User:Bhawani shankar bakoliya

Bell’s Palsy

WHAT WENT WRONG?

This is an acute idiopathic facial paralysis of the seventh cranial nerve that affects one side of the face. Often due to inflammation, the disorder is more common in diabetic patients. One side of the face is paralyzed, making the patient unable to close the eyelid, raise the eyebrow, or smile on the affected side of the face. Some patients will experience pain around the ear on the affected side.  The patient may have an associated change in taste.

PROGNOSIS

The more severe the symptoms at the time of presentation, the poorer the prognosis. Some patients will have long-term persistence of symptoms, like facial disfigurement.  The majority of patients will have complete resolution of symptoms.

HALLMARK SIGNS AND SYMPTOMS

• Unilateral facial paralysis—inability to close eye, wrinkle forehead, puff out cheeks, or smile

• Pain near the ear and jaw

• Altered taste

INTERPRETING TEST RESULTS

• Electromyogram (EMG) used to indicate recovery time; can determine prognosis.

TREATMENT

• Administer corticosteroids to decrease inflammation (unclear if there is a definitive benefit):

• prednisone in divided doses for first few days, then taper down

• Administer artificial tears to maintain moisture within eyes.

NURSING DIAGNOSES

• Disturbed sensory perception

• Disturbed body image

NURSING INTERVENTION

• Monitor for pain control.

• Monitor for visual changes—dryness of eye can lead to irritation of cornea.

• Monitor patient for reaction to medications.

• Provide meals in private—patient may have difficulty keeping food in mouth and may not feel food or liquid that is drooling out side of mouth.

•Explain to patient:

• How to properly instill artificial tear drops.

• How to use eye patch.