Bell’s palsy is a type of paralysis that is localized on the peripheral area of the face. It mainly involves the facial nerve, which is the seventh among the twelve cranial nerves. It often occurs unilaterally. Bell’s palsy is also commonly termed as idiopathic facial paralysis.
Pathophysiology/Etiology
Like most of the cranial nerve conditions, Bell’s palsy has an unknown origin. There are some possible factors that may be linked to its cause. These could include autoimmune diseases, viral infections, and vascular ischemia. Prior to the onset of symptoms, several of the patients manifest a kind of upper respiratory tract infection, which lasts for about 1 to 3 weeks. Patients with a history of Bell’s palsy or Diabetes Mellitus may likely suffer from a recurrence of the condition later on.
Clinical Manifestations
- Paralysis of the side of the face is a predominant symptom of Bell’s palsy. It mostly involves the peripheral facial muscles. This paralysis may alter the patient’s speech and can result from facing distortion.
- It includes all divisions of the seventh cranial nerve functions like numbness of the face, diminished blink reflex, painful sensations, decreased taste, inability to close eyelids, and tongue numbness.
Nursing Assessment
- Assess the motor and sensory responses of the facial nerve, specifically involving the face, eye, and tongue.
- Test the ability of the patient to close the eyelids, speak clearly, drink and eat.
Diagnostic Evaluation
- Physical examination – assess the function of the facial nerve and sensation of the cornea.
- Electrophysiologic testing – to evaluate the potential sensory nerve actions to perform functions.
Nursing Diagnoses
- Impaired tissue integrity related to loss of protective eye closure
- Pain-related to physiologic alterations of disorder
Nursing Interventions
Keeping the integrity of the cornea
- Place an eye patch on the affected eye during sleep to keep it shut.
- Encourage the patient to report immediately any pain experienced around the eye, reporting the level of pain and its location.
- Assess the condition of the eye, including redness and any discharges.
- Teach the patient to administer artificial tears or ophthalmic ointment as ordered.
Alleviating the pain
- Instruct the patient to place moist heat on the face.
- Perform routine massage on the face to relieve muscle pain.
- Teach the patient to administer corticosteroids to minimize the inflammation and non-narcotic analgesics to decrease the pain.
Patient Education/Health Maintenance
- Encourage the patient to use wrap-around glasses to minimize the evaporation of moisture from the eyes due to the wind and sun. Protective glasses are also encouraged to be worn to avoid irritants from entering the eyes. This will also help in increasing the humidity of the environment.
- Instruct the patient on the proper ways of closing the eyelids and eye patching.
- Demonstrate the correct method of facial exercises, including eyebrow-raising, lip pursing, and eye squeezing. Emphasize the importance of performing the exercise to prevent the occurrence of muscle atrophy.
Bell’s Palsy Nursing Management
- The patient must undergo continuous physical therapy to maintain the muscle tone of the face.
- To minimize the inflammation, corticosteroids are often prescribed for administration.
- Non-steroidal anti-inflammatory drugs are used to alleviate painful muscles.
- In some cases, surgery is performed to decompress the seventh cranial nerve, fix the deformities of the eyelids, and provide protection to the eyes.
Complications
- Ulceration of the cornea
- Impairment of vision
Nursing Alert! Keratitis, or the inflammation of the cornea, is one of the most dangerous complications for a patient with Bell’s palsy. As a precautionary measure, the nurse must ensure that the cornea is still protected even if the eyelids won’t close.
Reference
- The Lippincott Manual of Nursing Practice 6th edition edited by Nettina, Sandra M.
