Peripheral Nerve and Spinal Cord Problems

Question 1

Trigeminal Neuralgia

Answer 1

CN 5

etiology: compression of superior cerebellar artery, Herpes virus infection, tooth infection, brainstem infarct

Question 2

Trigeminal Neuralgia Manifestations

Answer 2

Pain: face (around eyes, nose, mouth, cheeks)

twitching
blinking
tearing

severe pain has been r/t suicide

-cold air, water, face washing, tooth brushing, talking, eating can all cause pain

Question 3

Trigeminal Neuralgia Dx Studies

Answer 3

Dx by exception

CT, MRI, EMG, CSF

Question 4

Trigeminal Neuralgia Collaborative Tx

Answer 4

Drug therapy: anti seizure meds (slow firing of nerves)

Conservative tx: nerve block; biofeedback

Surgical tx

Question 5

Trigeminal Neuralgia Nursing consideration/teaching

Answer 5

eating - soft foods, avoid really hot/cold foods or drinks

hygiene - soft towels, soft toothbrushes

environmental concerns - scarves

Question 6

Bell’s Palsy

Answer 6

Disruption of CN 7: sensory and motor

etiology: Herpes Simples Virus; 85% full recovery within 6 months

Question 7

Motor function test

Answer 7

smile, puff out cheeks, frown, raise eyebrows

Question 8

Sensory function test

Answer 8

taste

Question 9

Bell’s Palsy manifestations

Answer 9

Herpes vesicles in or around ear and Fever are seen together

Tinnitus (close proximity to CN 8 - acoustic)
Hearing deficit
Paralysis of motor branches of facial nerves (taste loss on affected side)

Question 10

Bell’s Palsy Dx studies

Answer 10

Pattern and Onset
EMG

Want to r/o Stroke (similar manifestations)

Question 11

Bell’s Palsy concerns

Answer 11

eating, aspiration risk, corneal abrasion b/c of not being able to close the eye

Question 12

Bell’s Palsy Tx

Answer 12

moist heat
electrical stimulation - if not recovering

prevention of complications: eye drops to keep moist and take eyelids shut at night

Drug therapy: corticosteroids to reduce inflammation to nerve
Antiviral agents to treat herpes (acyclovir)

Question 13

Guillian-Barre’ Syndrome

Answer 13

Acute, rapidly progressing polyneuritis; loss of myelin, edema and inflammation of the affected nerves; cell mediated immunological rxn

Question 14

Guillian-Barre’ Syndrome Manifestations

Answer 14

Preceded by URI or GI infection
Paralysis of lower extremities and works it’s way upwards
Parasthesia
Pain
Progressive paralysis includes thoracic area, facial weakness, extra ocular eye movement, dysphagia

• most cases are reversible but will take months to return to normal

Question 15

Guillian-Barre’ Syndrome Dx Studies

Answer 15

dx by exception

CSF and EMG

Question 16

Guillian-Barre’ Syndrome Tx

Answer 16

Plasmaphoresis
Sandoglobulin
Respiratory support - ventilator

Nutritional therapy: Tube feedings, TPN

Care of the immobilized patient: skin breakdown, contractors, pneumonia

Question 17

Guillian-Barre’ Syndrome and Vaccines

Answer 17

Get asked about a hx when filling out vaccine paperwork – cannot get the Flu vaccine