what is Bell's palsy?
paralysis, inflammation, & swelling of cranial nerve VII (7)
this is the facial nerve causing your face to become asymmetrical
is Bell's palsy acute or chronic?
acute, it occurs suddenly
when are chances higher of having bell's palsy?
in the 3rd trimester of pregnancy
what causes Bell's palsy?
it is unknown, but is associated with a viral infection (cold, respiratory infection, HSV, Varicella virus, lyme disease) also Guillain-Barre
if pt can wrinkle the entire forehead then what does this indicate?
A stroke, because if they can only wrinkle half of their forehead then this is Bell's Palsy
name some sx of Bell's palsy...
ptosis
eye doesn't close on affected side
can't smile on affected side
constant tearing of the eye
drooling
taste may be impaired
can't whistle
tx for Bell's palsy?
cortico steroids within 72 hrs
antiviral may be prescribed
analgesic med if pain
physical therapy
eye tx for Bell's palsy?
artificial tears to keep eye well hydrated
tape eye lid closed or eye patch (especially @ night)
protective sunglasses when outdoors
will bell's palsy recover ?
normally all symptoms recover, but it is possible recovery may never be complete
eating tx for Bell's palsy?
frequent small feeding
soft foods
eat & drink on unaffected side
eat sitting upright
good mouth care bc food may get stuck on side
facial exercises
what is Tic Douloureux ? (AKA Trigeminal neuralgia)
intense paroxysmal pain from the trigeminal nerve V (#5)
Is Tic Douloureux acute or chronic disease?
this is a chronic disease
where does Tic Douloureux occur at in the face?
ophthalmic- rare
Maxillary - most common
Mandibular
what other disease does Tic Douloureux occur in ?
MS patients
what is Tic Douloureux known as?
the suicidal disease bc it is so painful
what causes Tic Douloureux?
in most cases the vascular system is being compressed; pressure from an Aneurysm, cyst, or tumor. Also demyelenization of nerve like in MS
what are the pain characteristics like in Tic Douloureux?
Brief, paroxysmal (occurring several times a day)
may last seconds- 1-2 min
stabbing, shock like, severe nerve pain
unilateral like Bell's palsy
one or more branches of CN V
no pain b/w episodes
normally things trigger it
what may trigger an episode of Tic Douloureux?
stimuli such as: cold, pressure, touch, blast of air, shaving, bathing, brushing teeth, washing face, extremes in temperature..etc. (pt may try avoiding these things)
dx Tic Douloureux by?
only the classic pain pattern
will pt have remission of Tic Douloureux?
yes and they will have no episodes occurring; however, these remissions become shorter in duration over time
drug therapy for Tic Douloureux?
1. anticonvulsants (Gabapentin, phenytoin Na+, carbamazepine, clonazepam, diazepam)
2. Tricyclic (amytriptyline)
3. muscle relaxants (baclofen)
4. complementary therapy (acupuncture)
what drugs do not help Tic Douloureux?
narcotics
what meds need blood levels?
phenytoin Na+
carbamazepine
this is bc they have major side effects
nursing interventions for Tic Douloureux?
offer pain meds @ first encounter of pain (top priority)
help identify pain triggers to manipulate them
teach provide self care b/w episodes or during remissions
teach alternatives to oral hygiene (warm mouth washes)
take very good car of mouth during rem
tx by surgery for Tic Douloureux?
1. microvascular decompression
2. percutaneous glycerol rhizotomy
3. radio-surgery: gamma knife
how should pt w/ Tic Douloureux eat?
chew on unaffected side
soft foods & warm (some ppl may need neutral temp foods)
What is ALS (Amyotrophic Lateral Sclerosis/ Lougehrig's)?
-A rapidly progressive motor neuron disease
-weakness & atrophy from degeneration of neurons &
hardening of spinal cord
Is there a cure for ALS?
no this is incurable, basically like the death sentence within 2-5 yrs of onset
what does a pt w/ ALS normally die from?
Respiratory failure or complication of being bed bound- PN; maybe even aspiration
Clinical manifestations found in ALS pt ?
spasticity, hyperflexia (kicking legs up)
respiratory compromise (dyspnea)
flaccid, paralysis & muscle atrophy
weakness & waisting
fatigued
fasciculation of muscles (twitching)
+ Babinski
brain stem involved: atrophy of tongue, muscles of speech, chewing,
what is not affected in ALS pt?
the intellectual abilities, mental is still there
sensory function
vision & hearing
sexual function
how is ALS dx?
H&P shows fatigue & muscle atrophy & weakness
EMG will show denervation of the muscles
muscle biopsy
CSF analysis : glutamate is elevated (this is an amino acid in the brain)
what is tx of ALS?
no cure but want to slow the progression of it by giving Riluzole. Not sure how it works but it does protect from overexposure to glutamate
Side effects of Riluzole?
its a double whammy of weakness, nausea, decreased lung function, & HA
what are some respiratory interventions for ALS?
suctioning, O2 prn, HOB up, may need ventilator, tube feedings prn, oral care
what is primary goal for an ALS pt?
making them comfortable as possible (ex:palliative sedation)
encourage an advanced directive & hospice when life expectancy is < 6 ms
nursing interventions for muscle strengthening in an ALS pt?
moderate exercise program, supportive equipment, ROM to prevent contractors, care of a be bound client
nursing interventions for nutrition in an ALS pt?
soft diet
small frequent meals
high energy & nutrient foods
easy to swallow & chew
may need...GT feeding & suction available
What is multiple sclerosis ?
the myelin sheath becomes damaged, interrupting conduction of nerve impulses; may have multiple lesions (plaques) along the myelinated nerve fibers in the SC & brain. Patches of sclerotic tissue is formed
who is MS more common in ?
women & ppl who grew up in colder climates
what causes ms?
don't really know. but research shows its an abnormal autoimmune response to an infection or environmental trigger in a genetically susceptible individual
what may be sx of MS?
these may be asymmetrical:
numbness, tingling, & burning (face & extremities)
decreased proprioception
paresthesia
decreased sense of temp & vibration
weakness/ heaviness in lower extremities
paralysis
SPASTICITY & HYPERFEXIA
diplopia
bowel & bladder rete
how to dx MS?
no neuro or lab tests confirm it
hard to detect bc sx are so wide spread & may come & go
sometimes think its just stress
what supports the dx & follows progression of MS?
MRI
is there a cure for ms & what are the goals for these pt?
no! so goals are to slow progression of disease & manage their sx
why are gluco-corticosteriods given for MS?
this is for relapse management to shorten an acute attack
methylprednisolone or prednisone will be given in very high doses shortly, which may cause when to have crazy things happen
why are immune- modifiers/ anti multiple sclerosis meds given for?
these are for the progression of the disease & must be taken longterm. they will reduce frequency, severity of attacks, accumulation of lesions within, the disability.
what is the negative aspect of taking immune- modifiers/ anti multiple sclerosis meds ?
don't make them feel better, might make them feel worse
Never combine these drugs either!
not great for pregnancy so must do whichever outweighs the other & contraindicated in breastfeeding
what happens to a pt with ms during pregnancy ?
the frequency of exacerbations is reduced
however postpartum exacerbations increase for 6 ms
what drug improves walking in a pt w/ MS?
dalfamprine
by speed & length
what will make sx of MS worse?
hot temps! however some ppl are the opp & cold temps make it worse. pt may want to try cooling techniques