Bell’s Palsy is a temporary facial paralysis or weakness that affects one side of the face, resulting from damage or trauma to the seventh cranial nerve (facial nerve). This nursing diagnosis focuses on identifying symptoms, preventing complications, and supporting patients through recovery.
Causes (Related to)
Bell’s Palsy can affect patients in various ways, with several factors potentially contributing to its onset and progression:
- Inflammation or compression of the facial nerve
- Viral infections, particularly herpes simplex virus (HSV-1) or herpes zoster virus
- Autoimmune conditions
- Risk factors such as:
- Pregnancy
- Diabetes
- Hypertension
- Recent upper respiratory infection
- Environmental factors including:
- Cold exposure
- Physical trauma
- Stress
Signs and Symptoms (As evidenced by)
Bell’s Palsy presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Sudden onset of facial weakness or paralysis
- Pain behind or in front of the ear
- Changes in taste sensation
- Increased sensitivity to sound
- Difficulty eating and drinking
- Speech difficulties
- Eye dryness or excessive tearing
- Facial numbness or tingling
Objective: (Nurse assesses)
- Unilateral facial drooping
- Inability to close eye on the affected side
- Asymmetrical smile
- Decreased facial expressions
- Drooling from the affected side
- Impaired blinking
- Altered tear production
- Difficulty with articulation
Expected Outcomes
The following outcomes indicate the successful management of Bell’s Palsy:
- The patient will demonstrate improved facial muscle function within 3-6 months
- The patient will maintain eye moisture and integrity
- The patient will perform facial exercises correctly
- The patient will demonstrate proper eye care techniques
- The patient will maintain adequate nutrition and hydration
- The patient will verbalize understanding of the condition and treatment plan
- The patient will show improved psychological adaptation to temporary facial paralysis
Nursing Assessment
Monitor Facial Function
- Assess facial symmetry
- Document the degree of facial paralysis
- Evaluate eye closure capability
- Check mouth movement and control
- Monitor speech patterns
Assess Eye Health
- Check corneal integrity
- Monitor tear production
- Assess for signs of injury
- Document eye protection measures
- Evaluate blink reflex
Evaluate Oral Function
- Monitor swallowing ability
- Assess food and fluid intake
- Check for oral injuries
- Document speech clarity
- Evaluate oral hygiene
Monitor for Complications
- Check for signs of infection
- Assess psychological status
- Monitor pain levels
- Document any new symptoms
- Evaluate treatment response
Review Risk Factors
- Assess medical history
- Document recent infections
- Note stress levels
- Review medication history
- Check for chronic conditions
Nursing Care Plans
Nursing Care Plan 1: Impaired Physical Mobility (Facial)
Nursing Diagnosis Statement:
Impaired Physical Mobility (Facial) related to seventh cranial nerve dysfunction as evidenced by unilateral facial drooping and inability to close the eye completely.
Related Factors:
- Neuromuscular impairment
- Facial nerve inflammation
- Muscle weakness
- Pain and discomfort
Nursing Interventions and Rationales:
- Assess facial muscle strength and symmetry q shift
Rationale: Monitors progression and recovery of facial function - Teach facial exercises as prescribed
Rationale: Maintains muscle tone and promotes recovery - Provide emotional support and encouragement
Rationale: Enhances patient compliance and motivation
Desired Outcomes:
- The patient will demonstrate improved facial muscle control
- The patient will perform the prescribed exercises correctly
- The patient will show progressive improvement in facial symmetry
Nursing Care Plan 2: Risk for Corneal Injury
Nursing Diagnosis Statement:
Risk for Corneal Injury related to inability to close eye completely as evidenced by incomplete blink reflex and decreased tear production.
Related Factors:
- Impaired eyelid closure
- Decreased blink reflex
- Reduced tear production
- Exposure keratitis risk
Nursing Interventions and Rationales:
- Apply eye lubricants as prescribed
Rationale: Prevents corneal drying and injury - Teach proper eye protection techniques
Rationale: Ensures adequate eye moisture and protection - Monitor for signs of corneal damage
Rationale: Enables early intervention if complications develop
Desired Outcomes:
- The patient will maintain corneal integrity
- The patient will demonstrate proper eye care techniques
- The patient will report no eye discomfort or injury
Nursing Care Plan 3: Impaired Verbal Communication
Nursing Diagnosis Statement:
Impaired Verbal Communication related to facial muscle weakness as evidenced by difficulty articulating words and controlling oral secretions.
Related Factors:
- Facial muscle paralysis
- Impaired lip control
- Difficulty with articulation
- Psychological impact
Nursing Interventions and Rationales:
- Assess speech patterns and clarity
Rationale: Establishes baseline and monitors progress - Provide alternative communication methods
Rationale: Ensures effective communication despite limitations - Collaborate with speech therapy
Rationale: Optimizes communication strategies and recovery
Desired Outcomes:
- The patient will demonstrate improved speech clarity
- The patient will utilize effective communication strategies
- The patient will report satisfaction with the communication ability
Nursing Care Plan 4: Situational Low Self-Esteem
Nursing Diagnosis Statement:
Situational Low Self-Esteem related to altered facial appearance as evidenced by expressed feelings of self-consciousness and social withdrawal.
Related Factors:
- Altered body image
- Social stigma
- Temporary disability
- Communication difficulties
Nursing Interventions and Rationales:
- Provide emotional support and counseling
Rationale: Helps patient cope with temporary changes - Encourage social interaction
Rationale: Prevents isolation and maintains support systems - Teach coping strategies
Rationale: Enhances psychological adaptation
Desired Outcomes:
- The patient will express improved self-esteem
- The patient will maintain social relationships
- The patient will demonstrate effective coping mechanisms
Nursing Care Plan 5: Risk for Impaired Nutrition
Nursing Diagnosis Statement:
Risk for Impaired Nutrition related to difficulty eating and drinking as evidenced by impaired oral control and risk for aspiration.
Related Factors:
- Impaired oral muscle control
- Difficulty swallowing
- Risk of aspiration
- Decreased oral intake
Nursing Interventions and Rationales:
- Assess swallowing ability
Rationale: Ensures safe oral intake - Modify food and fluid consistency
Rationale: Facilitates safe swallowing - Monitor nutritional status
Rationale: Prevents nutritional deficiencies
Desired Outcomes:
- The patient will maintain adequate nutrition
- The patient will demonstrate safe swallowing techniques
- The patient will maintain the appropriate weight
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
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- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- McCaul, J. A., Cascarini, L., Godden, D., Coombes, D., Brennan, P. A., & Kerawala, C. J. (2014). Evidence based management of Bell’s palsy. British Journal of Oral and Maxillofacial Surgery, 52(5), 387-391. https://doi.org/10.1016/j.bjoms.2014.03.001
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Somasundara D, Sullivan F. Management of Bell’s palsy. Aust Prescr. 2017 Jun;40(3):94-97. doi: 10.18773/austprescr.2017.030. Epub 2017 Jun 1. PMID: 28798513; PMCID: PMC5478391.
