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Bells Palsy

Jo Cil L. MesiasBSN III D


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AKA:

Peripheral FacialParalysis


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Bells Palsy Defined

Effects Crainial Nerve number 7 which is the facial nerve.

Disrupts the motor branches of only one side of the face.


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Cause

No obvious pathologic cause

Reactivation of the HSV (simplex type 1 or zoster)

and lyme disease


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Clinical Features Sudden onset symptoms, usual

ly hours w/ maximal weaknessw/in 48 hrs

Unilateral

Eyebrow sagging

Inability to close eye

Loss of nasolabial fold

Decreased tearing Hyperacusis

Loss of taste to anterior 2/3 tongue

Mouth droop


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Signs and Symptoms Sudden weakness or paralysis of the facial muscl

es, (CN VII), only on one side of the patients face

. Inability to control most or all of these functions

on the affected side of the face.- blinking

- completely closing the eye- smile- frown- salivation


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Signs and Symptoms cont. May have difficulty hearing.. Difficulty tasting on the anterior two thirds of the to

ngue on affected side. excessive tearing on the effected side. small blisters seen on the external portion of the ear May have a hypersensitivity to pain or touch.


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Pathophysiology

Post infectious demyelination

Predisposing factors:Age: 20-40yrs oldGender: both male and female

Precipitating factors:Specific cause is unknown

It is also believed that the disorder

can be brought on by patients

with Lyme disease, diabetes, high

blood pressure, tumors, chickenpox,

or even

trauma to the face or skull near thenerve.

Compression of facial nervewithin its bony canal

Infection of the facial nerve


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Interruption in the transmission of messagesfrom the brain to the facial muscles

Impairment of ALL functions controlled by the7th cranial nerve

Facial weakness or paralysison one side of the face

drooping of the eyelidand corner of the mouthDroolingdryness of the eye ormouthexcessive tearing in oneeye

impairmentof tastespeechdifficultiesand inability

to eat on theaffected area


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Nursing DiagnosisRisk for aspiration r/t impaired swallowing secondary toparalysis

Interventions:

Assessed clients ability to swallow, presence of gagreflex, cough and clear airway.

Assessed clients ability to feed self, amount of dailyintake of foods and fluids.

Placed in sitting upright position.

Provided soft foods

Offered small bites and sips


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Impaired swallowing r/t relaxation of facialmuscles

Interventions: Encouraged rest periods

Encouraged facial exercise to improve muscle strength.

Observed oral cavity after each bite and have clientcheck around cheeks with tongue for food that are notswallowed.


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Impaired verbal communication related toparalysis of the facial muscles

Interventions: Facilitated hearing and vision of sound or obtaining

necessary aides desired for improving communication.

Determined meaning of words used by the client andcongruency of communication to attend needs of theclient.

Validated meanings of non-verbal communication toprevent errors.

Maintained eye contact at clients level to ensurecongruency of communication.

Discussed individual methods of dealing withimpairment to enhance self esteem.


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Prognosis

Benign disorder

Full recovery after 6 months with most patients, as long as early treatmentis started.

Despite good prognosis, this disorder still leaves8,000 people a year in the U.S. with permanent,

disfiguring facial weakness.


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Diagnosed

No specific diagnostic test available

Diagnosis is done by ruling out all other causes of facial paralysis, such as a stroke, TIA, and tumors


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Diet

No specific diet

Patient may have unilateral loss of taste

Chewing on the unaffected side will help to enjoythe taste of food

Decreased muscle movement may alter chewing

ability Patient should chew on the unaffected side to av

oid food trapping

No effects on bowel/bladder.


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Treatment

There is no known cure for bells palsy.

Care is palliative.


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Medications

Corticosteroids: Prednisone

Start immediately before paralysis is complete

for best results


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Medications cont.

Antivirals: Zovirax (acyclovir), Valtrex (valacyclovir), Famvir (famciclovir)

Artificial Tears: methylcellulose

Mild analgesics:


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Nursing Considerations & Teaching Needed Treated on an outpatient basis Protect face from cold & drafts of trigeminal hyperes

thesia (extreme sensitivity to pain or touch) Maintenance of good nutrition Chew on the unaffected side Good oral hygiene after every meal

Dark glasses may be worn for protective or cosmeticreasons

Artificial tears to prevent drying of the cornea Ointment or impermeable eye shield can be used at

night


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Report any ocular pain, drainage, or discharge tophysician

Facial sling may be used

Gentle upward facial massage

Active facial expressions

Physical appearance can be devastating for the patient

Respect need for privacy especially during meals


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Nursing Diagnoses

Acute pain related to the inflammation of CNVII

Imbalanced nutrition: less than body requirements related to inability to chew secondary to muscle weakness

Risk for injury related to inability to blink Disturbed body image related to change in fa

cial appearance secondary to facial muscle weakness

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