Bell's Palsy Nursing Management and Interventions

Bell's palsy is a facial nerve problem that looks alarming but usually recovers on its own. Your first job is reassurance (this is not a stroke), and your most important hands-on job is protecting the eye that no longer closes.

Definition

Bell's palsy is a disease of the seventh cranial nerve (facial nerve) that produces unilateral or bilateral facial weakness or paralysis. It is named after Scottish anatomist Charles Bell, who first described it.

Cause

The cause is unknown. Possible causes include vascular ischemia, viral disease (herpes simplex, herpes zoster), autoimmune disease, or a combination.

Manifestations

Bell's palsy may be a type of pressure paralysis in which ischemic necrosis of the facial nerve distorts the face, increases lacrimation, and causes painful sensations in the face, behind the ear, and in the eye. The patient may have speech difficulty and be unable to eat on the affected side because of weakness.

Complications

Corneal ulcers, blindness, and impaired nutrition.

Prognosis

Most patients recover completely, and Bell's palsy rarely recurs. It subsides spontaneously with complete recovery in 1 to 8 weeks.

Medical Management

The goals are to maintain facial muscle tone and prevent or minimize denervation.

• Corticosteroid therapy (prednisone) reduces inflammation and edema, which lowers vascular compression and restores blood flow to the nerve. Early administration appears to lessen severity, relieve pain, and minimize denervation.
• Control facial pain with analgesics or heat applied to the involved side.
• Electrical stimulation to the face may prevent muscle atrophy.
• Surgery may be done if a tumor is suspected, for decompression of the facial nerve, or for rehabilitation of a paralyzed face.

Nursing Management

Reassure the patient that a stroke has not occurred and that most people recover spontaneously within 3 to 5 weeks. Teaching self-care at home is a nursing priority.

Teaching Eye Care

The eye usually does not close completely and the blink reflex is diminished, leaving it vulnerable to dust and foreign particles, corneal irritation, and ulceration. A distorted lower lid also disrupts tear drainage. Teach the patient to:

• Cover the eye with a protective shield at night.
• Apply eye ointment to keep the eyelids closed during sleep.
• Close the paralyzed eyelid manually before sleep.
• Wear wraparound sunglasses or goggles to reduce tear evaporation.

Teaching About Maintaining Muscle Tone

• Perform facial massage with a gentle upward motion several times daily, once the patient can tolerate it.
• Do facial exercises such as wrinkling the forehead, blowing out the cheeks, and whistling to prevent muscle atrophy.
• Avoid exposing the face to cold and drafts.

Diet & Nutrition

• Chew on the unaffected side of the mouth.
• Provide a soft, nutritionally balanced diet and eliminate hot fluids and foods.
• Give frequent mouth care, removing food residue that collects between the cheeks and gums.