in the membranous labyrinth of the inner ear to drain excess fluid
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Ventilation tube insertion via myringotomy with pressure producing instrument
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Lateral semicircular canal plugging
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Vestibular nerve resection/cochleovestibular nerve section: this procedure involves cutting the
nerve that connects balance and movement sensors in your inner ear to the brain (vestibular
nerve). This procedure usually corrects problems with vertigo while attempting to preserve hearing
in the affected ear. It requires general anesthesia and an overnight hospital stay.
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Labyrinthectomy: with this procedure, the surgeon removes the balance portion of the inner ear,
thereby removing both balance and hearing function from the affected ear. This procedure is
performed only if you already have near total or total hearing loss in your affected ear.
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Vestibular ablation( removal of a body part or the destruction of its function)
Medications
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Intratympanic infusion of gentamicin (for patients not responding to
medication)
Acute Attack Management:
First-line agents: Atropine sulfate (AtroPen), diazepam (Valium),
transdermal scopolamine (Transderm-Scop)
Second-line agents (I.V.): Droperidol (Inapsine), promethazine
hydrochloride (Promethegan), diphenhydrAMINE hydrochloride
(Benadryl)
Maintenance Therapy:
First-line agents: Meclizine hydrochloride (Antivert), diazepam (Valium)
Second-line agents: Dimenhydrinate (Dramamine), promethazine
hydrochloride, diphenhydramine hydrochloride (Benadryl),
intratympanic gentamicin or dexamethasone (oral; injection) (DexPak)
Nursing interventions
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Independent treatment
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Maintain a safe environment. Provide assistance when necessary
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Give prescribed drugs as ordered
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Obtain specimens for laboratory testing, such as serum electrolyte
levels f the patient is receiving diuretics
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During an acute attack, ensure bed rest with eyes closed
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Review with the patient possible triggers for attacks; assist with
identifying triggers as necessary
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Have the patient limit his/her dietary intake during an attack.
Anticipate the need for sodium restriction, if indicated.
Nursing interventions
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Encourage the patient to verbalize feeling and concerns. Assist with
relaxation techniques and positive coping strategies.
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Allow the patient to participate in care and decision making to
foster feelings of control
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Encourage the patient to remain as active as possible between
attacks
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Reinforce vestibular rehabilitation, as indicated
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Decrease visual and auditory stimulus during acute attacks;
promote a quiet, calming environment
Nursing interventions
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Dependent treatment
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Psychosocial
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Enlist the help of family members to assist the patient in eliminating risk factors for
injury, especially in the home environment.
Doctors orders
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Obtain a dietary consult as indicated.
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Obtain a physical therapy consult as indicated.
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Obtain a social services consult as indicated.
Nurse patient relationship
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Refer to appropriate community agencies and groups that can assist in meeting
needs.
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Communication
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Patient teaching
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Drug administration
Patient Education
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Encourage patient to express feelings of increased tolerance of activities
and comfort.
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Seek appropriate support to assist with coping
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Have patient verbalize an understanding of the disease process and
identify prescribed treatment plan to control his/her condition
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Educate the patient on strategies to safeguard his home or environment to
prevent falls.
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Have patient remain free from injury and to participate in decisions about
his/her care.
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Need to avoid sudden movements or positions that make vertigo
hazardous to the pt.
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Lifestyle modification in diet to reduce salt intake, and avoid caffeine and
nicotine substances
Prognosis
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Meniere’s disease has no cure but can be managed with life style
changes and stress management
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As disease progresses hearing loss may progress but can be treated
with hearing aid
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In severe cases of Meniere’s surgical intervention
Nursing diagnosis
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Activity intolerance
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Related to: imbalance, impaired hearing, Patient claims of “dizzy
spells”
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Evidence by: vertigo, hearing loss, and tinnitus
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Secondary to : Meniere's disease
Expected outcomes: patient will have stable vital signs while active.
Patient knowledge of underlying cause. Tolerate increased activity.
Express feeling.
Nursing diagnosis risk
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Risk for injury
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Related to: impaired balance and hearing. Patient claims of “dizzy
spells”
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Evidence by: vertigo and tinnitus
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Secondary to : Meniere's disease
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Expected outcomes: patient will remain free from injury, identify and
reduce risk factors, and state environmental or lifestyle changes
necessary to maintain safety.
Patient Goal
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Increased activity intolerance presented by effective lifestyle
changes and stress management. Episodes of vertigo decrease or
stop. Patient is educated of their disorder, adapting life to it, and
maintaining healthy communication with family and friends. Hearing
loss is treated with hearing aid if needed. The patient remains free of
injury.
Sources
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Meniere's disease. (n.d.). Retrieved March 03, 2016, from
http://www.mayoclinic.org/diseases-conditions/menieresdisease/basics/definition/con-20028251
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http://advisoredu.lww.com/lna/document.do?bid=4&did=403473&hits=disease,m
eniere,menieres
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Meniere’s Disease. (n.d.). Retrieved March 03, 2016, from
http://www.american-hearing.org/disorders/menieres-disease

Meniere's Disease Information Center -- Extensive Information for
Patients, Families, Doctors. (n.d.). Retrieved March 03, 2016, from
http://www.menieresinfo.com/