GF10: Neuro Bell's Palsy Flashcards
What is Bell’s Palsy?
A dysfunction of cranial nerve VII that manifests in facial muscle weakness or paralysis on one side of the face
What is the Patho of Bell’s Palsy?
Malfunction results from inflammation of CNVII causing compression where it exits the skull to travel to the face
What are some possible causes of Bell’s Palsy?
- Idiopathic
- Associated w/ viral infections
- Triggered reactivation of a dormant virus
- Brain tumors, meningitis, middle ear infection
- A demyelinating or autoimmune disease
What are some viral infections associated with Bell’s Palsy?
- Cold sores, genital herpes (herpes simplex virus)
- Chickenpox, shingles (varicella-zoster virus)
- Mononucleosis (Epstein-Barr virus)
- Cytomegalovirus (CMV)
What are some triggers that can reactivate a dormant virus and result in Bell’s Palsy?
- Stress
- Trauma
- Minor illness
What are some risk factors of Bell’s Palsy?
- Diabetes
- HTN
- Obesity
- Pregnancy
- Upper Respiratory Infections
How is Bell’s Palsy diagnosed?
- Based on clinical presentations after other possible causes of facial paralysis are ruled out
- Clinical presentations include unilateral forehead, eyelid and mouth paralysis/weakness
When assessing for Bell’s Palsy, what is indicated if forehead is not affected?
it is indicative of stroke, as CNVII includes muscles of forehead
What diagnostic tests are used for Bell’s Palsy?
- MRI, CT
- To rule out structural studies such as tumor or skull fracture
- Electromyography
- Used to confirm nerve damage and determine the extent of severity
What are the s/s of Bell’s Palsy?
- Unilateral paralysis/weakness of the face
- Drooping eyelid/mouth w/ inability to close eye
- Drooling
- Inability to smile symmetrically
- Decrease in lacrimation to eye (dry eye)
- Flattening of nasolabial fold
- Abnormal/distorted sense of taste
- Facial pain
- Intolerance to loud noise
How do the s/s of Bell’s Palsy evolve?
- Symptoms develop suddenly, reaching peak severity around 72hrs after onset
- s/s usually self-resolve without medical attention
What are the nursing interventions for eye care of the Bell’s Palsy pt?
- Eyelid ability to close/blink is impaired
- Eye at risk for drying and potential injury
- Must keep eye moist with lubricating eye drops
- Protect from injury w/ eyepatch, especially at night
What is the percentage ratio of those who recover from Bell’s Palsy to those who have continuing long-term issues?
- 90% (with and without tx) will recover completely
- 10% of cases that had severe nerve damage may have some symptoms for life
Symptoms tend to improve after a __ - __ weeks and a complete recovery is achieved in about __ months
- 2-5 wks
- 6 mos
What is the medication tx for Bell’s Palsy?
- Corticosteroids (prednisone), when started early (w/in 3 days), can reduce inflammation and improve recovery
- Pending cause, antivirals (acyclovir, famciclovir, valacyclovir) or vaccines (zoster’s for shingles) can help resolve the inflammation of CNVII
What are the physical tx may provide relief for the Bell’s Palsy pt?
- Some pts benefit from pt or facial massage
- Apply warm moist heat, to help circulation, relieve pain/inflammation
True or False
Decompression surgery to relieve pressure on nerve is usually recommended
False, Decompression surgery to relieve pressure on nerve is rarely needed and not usually recommended
Describe CNVII
- One facial nerve for each side of the face
- Controls muscles of facial expression (including eye blinking and closing)
- Carries nerve impulses to tear and salivary glands
- Conveys taste sensations from anterior two-thirds of tongue
How is taste affected by CNVII dysfunction?
No sweet or sour taste, bitter is back of tongue and not affected
What is our general pt education for Bell’s Palsy?
- Eye patch or tape eye closed at night
- Use artificial tears to prevent dry eyes
- Wear glasses to prevent injury
- Chew on unaffected side w/ oral hygiene after every meal
- Clients can still drive and don’t need walking assist devices as their balance and limbs are NOT affected
What are some possible complications that may arise for 10% of Bell’s Palsy pts?
- Chronic loss of taste (ageusia)
- Chronic facial spasm
- Corneal infections (from not protecting eyes)
- Facial pain (rare)
