Reference — Med-Surg
Vertigo Assessment & Safety Reference
Three questions sort most vertigo: how long does it last, what triggers it, and does anything neurological come with it. This reference condenses the framework, the maneuvers you’ll see ordered, the attack-care checklist, and the red flags.
Educational use only. Dix-Hallpike and Epley maneuvers are performed by trained providers/therapists per facility policy; new vertigo with any neurological finding is escalated as a possible stroke. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Timing, Triggers & Duration — The Sorting Framework
| Pattern | Points To |
|---|---|
| Seconds to a minute, triggered by head position changes (rolling over, looking up) | BPPV — no hearing change; Dix-Hallpike confirms, Epley treats |
| 20 minutes to hours, episodic, with tinnitus, aural fullness, and fluctuating hearing | Ménière's disease — low-sodium diet and diuretics between attacks |
| Constant for days, often after a viral illness, gradually improving | Vestibular neuritis (hearing spared) or labyrinthitis (hearing involved) |
| Any pattern WITH neuro signs — diplopia, dysarthria, weakness, vertical nystagmus, can't stand | Central cause — stroke/cerebellar workup, not vestibular suppressants |
First, confirm it’s true vertigo (spinning/movement illusion) — lightheadedness on standing points to orthostatic and cardiac causes instead, a different workup entirely.
Dix-Hallpike & Epley — What They Are
Dix-Hallpike (diagnostic)
The patient is moved quickly from sitting to lying with the head turned 45° and extended over the table edge. In BPPV, the position reproduces the vertigo with a characteristic burst of nystagmus after a brief delay. Expect the patient to hate it — warn them it provokes the symptom on purpose, briefly.
Epley / canalith repositioning (therapeutic)
A sequence of head positions that uses gravity to roll the displaced crystals out of the semicircular canal — often curative in one or two sessions. Nursing role: pre-procedure teaching, support during the provoked vertigo, antiemetic if ordered, and fall-safe transport afterward. Patients may be taught a home version; recurrence is common and simply means repeating it.
Attack Care Checklist
- ✦Stop ambulation — assist to bed or chair immediately; the patient will fall if they walk
- ✦Dark, quiet room; head still and supported; eyes fixed on one stationary object if open
- ✦Move and reposition slowly, warning before every touch
- ✦Antiemetic and vestibular suppressant (meclizine, etc.) as ordered — then re-assess sedation and fall risk
- ✦IV fluids per orders if vomiting is prolonged; monitor intake and hydration
- ✦Bed low, call light in hand, toileting plan (urgency after antiemetics is a classic fall moment)
- ✦Quick neuro screen during/after the attack — confirm nothing central has appeared
- ✦Document onset, duration, triggers, ear symptoms, nystagmus, and response to treatment
Central Red Flags — Escalate Now
- ✦Diplopia, dysarthria, dysphagia, or facial droop accompanying the vertigo
- ✦Focal weakness or numbness anywhere
- ✦Vertical or direction-changing nystagmus (peripheral nystagmus is horizontal/rotary and fatigues)
- ✦Imbalance so severe the patient cannot stand or sit unsupported — out of proportion to the spinning
- ✦Sudden severe headache or neck pain with the vertigo
- ✦New deafness with vertigo — sudden sensorineural loss is itself urgent
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with Academy of Medical-Surgical Nurses (AMSN) · Current medical-surgical nursing standards. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →