Bell's Palsy

Bell’s Palsy Nursing Diagnosis Interventions and Care Plans

Bell’s Palsy NCLEX Review Care Plans

Nursing Study Guide for Bell’s Palsy

Acute peripheral facial palsy, more commonly known as Bell’s palsy, is a medical condition that involves the sudden weakness of facial muscles.

It has an unknown exact cause and can occur at any age.  Its symptoms include sudden facial weakness, which makes one side of the face droop, the person’s smile crooked, and the eye on the affected side remains opened.

Symptoms normally become better in a few weeks, with expected recovery in about six months and low recurrence rate, but some unfortunately experience these symptoms for life.

Some theories say that it is caused by either an inflammation of the facial nerves, or the body’s reactive response to a viral infection.

Signs and Symptoms of Bell’s Palsy

  1. Facial weakness – sudden onset of mild weakness to total paralysis on one side of the face which can happen within hours to days; may lead to facial paralysis
  2. Facial droop – can be accompanied by difficulty in closing one or both eyes, smiling, and making facial expressions
  3. Drooling
  4. Jaw or ear pain on the affected side of the face
  5. Increased sensitivity to sound on the affected side
  6. Noticeable changes in saliva and/or tear production
  7. Headache
  8. A loss of taste

Causes and Risk Factors of Bell’s Palsy

The root cause of Bell’s palsy is still unclear, but some viruses such as herpes viruses, adenovirus, rubella, influenza B, Epstein-Barr, rubella, and mumps virus have all been linked to this condition.

In Bell’s palsy, the facial nerve suffers from inflammation and swelling probably due to a viral infection.

This affects not only the facial expressions and dropping of one side of the face, but also the saliva, taste, tears, and the middle ear.

Some risk factors that can contribute to the development of Bell’s palsy include:

  1. Diabetes
  2. Pregnancy – usually in the 3rd trimester
  3. Viral infection – particularly upper respiratory tract infections (URTI) such as cold and flu
  4. Family history – genetics may affect the emergence of recurrent attacks of Bell’s palsy

Complications of Bell’s Palsy

Full recovery from Bell’s palsy usually occurs within a month in mild cases; however, a more severe case with total paralysis can take longer to resolve. Complications of Bell ’s palsy may include the following:

1.         Irreversible damage to the facial nerve. Other damages to the seventh cranial nerve which controls facial muscles can also happen.

2.         Nerve fibers can grow abnormally. This abnormal growth can cause synkinesis, which is the involuntary movement of certain muscles when trying to move another muscle group. A good example is how the eye may close on the affected side of the face when trying to smile. Synkinesis may happen which causes involuntary movements of one body part when trying to move another.

3.         The eye on the affected side of the face can stay open causing partial or complete blindness. This can be the result of too much dryness of the eye and scratching of the cornea which is the transparent outer covering protecting the eyes. 

4.         Dry eyes and other complications.     Not only that excessive dryness of the eye can cause blindness, it can also lead to infections and ulcers.

Diagnosis of Bell’s Palsy

  1. Neurological exam – to assess the patient’s facial motor capacity such as closing the eyes, lifting the eyebrows, smiling, and frowning
  2. Blood test – to check for any viral infections or other risk factors that are related to Bell’s Palsy
  3. Electromyography (EMG) – to check the electrical activity of the affected muscles when it they are stimulated in order to determine the presence and severity of nerve damage
  4. Imaging – CT scan to visualize any abnormalities in the affected area

Treatment of Bell’s Palsy

Many patients with Bell’s palsy experience full recovery even without active treatment.

Progressive symptoms may be treated through pharmacologic approach and physiotherapy.

  1. Medications. Corticosteroids are anti-inflammatory drugs that can cause a reduction in the swelling of the facial nerve. Antiviral drugs may be prescribed with corticosteroids for severe Bell’s palsy. This depends on the discretion of the medical team.
  2. Physiotherapy. The affected muscles of the face may become paralyzed. They are also at risk for shortening and shrinking, which can result to permanent contractures if not managed. A physical therapist can help teach the patient effective facial muscle exercises and massages to prevent this complication.
  3. Surgery. This is rarely used nowadays for the treatment of Bell’s palsy, as decompression surgery could cause permanent hearing loss and facial nerve injury. If needed, plastic surgery such as eyebrow lift and facial implants may be recommended to treat long-term facial nerve and muscle issues.

Nursing Care Plans for Bell’s Palsy

Nursing Care Plan 1

Nursing Diagnosis: Risk for Trauma/Injury related to loss of sensory coordination and muscular control secondary to Bell’s palsy

Desired Outcome: The patient will be able to prevent trauma or injury by means of maintaining his/her treatment regimen.

InterventionRationale
Explore the usual pattern of Bell’s palsy attack on the patient and enable to patient and caregiver to identify any worsening of symptoms.  To empower the patient and his/her caregiver to recognize Bell’s palsy attack and help protect the patient from any injury or trauma. To reduce the feeling of helplessness on both the patient and the caregiver.  
Place the bed in the lowest position. Put pads on the bed rails and the floor.To prevent or minimize injury in a patient during a Bell’s palsy attack.
Advise the caregiver to stay with the patient during and after the Bell’s palsy attack.To promote safety measures and support to the patient. To ensure that the patient is safe if the Bell’s palsy attack recurs.
Administer medications as prescribed.To treat the symptoms of Bell’s palsy and prevent the recurrence of Bell’s palsy attacks. Corticosteroids are anti-inflammatory drugs that can cause a reduction in the swelling of the facial nerve. Antiviral drugs may be prescribed with corticosteroids for severe Bell’s palsy. This depends on the discretion of the medical team.
Refer the patient to a physiotherapist.The affected muscles of the face may become paralyzed. They are also at risk for shortening and shrinking, which can result to permanent contractures if not managed. A physical therapist can help teach the patient effective facial muscle exercises and massages to prevent this complication.

Nursing Care Plan 2

Nursing Diagnosis: Deficient Knowledge related to new diagnosis of Bell’s Palsy as evidenced by patient’s verbalization of “I want to know more about my new diagnosis and care”

Desired Outcome: At the end of the health teaching session, the patient will be able to demonstrate sufficient knowledge of Bell’s palsy and its management.

InterventionsRationales
Assess the patient’s readiness to learn, misconceptions, and blocks to learning (e.g. decreased cognitive ability).To address the patient’s cognition and mental status towards the new diagnosis of Bell’s Palsy and to help the patient overcome blocks to learning.
Explain what Bell’s Palsy is and related signs and symptoms. Avoid using medical jargons and explain in layman’s terms.To provide information on Bell’s Palsy and its pathophysiology in the simplest way possible.
Educate the patient about safety measures related to Bell’s Palsy and its symptoms. Create a plan for Activities of Daily Living (ADLs) with the patient and the caregiver, especially including important activities such as driving, operating machinery, swimming, and bathing.To help the patient avoid alcohol intake that may lead to preventing further damage to the pancreas. To encourage the patient to live his/her daily life optimally, while ensuring that he/she is safe from injury if a Bell’s palsy attack occurs.
Inform the patient the details about the prescribed medications (e.g. drug class, use, benefits, side effects, and risks) to manage Bell ’s palsy. Ask the patient to repeat or demonstrate the self-administration details to you.To inform the patient of each prescribed drug and to ensure that the patient fully understands the purpose, possible side effects, adverse events, and self-administration details.
Teach the patient on how to perform proper eye care:Manual closure of the paralyzed eyelid before the patient sleeps.Use a protective shield to cover the affected eye at night.Encourage the patient to wear goggles or sunglasses that wrap around the eyes.Apply a prescribed ointment to control tear production.Bell’s palsy may cause the inability to shut the affected eye completely, and may also include diminished blink reflex. These may cause increased risk of irritation and injury from foreign objects like dust.
Teach the patient on how to perform proper maintenance of muscle tone:Demonstrate how to perform a proper facial massage by doing gentle upward movements. This should be done several times per day. Instruct the patient to avoid exposure of the face to cold and drafts and to reduce stress levels.Encourage to exercise facial muscles by gently blowing the cheeks, whistling, smiling, frowning, and wrinkling the forehead.

 
The affected muscles of the face may become paralyzed. They are also at risk for shortening and shrinking, which can result to permanent contractures if not managed. Facial exercises can be used to prevent muscle atrophy. Cold and drafts, as well as heightened stress levels may trigger the symptoms of Bell’s palsy.

Other nursing diagnoses:

  • Acute Pain
  • Noncompliance
  • Situational Low Self-Esteem

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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  1. Great for writing!

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