BELL`S PALSY

Villanueva, Relyssa Ashley L.

BSN
Introduction
Bell`s palsy affects the motor aspects of the facial nerve, the seventh cranial nerve. Bell`s palsy
is the most common type of peripheral facial paralysis. It affects both women and men in all age
groups. However, it occurs most commonly between ages 20 and 40 years.
Bell`s palsy results in a unilateral paralysis of the facial muscles of expression. There is no
obvious pathologic cause although there is accumulating evidence that reactivation of herpes
virus (simplex type 1 or zoster) and Lyme disease may be implicated.
Epidemiologic studies show that 11 to 40 persons per 100,000 are affected each year, most
commonly between the ages of 30 and 45 years.5 Although most patients recover well, up to 30%
of patients have a poor recovery, with continuing facial disfigurement, psychological difficulties,
and facial pain. (Sullivan, et al. 2007)

Sign and symptoms

 Acute onset of unilateral upper and lower facial paralysis (over a 48-hr period)
 Posterior auricular pain
 Decreased tearing
 Hyperacusis (hearing disorder)
 Taste disturbances
 Otalgia(ear pain)
 Weakness of the facial muscles
 Poor eyelid closure
 Aching of the ear or mastoid
 Tingling or numbness of the cheek/mouth
 Epiphora (watering eyes)
 Ocular pain
 Blurred vision
 Flattening of forehead and nasolabial fold on the side affected by palsy
 When patient raises eyebrows, palsy-affected side of forehead remains flat
 When patient smiles, face becomes distorted and lateralizes to side opposite the palsy

OBJECTIVES

General Objective:

The main goal of the study is to establish a holistic plan of care for a patient with Bell`s
Palsy. Moreover, to have a clearer knowledge by identifying the etiology, signs and
symptoms, risk factors, and the medical management for the disease.

Client-Specific Objective:

The client will be able to:

 KNOWLEDGE:
1. Verbalize understanding on the nature of Bell`s Palsy.
2. Identify the etiology and the contributing risk factors of the disease.
3. Verbalize understanding of the needed management for the disease that is specific for
the patient.
4. Identify how the trauma can change his way of living in terms of work, interacting
with his family, and friends.

SKILLS:
1. Apply the acquired knowledge about self-care in line with condition
2. Demonstrate techniques on how to reduce or manage feelings of discomfort or pain.
3. Demonstrate compliance to interventions to all the nursing care plans.

ATTITUDE:
1. Emphasize the importance of compliance to medical and pharmacological
intervention.
2. Express feelings of confidence, and positivity towards full recovery.
3. Express hopefulness towards independence in doing normal activities of daily living.

Student-Specific Objectives:

The student nurses will be able to:

KNOWLEDGE:
1. Explain what Bell`s Palsy is from the etiology to the signs and symptoms.
2. Discuss profoundly all relevant answers to any questions the panel will deliver.
3. Impart knowledge about the disease to the class following the nursing principle of
ADPIE.

SKILLS:
1. Demonstrate the use of holistic approach to identify patient’s need for care.
2. Use our knowledge, and skills to help manage and/or prevent any of the patient’s
discomfort or pain.
3. Use therapeutic communications to deal with patient’s anxiety.

ATTITUDE:
1. Explain the importance of establishing rapport with the patient, and the patient’s
significant others to achieve effective, and timely medical management.
2. Demonstrate attentiveness to any of patient’s needs and concerns.
 3. Demonstrate enthusiasm in helping the patient reach complete recovery.

Overview of Anatomy and Physiology

 The facial nerve (cranial nerve VII) determines facial expressions and the taste sensations
of the tongue.
 The facial nerve (cranial nerve VII) is responsible for the muscles that determine facial
expression, as well as the sensation of taste in the front of the tongue and oral cavity.
 The facial nerve’s motor component begins in the facial nerve nucleus in the pons, and
the sensory component begins in the nervus intermedius. The nerve then runs through the
facial canal, passes through the parotid gland, and divides into five branches.
 Voluntary facial movements, such as wrinkling the brow, showing teeth, frowning,
closing the eyes tightly (inability to do so is called lagophthalmos), pursing the lips, and
puffing out the cheeks, all test the facial nerve.
 Bell’s Palsy: Bell’s palsy is a form of facial paralysis resulting from a dysfunction of the
cranial nerve VII (the facial nerve) that results in the inability to control facial muscles on
the affected side

Pathophysiology

Laboratory & Diagnostic test

 Imaging tests such as computerized tomography (CT scan) or magnetic resonance

imaging (MRI scan) - are used to detect infection, tumor, bone fracture, or other
abnormality in and around the facial nerve.
  Hearing and balance tests - are used to determine if the nerve responsible for hearing is
also damaged and assess injury to the inner ear. Tests can be performed to evaluate the
eye's ability to produce tears. The sense of taste also can be evaluated to determine the
location and severity of a facial nerve lesion.
 Electromyography (EMG) - assesses injury by electrically stimulating the facial nerve.
Electrical current is applied to the skin over the nerve and nerve function is determined
by the amount of current needed to cause contraction of the facial muscles. The test is
often repeated to assess disease progression and the extent of injury.
 Laboratory tests can help the physician determine the underlying cause. For example, a
blood test for Lyme disease may be ordered if there is a chance that the patient was bitten
by a deer tick, or a blood glucose test may be obtained to determine if the patient has
undiagnosed diabetes.

Collaborative Management
1. Pharmacologic treatment
a. Corticosteroids like prednisone and prednisolone are known anti-inflammatory
agents. These reduce the swelling of the facial nerve and work best when given
within a few days of the onset of symptoms. Side effects: nausea, increased sweating,
difficulty sleeping, oral thrush
b. Antiviral drugs like valacyclovir are occasionally prescribed with corticosteroids in
severe cases of facial paralysis.
c. Botulinum toxin (Botox) injections are given to patients with long term Bell’s palsy.
Botox is injected into the affected facial muscles for relaxation and decreased
involuntary muscle movements. Complications of Bell’s palsy like tear production
when eating or winking of the eye when eating, smiling or laughing can be resolved
by the injection. Botox injections may have to be repeated after four months.
2. Protect the eye from injury, may have eye ointment
3. Facial exercise

Nursing Management
1. Moisturizing eye drops during the day and eye ointment during bedtime
2. Manually close the paralyzed eyelid before going to sleep
3. Wear sunglasses or goggles during the day, to decrease normal eye evaporation
4. Promote facial exercise and suggest to massaging the face several times daily, using a
gentle upward motion, to maintain muscle tone
5. Exposure of the face to cold and drafts is avoided
References:
Brunner and Suddarth`s Textbook of Medical-surgical Nursing, Volume 1
Retrieved from:
https://books.google.com.ph/books?id=SmtjSD1x688C&pg=PA1972&lpg=PA1972&dq=bell%2
7s+palsy+brunner+and+suddarth&source=bl&ots=cjo5gg_PgX&sig=ACfU3U0L8YSNirpGJ7T
dWFPu4wx70ofo5g&hl=ceb&sa=X&ved=2ahUKEwjf9ICO37PjAhWMdXAKHS-
1BiQQ6AEwC3oECAcQAQ#v=onepage&q&f=true
Tha T. U, M.D.(2000) retrieved from: http://www.healthcommunities.com/bells-
palsy/diagnosis.shtml
Boundless Anatomy and Physiology retrieved from:
https://courses.lumenlearning.com/boundless-ap/chapter/cranial-nerves/
Doenges, M. E.,Moorhouse, M.F,Murr, M.C.(2016) Nurse`s Pocket Guide 14th Edition
MIMS Philippines 141st Edition 2014