Bell's Palsy
Seventh Cranial Nerve Disease • Facial Palsy / Facial Paralysis
Introduction
Bell's palsy is also known as facial palsy or facial paralysis. It can occur at any age. The exact cause is unknown but it is believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of the face.
It may be a reaction which occurs after a viral infection.
Definition
It is unilateral paralysis of the facial nerve causing weakness of muscles of one side of the face.
Causes
The exact cause of this disease is unknown, but many researchers believe it's most likely triggered by a viral infection.
- Herpes simplex virus
- Herpes zoster virus
- HIV
- Epstein-Barr virus
- Sarcoidosis, which causes organ inflammation
- Lyme disease, which is a bacterial infection caused by infected ticks.
Clinical Manifestations
Drooping of eyes
Facial muscle weakness
Decreased tearing
Painful eye sensations
Decreased blink reflex
Photophobia
Drooling
Distorted body image
Management
- Analgesics
- Gentle massage
- Corticosteroids
- Moist heat application.
Nursing Management
- Assess pain for location, intensity, radiation and duration.
- Identify the factors which increase pain and control them.
- Administer corticosteroids and non-opioid analgesics to relieve pain and inflammation.
- Instruct the patient to apply moist heat to face to relieve symptoms. Perform and teach facial massage to alleviate feelings of stiffness.
- Teach the patient facial exercises and methods to get appropriate pronunciation, volume, e.g., take a deep breath before speaking to increase volume of sound and number of words with each breath.
- Exercise facial muscles by smiling, grimacing and puckering.
- Read aloud in front of a mirror or into a tape recorder to monitor progress.
- Encourage the family to communicate with patient.
- Provide the patient with feedback about any progress made with verbal communication because positive feedback increases confidence level and facilitates the patient's ongoing efforts to communicate verbally.
- Instruct/teach importance of follow-up care by rehabilitation team, e.g., physiotherapy, occupational therapy and speech therapists.
- We should encourage energy-saving techniques such as sitting to perform activities, limiting up and down stairs, etc.
- Encourage or instruct to take balanced diet, rest, exercise and relaxation; also develop healthy lifestyle.
- Provide knowledge about disease condition to patient and family members to enhance their coping abilities and decrease anxiety.
- Consult with occupational therapist and rehabilitation team to enhance level of overall function and participation in activities.
Nursing Diagnosis
- Chronic pain related to disease process.
- Disturbed body image related to paralysis of facial nerve.
- Low self-esteem related to disease process.