NURSING CARE RELATED TO THE SENSORY AND
NEUROLOGICAL SYSTEMS

2-37

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Section VII. CRANIAL NERVE DISORDERS

2-37. BELL'S PALSY

a. Definition. Bell's Palsy is a cranial nerve disorder characterized by facial paralysis. Peripheral involvement of the 7th cranial nerve (facial nerve) produces weakness or paralysis of the facial muscles. The cause of this condition is unknown, but the majority of patient's have experienced a viral upper respiratory infection 1 to 3 weeks prior to the onset of symptoms. Complications associated with Bell's palsy include facial weakness, facial spasm with contracture, corneal ulceration, and blindness.

b. Signs and Symptoms.

(1) Distortion of face.

 

(2) Numbness of face and tongue.

 

(3) Overflow of tears down the cheek from keratitis caused by drying of cornea and lack of blink reflex.

 

(4) Decreased tear production that may predispose to infection.

 

(5) Speech difficulty secondary to facial paralysis.

c. Nursing Care Considerations.

(1) Objectives of care:

 

(a) Maintain muscle tone of the face.

 

(b) Prevent or minimize denervation.

(2) Protect the involved eye.

(a) If blink reflex is absent, eye is vulnerable to dust and foreign particles.

 

(b) Instill artificial tears (methylcellulose) to protect the cornea.

 

(c) Increase environmental humidity.

 

(d) Instruct patient to close affected eye frequently using accessory facial muscles.

 

(e) Instruct patient to wear a protective patch at night. (Keep in mind that patch may eventually abrade cornea as paralyzed eyelids are difficult to keep closed.)

 

(f) Instruct patient to wear protective glasses to further protect eye and decrease normal evaporation of moisture from eye.

(3) Administer steroid therapy, as ordered. (May reduce inflammation and edema and restore normal blood circulation to the nerve.)

 

(4) Provide for pain relief with analgesics and local application of heat.

 

(5) Facial massage may be prescribed to help maintain muscle tone.

 

(6) Surgical intervention may be necessary.

(a) Decompression of facial nerve.

 

(b) Surgical correction of eyelid deformities.

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