Incidence & Prevalence
Bell’s palsy is a condition when one side of the face becomes paralysis for unknown reasons (Winland-Brown & Keller, 2015). It occurs suddenly in otherwise healthy people. It affects sexes equally with the median age being 40 (Ferri, 2018). The main people being affected are people less than 70 years old and pregnant woman usually in the third trimester or first week postpartum (Ferri, 2018). It also can affect more people with diabetes or has had an upper respiratory infection or flu affecting 40,000 Americans each year (National Institute of Health [NIH], 2017).
Pathophysiology
The facial nerve, cranial nerve VII, is affected which is why the person experiences sensory and motor deficits (Winland-Brown & Keller, 2015). Even though the cause is unknown, it is thought that most cases are caused by a viral infection. It is felt that it may be caused by the herpes simplex infection of the geniculate ganglion or the varicella-zoster virus by demyelinating the nerve causing severe pain and hearing loss (Winland-Brown & Keller, 2015). It can take on average 3 to 6 months to recover from Bell’s palsy but can be as long as 12 months (Winland-Brown & Keller, 2015). Depending on how the facial nerve is affected would determine how the symptoms may present.
Physical Assessment & Examination
Therefore, the symptoms of Bell’s palsy can vary from person to person. The symptoms can be severe or mild. The typical symptoms can be facial twitching, weakness, paralysis on one side. Eyelid, mouth drooping, eye and mouth dryness, excessive tearing in the one eye, taste irregularities, ear ringing, headache, impaired speech sometimes (NIH, 2017). These symptoms come on sudden and peak after 48 hours (NIH, 2017).
The patient will not be able to raise the eyebrow, wrinkle the forehead, close the eyelid, whistle, or retract the muscles of the mouth or chin (Winland-Brown & Keller, 2015). The tongue can deviate, and they have a difficult time talking, needing to puffy cheeks and purse the lips to compensate (Winland-Brown & Keller, 2015). If the provider cannot complete concluding the diagnosis is Bell’s palsy based on the presentation and patient’s history, and then a CT scan or MRI can be performed. In addition, electromyography can help determine the extent of nerve involvement (Winland-Brown & Keller, 2015).
Evidence-Based Treatment Plan & Outcomes
Usually, treatment for Bell’s palsy is more supportive because the condition will gradually heal on its own (Winland-Brown & Keller, 2015). If the patient cannot blink, then preventing eye injury would be appropriate care. An eye patch may help protect the eye along with lacri-lube at night and artificial tears during the day (Ferri, 2018; Winland-Brown & Keller, 2015). If medication is started, it should be initiated as soon as the diagnosis is made. Corticosteroids can help speed up the recovery time if started within 72 hours of symptoms (Ferri, 2018). Prednisone 60 to 80 mg daily for 1 week is the recommended treatment guidelines (Ferris, 2018). There is a debate on whether or not starting the patient on an antiviral would be beneficial such as valacyclovir (Ferri, 2018). If the patient is experiencing ear pain, then having them take an over-the-counter medication for pain such as acetaminophen or ibuprofen would be appropriate (Winland-Brown & Keller, 2015). Regular interval follow-ups would be needed to assess for improvement or deterioration if, after 6 months, there are no improvements in their symptom or there are other neurological signs appearing, then a referral to a neurologist would be necessary (Winland-Brown & Keller, 2015).
Education
Reassurance to the patient and family with this condition is important. Initially, there can be shock and stress due to the loss of function on that side of the face. It can cause increased anxiety and self-esteem issues until it is resolved. Some things that may help the patient cope would be to have to wear make-up or have them wear their hair in a way in which would minimize the facial appearance (Winland-Brown & Keller, 2015). Also drinking from a bottle versus a glass may be easier. Educating the patient about appropriate eye care and oral hygiene is important. The chewing is impaired, so food can get trapped in the mouth. Softer foods would be safer due to less risk of choking from not chewing food appropriately (Winland-Brown & Keller, 2015). Once the strength is regained, facial exercises and massages can be started (Winland-Brown & Keller, 2015).
References:
Ferri, F. F. (2018). 2018 Ferri’s clinical advisor. (pp. 147-148). Philadelphia, PA: Elsevier, Inc.
National Institute of Health. (2017). Bell’s palsy fact sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Bells-Palsy-Fact-Sheet
Winland-Brown, J. E. & Keller, M. B. (2015). Neurological problems. In L.M. Dunphy, J. E. Winland-Brown, B. O. Porter, & D. J. Thomas (Eds.), Primary care: The art and science of advanced practice nursing (4th ed., pp. 77-148). Philadelphia, PA: F. A. Davis Company.
