With

Bells palsy, impulses from the seventh cranial nerve - the nerve responsible for motor innervations of the facial muscles are blocked.

ulceration Blindness Impaired nutrition Psychosocial problems

Corneal

 Pain

on the affected side Difficulty eating on the affected side Difficulty speaking clearly Drooping mouth or drooling Distorted taste perception over the affected anterior portion of the tongue. Inability to raise the eyebrow, smile, show teeth, or puff out the cheek on the affected side. Difficulty closing eye on the affected side; if attempted, the eye rolls upward (bells phenomenon) and shows excessive tearing.

Diagnosis

is based on clinical presentation. Electromyography

 Administration Analgesics Moist

of corticosteroids

heat applied to the affected side Lubricants or an eye ointment may be needed to protect the eye; patching during sleep may also be necessary. Electrotherapy

 Provide

psychological support to the patient. Reassure him/her that he/she hasnt had s stroke. Tell him/her that spontaneous recovery usually occurs within 8 weeks. These should help decrease anxiety and help adjust to the temporary change in his body image. Administer medications and monitor for adverse reactions. Monitor serum glucose levels during corticosteroid therapy. Apply moist heat to the affected side of the face, as ordered.

 Massage

the patients face with a gentle upward motion two to three times daily for 5 to 10 minutes; teach massage to the patient. Apply a facial sling, if necessary, to improve lip alignment. Provide frequent and complete mouth care, taking special care to remove residual food that collects between the cheek and gums. Provide a soft, nutritionally balanced diet, eliminating hot foods and fluids. Provide preoperative and postoperative care, as appropriate. Provide appropriate education to the patient an his family before discharge.

Dysfunction

affects cranial nerves III, IV, and VI. These nerves are responsible for innervating eye movements.

 Diabetes Trauma Pressure

neuropathy

from an aneurysm or a brain tumor Other: vary depending on the cranial nerve involved

Diplopia Ptosis Strabismus Nystagmus Ocular

torticollis

 Recent

onset of diplopia Torticollis with CN III palsy: Ptosis Extropia Papillary dilation and unresponsiveness to light and accommodation Inability to move the eye Inability to move the eye downward and upward Estropia

 Diagnosis

is based on neuroopthalmologic examination Blood studies CT-scan, MRI, or skull x-rays Angiography C&s tests

treatment varies depending on the cause, such as: Neurosurgery may be necessary for a brain tumor or an aneurysm. Massive doses of antibiotics may be appropriate for infection After treating the primary condition, the patient may need to perform exercises that stretch the neck muscles to correct acquired torticollis (wry neck). Other care and treatments depend on residual symptoms.
Appropriate

 Provide

emotional support to help minimize the patients anxiety about the cause of the motor nerve palsy. Provide treatment appropriate for the specific cause of the palsy. Encourage neck exercise if torticollitis is present. Provide appropriate education to the patient before discharge.

called multiple neuritis, peripheral neuropathy, and polyneuritis, is the inflammatory degeneration of peripheral nerves that primarily supply the distal muscles of the extremities. It results in muscle weakness with sensory loss and atrophy and decreased or absent deep tendon reflexes.
Also

 Exact

cause is unknown; it is thought to be mediated by inflammation, ischemia, and demyelination of the larger peripheral nerves Drugs that may cause peripheral neuritis include: thalidomide (Talomid) metronidazole (Flagyl) phenytoin (Dilantin)

 Peripheral

neuritis is damage to nerves that run from the spinal cord to the rest of the body, which impairs function of the sensory, motor, and autonomic nerves.

pain Depression Drug dependence

Chronic

 Symptoms

vary according to which type of nerve is affected and may include: Altered sensations or paresthesia Impaired balance when standing or walking Difficulty maintaining a grip on objects Muscle weakness

 Patient

history and physical examination delineate characteristic distribution of motor and sensory deficits. Electromyography Nerve biopsy and nerve conduction tests

 Supportive

measures to relieve pain Adequate bed rest Physical, vocational, and occupational therapy Orthopedic interventions to promote independence OTC analgesics or prescription pain medications may be needed to control nerve pain.

(phenytoin, carbamazepine) or tricyclic antidepressants duloxetine (Cymbalta) may be prescribed specially for the treatment of diabetic neuropathy
Anticonvulsants

For

patients with bladder dysfunction, manual expression of urine (pressing over the bladder with the hands), intermittent catheterization, or medications, may be necessary. Others: acupuncture,plasmapheresis and IV gamma globulin, electrical nerve stimulation, and biofeedback.

 Encourage

participation in physical therapy. Provide ROM exercises, if necessary. Teach use of assistive device, if appropriate. Assess affected areas frequently for bruises, open skin areas, or other injuries and provide appropriate care. Provide safety measure to prevent injury.

 Reposition

the patient every 2 hours or teach to change position frequently if nerve damage prevents adequate sensation of pressure. Provide small, frequent meals if appropriate. Assist the patient with bladder dysfunction with manual expression of urine and intermittent catheterization, as necessary. Provide appropriate education to the patient and his family during discharge.

Also

known as tic douloureux, is a disorder of one or more branches of the 5th cranial nerve.

 Typical

trigeminal neuralgia (also known as classical, idiopathic, and essential trigeminal neuralgia) Atypical trigeminal neuralgia Pre-trigeminal neuralgia MS-related trigeminal neuralgia Secondary trigeminal neuralgia Post traumatic trigeminal neuralgia Failed trigeminal neuralgia

 Intractable

pain Lack of self-care Depression

 Localized

searing or burning that occurs lightning-like jabs and last from 1-2 minutes (pain is usually initiated by a light touch to a hypersensitive area, such as the tip of the nose, cheeks, or gums. Pain may also follow a draft of air, exposure to heat or cold, eating, smiling, talking, or drinking hot or cold beverages) Constant, dull ache Splinting of the affected area

Skull

x-rays, CT-scan, and

MRI

carbamezipine(Tegretol) oxcarbezapine Nerve

block injections Percutaneous surgery (through the cheek) to open skull surgery Pin-point radiation

 Provide

emotional support to the patient and family. Observe and record the characteristics of each attack, including the patients protective mechanism. Provide small, frequent meals at a room temperature to maintain adequate nutrition. Assist the patient in identifying factors that precipitate an attack, and urge the patient to avoid stimulation (air, heat, cold) to trigger zone (lips, cheeks, gums). Administer medications, as ordered, and monitor for adverse effects. Provide appropriate preoperative and postoperative care, as appropriate.

 Also

known as reflex sympathetic dystrophy (CRPS1) or causalgia (CRPS2) is a chronic pain disorder that results from abnormal healing after an injury -either minor or major- to a bone, muscle, or nerve.

 Stage

I (acute) Stage II (subacute or dystrophic) Stage III (chronic or atrophic)

 Specificity Intensity Pattern Neuromatrix Gate

control

pain Depression Drug dependence

Chronic

 Severe

and constant pain Altered blood flow to the affected area Discoloration, sweating, or swelling of the affected area (may also be warm or cool to the touch) Skin, hair, and nail changes Impaired mobility and muscle wasting (if adequate treatment is delayed)

Diagnosis

is based on the patients history and clinical findings Bone x-rays Bone scans, nerve conduction studies, and thermography

Typically

consists of a combination of therapies, including administration of antiinflammatory, antidepressant, vasodilator, and analgesic agents Corticosteroids may be prescribed for some patients Physical therapy

of hot and cold Use of transcutaneous electrical nerve stimulation (TENS) unit Nerve or regional blocks Surgical sympathectomy
Application

medications, monitor their effects and adverse effects. Assist with ROM exercises. Provide rest period as needed. Provide emotional support. Consult a pain care specialist to provide additional options for the patient and help manage discomfort.
Administer