Bell’s Palsy

Description

• Disorder of seventh cranial nerve and results

in weakness or paralysis of the facial muscles
on the affected side (unilateral)
• Occurs between age of 20 – 60 equally in
males and females
• Cause unknown, but thought to be related to
herpes virus or vessel ischaemia, autoimmune
disease.

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AMERICAN DREAM REVIEW INSTITUTE
 pathophysiology
• The inflamed, edematous nerve becomes
compressed to the point of damage, or its
nutrient vessel is occluded, producing ischemic
necrosis of the nerve.
• There is distortion of the face from paralysis of
the facial muscles: increased lacrimation
(tearing); and painful sensations in the face,
behind the ear, and in the eye.
• speech difficulties; unable to eat on the
affected side because of weakness or paralysis
of the facial muscles.

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 Manifestations

• Numbness, stiffness noticed first

• Later face appears asymmetric: side of face
droops; unable to close eye, wrinkle forehead
or pucker lips on one side
• Lower facial muscles are pulled to one side;
appears as if a stroke

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 Prognosis

• Majority of person recover fully in few weeks

to months
• Some persons have residual paralysis
• complete recovery in 3-4 months in majority
of clients

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 Diagnosis

• based on physical examination

• Careful history – timing
– Associated symptoms (pain, dysgeusia)
– vesicles, severe pain
– Trauma, acute or chronic OM, recurrent
– Exposures
• Physical exam
• Audiometry
• CT/MRI/other
• Electrophysiology

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 Collaborative Care
• Corticosteroids are prescribed
(prednisolone) especially the within the 1st
week
• Analgesic for facial pain (heat therapay to
control pain)
• Electrical stimulation may be applied to the
face to prevent muscle atrophy
• Surgical management for exploration of the
facial nerve.
• Treatment is supportive 9
 Nursing Care
• Teaching client self-care: prevent injury and
maintain nutrition
• Use of artificial tears, wearing eye patch or
taping eye shut at night; wearing sunglasses
• Soft diet that can be chewed easily, small
frequent meals
• Psychological support: tell the patient he has
not had stroke and recovery is imminent

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 Nursing interventions
• Watch for steroid adverse reactions (GI irritation and
fluid retention)
• Apply moist heat on the affected side
• Apply facial sling to improve lip alignment and
remember oral care
• Incase of surgery provide complete pre and post
operative care.
• Massage the patient’s face 5 to 10 mins with a gentle
upward motion to help maintain the muscle tone.

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 Nursing diagnoses
• Altered nutrition; less then body requirement
• Anxiety
• Body image disturbance
• Knowledge deficit
• pain

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