trigeminal, bells palsy,myasthenia

Question 1

Impairment of CN V, Excruciating, recurrent, stabbing facial
pain or shooting/ electric pain along trigeminal nerve (lips, gums, nose, cheeks)

Answer 1

TRIGEMINAL NEURALGIA (TIC
DOULOUREUX)

Question 2

causes of trigeminal

Answer 2

CAUSES
▪ Compression of the nerve
▪ Lack in blood supply

Question 3

assessment of trigeminal

Answer 3

run cotton balls masakit

Question 4

triggers trigeminal

Answer 4

Movement of the facial muscle
▪ Touching of face
▪ Drinking or eating hot/cold food or
beverages
▪ Brushing of teeth

Question 5

signs and symptoms of trigeminal neuralgia

Answer 5

Pain spasm-like to electric/ shooting
pain⭐
▪ Radiates to cheeks, lips, gums
▪ Unilateral pain

Question 6

diagnostic procedure of trigeminal neuralgia

Answer 6

MRI with barium dye – injection of barium
dye – presence of blockage – indicates damage; 5-10 cc injected in blood vessels.

Question 7

management of neuralgia

Answer 7

avoid exposure to extreme temperatures
chew on unaffected side
administer antipasmodic (BACLOFEN)
administrater anticonvulsant (PHENOBARBITAL)
instruct not to rub eye
soft diet (walang ngipin)
avoid pain to px

Question 8

antipasmodic of trigeminal neuralgias

Answer 8

baclofen

Question 9

anticonvulsant of trigeminal neu

Answer 9

phenobarbital
etc:phenytoin,carbamazepine

Question 10

Impairment of CN VII (Facial) ,Unilateral drooping face

Answer 10

bells palsy

Question 11

causes of bells palsy

Answer 11

Lower motor neuron lesions
Viral infection
o Rubella
o Herpes simplex/zoster o Influenza
o Mumps

Question 12

infections of bells palsy

Answer 12

viral
o Rubella
o Herpes simplex/zoster
o Influenza
o Mumps

Question 13

diagnostic bells palsy

Answer 13

MRI
Electromyelography
EMG) – electrical impulse of muscle

Question 14

s/s of bells palsy

Answer 14

Facial droop (reversible)
▪ Inability to raise eyebrows
▪ Unilateral affectation
▪ Ptosis
▪ Hearing sensitivity (Conduction Hearing
Loss)
o Rinne’s test
Normal: AC>BC
Abnormal: AC<BC
▪ Facial flaccidity (softening of muscles)
▪ Facial paralysis
▪ Goes away with residuals – recovers
gradually

Question 15

management of bells

Answer 15

Facial muscle exercises
▪ Protect eye from dryness and prevent
injury (exposure of conjunctiva, masakit)
▪ Provide artificial tears as prescribed
▪ Promote frequent oral care (drooling,
maipon bacteria/ pathogen sa baba ng
mouth)
▪ Chew on unaffected side
▪ Heat application /hot compress (hindi
nagagalaw decrease ang blood supply. Hot compress inc blood supply to the area for faster healing)

Question 16

pharma of bells

Answer 16

Corticosteroids – reduce inflammation
Antivirals (Valacyclovir⭐, Acyclovir, Famciclovir/ Famcyclovir) – reduce severity of the effects of virus, not kill the
virus mismo
Analgesics

Question 17

drug of choice for bells

Answer 17

valacyclovir

Question 18

Autoimmune disorder, Decreases number of functioning
ACETYLCHOLINE RECEPTOR SITES

Answer 18

myasthenia gravis

Question 19

Neuromuscular disorder characterized by failure of transmission of nerve impulses at the myoneural junction

Answer 19

myasthenia gravis

Question 20

s/s of myasthenia

Answer 20

Muscle weakness associated with activity
→relieved by rest
⭐ Early morning – Increased energy
⭐ Afternoon-Evening – weakness
▪ Fatigue
▪ Ptosis, Diplopia, Strabismus – Levator palpebrae superioris (affected muscle)
▪ Impaired speech (because of weakness)
▪ Snarl-mask like facial expression (hyena
na nakasmile ganon)
▪ Dysphagia and drooling
▪ Respiratory difficulty

Question 21

diagnostic prcedure of myasthenia

Answer 21

tensilon (endophonium test)

Question 22

whats tensilon

Answer 22

Drug injected to temporarily
increase muscle strength
✓ Increased muscle strength
and absence of weakness for
3-5 minutes = + MG
✓ No changes or increased
muscle weakness = to rule
out MG/ cholinergic crisis
✓ Thru IV (2mg first then 8
mg)

Question 23

management of myasthenia

Answer 23

PRIORITY IS SAFETY IN AIRWAY! ⭐
1. Assess airway (gag reflex, di makalunok nang maayos, risk for aspiration; assess ability to chew and swallow – soft diet and
cold beverage)
2. Assess breathing
3. Promote rest thru cluster activity
o Isang bagsakan lang to conserve energy because of weakness
o Long periods of rest
4. Prevent clients from falls (weak legs)
5. Avoid exposure to infections
(Corticosteroids)
6. Start meal with cold beverage to contact
muscle of the throat.
7. Administer meds on time to prevent
complication (MC)
8. Administer meds 20-30 minutes before
meals

Question 24

drugs of myasthenia

Answer 24

Acetylcholinesterase
Inhibitor/ o Neostigmine (Prostigmine) DOC
Anticholinesterase

Glucocorticoids/ Corticosteroids
o Anti-inflammatory effects to
suppress production of antibodies

3. Antacids
   o To prevent GI upset due to glucocorticoids

Question 25

DOC of myasthenia

Answer 25

neostigmine (prostigmine)

Question 26

myasthenia crisis

Answer 26

Undermedication or not on time) o Increase SNS, Decrease AcH o Inc. BP o Inc. HR o Severe respiratory distress and cyanosis o Absentswallowreflex o Bowel and bladder incontinence o Severe weakness o Increase dose of Edrophonium (gradual ang pagtaas) ⭐ (pwede rin Mestinon) and ready for Mech Vent

Question 27

cholinergic crisis

Answer 27

Increase AcH, Increase PNS o Diarrhea o Polyuria o Blurred vision (vasoconstriction) o Increase salivation Dysphagia – Active weakness GIT with o Severe weakness o Discontinue drugs until it decreases o Provide Mech Vent o Provide 1mg of Atropine Sulfate (Antidote – anticholinergic drugs)

Question 28

surgical intervention for myasthenia

Answer 28

Thymectomy – removal of the thymus gland that possibly causes the autoimmune response. 25% of patients with MG is found with thymoma