CRANIAL NERVE

DISORDERS

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BELL’S PALSY

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• Affectation of the seventh cranial (facial)
nerve
• Produces unilateral facial weakness or
paralysis.
• Onset is rapid while it affects age-groups.
• Subsides spontaneously (80-90%)
• It may recur on the same or opposite side
of the face.

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 Possible Causes
• Blockage of the seventh cranial nerve
(Facial)
– Infection
– Hemorrhage
– Tumor
– Meningitis
– Local trauma

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 Assessment Findings
• Inability to close eye completely on the
affected side
• Pain around the jaw or ear
• Unilateral facial weakness
• Eye rolls upward and tears excessively
when the client attempts to close it
• Ringing in the ears
• Taste distortion on the affected anterior
portion of the tongue
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 Nursing Diagnoses
• Acute pain
• Disturbed sensory perception
• Disturbed body image

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 Collaborative Management
• Electrotherapy after the 14th day of
prednisone therapy to help prevent facial
muscle atrophy
• Moist heat
• Medications:
• Corticosteroid: prednisone (Deltasone) to
reduce facial nerve edema and improve
nerve conduction and blood flow

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 Nursing Interventions
• During treatment with prednisone, watch for
adverse reactions:
– GI distress (usually relieved with an antacid)
– Fluid retention.
– Immunosuppression
– Hyperglycemia (diabetics must be
monitored)
• Apply moist heat to the affected side of the
face, taking care not to burn the skin to reduce
pain.
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• Apply moist heat to the affected side of
the face, taking care not to burn the skin
to reduce pain.
• Massage the client’s face with a gentle
upward motion two to three times daily for
5 to 10 minutes.
• Arrange for privacy at mealtimes to
reduce embarrassment
• Oral care (as residue is common)
• Psychological support. Give reassurance
that recovery is likely within 3 to 6 weeks
to allay the client’s anxiety.

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TRIGEMINAL
NEURALGIA

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• also called Tic Douloureux
• Is a painful disorder of one or more
branches of the fifth cranial (trigeminal)
nerve that produces paroxysmal attacks
including facial pain.
• Incidence:
– above 40
– more common in women
• Can subside spontaneously, with
remissions lasting from several months to
years.

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 Possible Causes
• Unknown
• Trigeminal nerve compression secondary
to tumor
• Occasionally, it can be a manifestation of
multiple sclerosis or herpes zoster

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 Assessment Findings
• Searing pain in the facial area
• Triggers:
– Light touch to a sensitive area of the face
(trigger zone)
– Exposure to hot or cold temperature
– Eating, smiling, or talking
– Drinking hot or cold beverages

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 Diagnostic Evaluation
• Skull X-rays, tomography, and CT scan
rule out sinus or tooth infections, and
tumors

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 Nursing Diagnoses
• Acute pain
• Powerlessness
• Anxiety

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 Collaborative Management
• Surgery for decompression
• Nerve blocks to relieve pain

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 Nursing Interventions
• Observe and record the characteristics of
each attack.
• Provide adequate nutrition in small frequent
meals at room temperature. (Temperature
extremes may cause an attack)
• Place food in the unaffected side of his
mouth when chewing.
• Health teachings on good oral hygiene.
• Reinforce natural avoidance of stimulation.

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 Parkinson's, Bell's Palsy, Trigeminal Neuralgia
• Bradykinesia
• Unintentional tremors
• High dopamine level
• Pill rolling
• Shuffling gait
• Mask like facial expression
• Propulsive gait
• Painful disorder of 5th cranial nerve
• Avoid exposure to hot or cold environment
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• Weakness of facial nerve
• Inability to close eyes completely
• Unilateral facial weakness
• Tic douloreux
• Give parlodel
• Limit talking and smiling
• No hot or cold beverages
• Risk for injury
• Give Levodopa

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• Is an outpouching of cerebral artery
that results from weakness of the
middle layer of an artery.
• Types are:
– Saccular (berry) – most common
– Fusiform
– Ruptured

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 Possible Causes
• Atherosclerosis
• Congenital weakness
• Head trauma

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 Assessment Findings
• Asymptomatic until aneurysm ruptures
• Headache (commonly described by the client
as the worst he had ever had)
• Decreased LOC
• Diplopia, ptosis, blurred vision
• Fever
• Hemiparesis
• Nuchal rigidity
• Seizure activity

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 Diagnostic Evaluation
• Cerebral angiogram identifies the aneurysm
• CT scan shows a shift of intracranial midline
structures and blood in subarachnoid space
• Lumbar puncture (contraindicated with
increased ICP) shows increased CSF
pressure, protein level, and WBCs and
glossy bloody
• MRI shows shift of intracranial midline
structures and blood in subarachnoid space.

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 Nursing Diagnoses
• Ineffective tissue perfusion (cerebral)
• Anxiety

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 Collaborative Management
• Aneurysm and seizure precautions
• I.V. therapy
• O2 therapy
• Medications
– Anticonvulsants– for possible seizures
– Antihypertensives – prevent rupture
– Calcium channel blocker: to prevent cerebral
vasospasm
– Vasopressor: -maintain systolic blood pressure at
140 to 160 mm Hg
– Stool softener: docusate sodium (Colace)

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