Symptom: Dizziness

Initial Grading Reminder

CTCAE Grading of Dizziness:

Grade 1: Mild unsteadiness or sensation of movement
Grade 2: Moderate unsteadiness or sensation of movement; limiting instrumental ADLs
Grade 3: Severe unsteadiness or sensation of movement; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Do you have any history of GI problems? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you recently started any new medications, OTCs, supplements, or marijuana? Does anyone in your household have diarrhea/vomiting?

Grade the symptom

Ask the patient:

How frequently are your bowel movements? How much have they increased over your normal? Are you having accidents? Are you feeling faint? Are you able to keep water down? Are you urinating?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any rash, are you feeling flush, or having difficulty breathing? Did you have any difficulty with your infusions? Do you have any back pain, itching, flushing, difficulty breathing? Do you have a fever?

Note: These symptoms are suggestive of an allergic reaction.

Are you drinking (how much fluid are you drinking per day)? Do you have diarrhea? Do you have a stiff neck or headache? Do you have any swelling in your legs? Have you had any seizures or hallucinations? Is your breath fruity? Have you been urinating (a little or a lot)? Do you have any severe abdominal pain?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Any patient with moderate or worse (or worsening) unsteadiness should be seen.

    Patients with any of the red-flag symptoms should be seen immediately.

    Patients with any of the signs of an allergic reaction should go right to the ED.

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    Nursing Assessment of Potential Causes

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    Allergic Reaction to Infusion

    Rash, flush, breathing difficulty, back pain, itch, fever, confusion, dizziness

    Differential Diagnosis

    What do you suspect is the cause of the dizziness?