Bell’s Palsy Nursing Diagnosis and Nursing Care Plan

Bell’s Palsy Nursing Care Plans Diagnosis and Interventions

Bell’s Palsy NCLEX Review and Nursing Care Plans

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.

Bell’s Palsy Nursing Diagnosis

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.

Bell’s Palsy Nursing InterventionsRationale
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.

Bell’s Palsy 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.

Bell’s Palsy Nursing 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.

Bell’s Palsy Nursing Care Plan 3

Acute Pain

Nursing Diagnosis: Acute Pain related to ischemic necrosis of the facial nerve secondary to Bell’s Palsy as evidenced by expressions of pain around the jaw and behind the affected ear, increased sensitivity to sound on the affected side, restlessness, headache, and facial drooping.

Desired Outcomes:

  • The patient will use appropriate diversional activities and relaxation techniques.
  • The patient will describe satisfactory pain relief at a level less than 3 to 4 on a rating scale of 0 to 10.
  • The patient will display improved well-being including baseline levels for vital signs.
  • The patient will utilize pharmacological and nonpharmacological pain-relief methods.
Bell’s Palsy Nursing InterventionsRationale
Perform a thorough assessment of pain. Assessing the patient’s pain will reveal its location, features, onset, duration, frequency, quality, and intensity.      The most trustworthy source of knowledge on a patient’s pain is the patient who is actually experiencing it. Their ability to characterize the location, intensity and duration of their pain makes their self-report the gold standard in pain evaluation. Thus, assessing pain through an interview aids the nurse in creating the best pain treatment plans.
Determine the location of the pain by asking the patient to point to the painful site.The patient can get assistance from charts or anatomy diagrams, and the nurse pinpoints specific pain points. Asking the patient to pinpoint the site will enable to nurse to determine the proper pain location for patients with limited vocabulary.
Perform a pain history assessment on the patient.      In order to learn more about the patient’s medical history and discomfort, the nurse should inquire about their past use of pain medication, when they last used it, other medications they are now taking, and any allergies or known drug adverse effects.
Include pain assessment every time the patient’s vital signs are assessed.Many medical facilities designate the evaluation of pain as the “fifth vital sign,” which should be included in the regular examination of vital signs.
Evaluate the patient’s ability or desire to explore different pain-relief methods.        While some patients may be prepared to explore conventional pharmaceutical procedures, they may be reluctant to try the effectiveness of nonpharmacological alternatives. The nurse has a responsibility to explain to the patient the many ways to control pain because a combination of the two therapies may be more beneficial.
Identify the factors that help the patient to reduce pain.  Ask the patient to describe any pain-relief measures taken in the past. These could consist of things like prayer, meditation, and deep breathing techniques. Planning for the best pain treatment might incorporate information on these pain-relief activities.
Analyze how the patient reacts to pain management techniques.        It is important to help patients communicate the effects of pain treatment methods as factually as possible. Inconsistencies between a patient’s behavior or look and what they say about their level of pain relief may be due to various ways they are coping with their pain rather than the absence of pain relief itself.
Provide the patient with pain relief measures before the pain becomes worse.When a bigger dose of an analgesic may be necessary, it is advisable to give it before the pain starts or before it becomes severe. The strategy will be helpful before physical therapy for facial nerve stimulation.
Recognize and accept the patient’s pain.      Nurses have a responsibility to inquire about their patients’ suffering and to take their complaints seriously. It creates a dysfunctional therapeutic connection that could make pain management more difficult and decrease rapport if the nurse challenges or disregards the pain reports.
Offer the patient non-pharmacologic pain management techniques such as cutaneous stimulation, and cognitive-behavioral therapy (CBT) physical interventions.  Physical, cognitive-behavioral, and lifestyle pain treatment are nonpharmacologic approaches to pain management. These techniques modify psychological reactions to pain in order to offer comfort. Although only momentary, cutaneous stimulation effectively relieves pain. It functions by diverting the patient’s attention from uncomfortable feelings with tactile stimuli.
Educate the patient about proper eye care such as putting a barrier of protection over the eyes at night, using eye ointment to keep the eyes closed during sleep, manually closing the paralyzed eyelid before sleeping, and wearing sunglasses or goggles.Ulceration and corneal discomfort are both possible. The normal drainage of tears is altered by lower lid distortion.
Apply a warm compress to the affected side of the patient’s face.  By increasing blood flow to the injured area and reducing pain responses, heat is used to treat injuries that have progressed into their chronic phase.
Administer the prescribed medications on schedule.Early corticosteroid therapy appears to reduce the severity, alleviate pain, and decrease denervation.

Bell’s Palsy Nursing Care Plan 4

Impaired Verbal Communication

Nursing Diagnosis: Impaired Verbal Communication related to facial weakness secondary to Bell’s palsy, as evidenced by stuttering, refusal to speak, difficulty in forming words and inability to use facial expressions.

Desired Outcomes:

  • The patient will develop a strategy to communicate clearly to meet the needs.
  • The patient will be actively involved in physical and speech therapy to assist with effective communication.
  • The patient will use devices to improve verbal communication.
Bell’s Palsy Nursing InterventionsRationale
Assess the patient’s mental state and analyze the psychological reaction to a communication difficulty and the patient’s willingness to use other channels of communication.In order to identify contributing factors, it is essential to assess the patient’s mental state.  
Assess the environmental factors including the room noise level.The environment may impact one’s capacity for communication.
Analyze the patient’s level of energy.  Communication difficulties or barriers might result from exhaustion or shortness of breath.
Utilize tools and devices that can help promote better communication.    Those who have speech problems can benefit from assistive technology like text-to-speech, TTY, or TDD. Kids can communicate better with the aid of picture boards and other apps.
Use sign language.In order to connect with patients, nurses might incorporate key terms and phrases into their job. It can be helpful to memorize words like “pain,” “bathroom,” and “water” that are frequently used in hospitals.
Observe the patient’s gestures and nonverbal cues.Patients might utilize particular hand motions or nonverbal clues to express themselves. Although it could take some time for the nurse to understand what they are, it should be respected.
Place necessary items within the patient’s reach.To increase the patient’s sense of autonomy.  
Avoid acting as though the patient doesn’t understand what is being said in front of them.The patient’s sense of frustration and powerlessness grows as a result.
Provide feedback or clarification of what has been communicated.Feedback helps to improve communication.
Encourage the patient to perform facial exercises.Increased muscle strength and a return to facial coordination are helped by facial exercises and physical treatment for Bell’s palsy. The majority of exercises should be performed up to 30 times each, three to four times per day, in brief periods.
Limit the use of radio and television as distractions when speaking with patients.  To maintain the patient’s concentration, lessen the number of stimuli that the brain has to interpret, and improve the nurse’s listening skills.
Maintain eye contact when chatting with the patient and stand near the patient.Patients may need to see the nurses’ face or lips in order to better grasp what is being said especially when the eye is affected.
Provide enough time for the patient to respond.    Patients could find it challenging to reply under time constraints; they might need extra time to organize their thoughts, find the right words, or perform any necessary language translations.
Arrange queries that call for a “yes” and “no” response, use specific and short sentences, and limit questioning to one at a time.When patients are unable to express themselves clearly, they may become frustrated. The patient can maintain mental attention using this technique.
Talk to the patient clearly and slowly.    With this method, the patient has access to numerous channels for informational exchange.
Instruct the patient to perform cheek tapping on the affected side.If the patient has severe cheek and lip weakness, taping the cheek will provide some support and comfort and may also help reduce the amount of drooling.
Arrange physical and speech therapy for the patient.  The therapist may include exercises to strengthen the muscles of the mouth and tongue such as lip strengthening exercises to help improve lip closure.
Make a list of the words the patient can utter and add to it as necessary. Share this with the patient’s family, close friends, and other caregivers.The number of persons the patient can communicate with increases when they share information with one another.  

Bell’s Palsy Nursing Care Plan 5

Risk for Imbalanced Nutrition: Less Than Body Requirements

Nursing Diagnosis: Risk for Imbalanced Nutrition: Less Than Body Requirements related to facial paralysis secondary to Bell’s palsy.

Desired Outcomes:

  • The patient will maintain an ideal weight for height and age.
  • The patient will determine the factors causing weight loss.
  • The patient will use appropriate interventions to aid in eating and drinking easily.
Bell’s Palsy Nursing InterventionsRationale
Determine the patient’s exact body weight and never estimate.      The first and most important stage in an anthropomorphic evaluation is to precisely weigh the patient using a scale. The number of calories and nutrients needed are based on weight. Unintentional weight loss might be a sign of poor health and a body’s inability to fight off infection.
Determine the patient’s body mass index (BMI).  A low BMI may signify that the body has too little body fat. A very low BMI may indicate a number of health issues, such as anemia, impaired immunological response, and bone loss.
Analyze the patient’s dietary intake.        Following the screening for the risk of malnutrition, patients who were identified as being at nutritional risk should have their nutritional status evaluated. When performing an assessment, nurses and medical professionals can gather more data and conduct a physical exam that is specifically focused on nutrition to establish whether a nutrition problem exists, what the issue is, and how serious it is.
Assess the patient’s eating habits.  The health care team will have baseline information from the patient’s eating habit, will know what interventions might be beneficial, and will be better able to identify nutritional risk and deteriorating nutritional status.
Schedule the patient for a consult with the dietitian for a thorough nutritional assessment and strategies for nutritional support.    The nitrogen balance can be used as a gauge of a patient’s nutritional health by specialists like a dietician. Protein deficiency may be the result of an imbalanced nitrogen cycle. To encourage adequate nutritional consumption, the dietician can also determine the patient’s daily needs for a variety of nutrients.
Advise the patient to avoid foods that are hard, stringy, chewy, or those that include pips, skins, shells, or husks.  As they can be challenging to prepare and to chew considering the facial paralysis, always opt for a diet that is easy to chew and swallow such as pasta dishes, fish, well-cooked meats and vegetables.
Encourage the patient to remember to swallow more often or to drink water.This will help to stop the saliva from gathering in the mouth.
Use a tape underneath the bottom lip of the patient to pull it up so the teeth can be less exposed.Particularly if the patient has bell’s palsy, the lower lip often hangs down and reveals the teeth. The gums and teeth may become dry as a result.
Provide a peaceful and comfortable atmosphere for the patient when eating.  A pleasant environment makes dining more enjoyable and reduces stress. The patient can concentrate better on eating in a peaceful, distraction-free setting.
Encourage the patient to have a proper positioning when eating or drinking    The risk of aspiration when eating is decreased by positioning the patient upright or elevating the head of the bed by 30 degrees, which also helps the patient with swallowing.
Schedule appropriate rest periods before meals if the patient is weak, and prepare food for them by opening the packages and cutting up the food.Providing assistance on the patient’s activities of daily living will save the patient’s energy for activities they value. Patients who take more than an hour to finish a meal might need help.
Instruct the significant others to accompany the patient during meals.  In both hospital and home settings, it’s important to pay attention to the social perspectives on eating.

More Bell’s Palsy Nursing Diagnosis

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. (2022). 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. (2020). 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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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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