G2 Bell's Palsy & Spinal Cord Injury PDF

BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 Bell's palsy is probably more common in BELL’S PALSY diabetics and possibly in...

BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 Bell's palsy is probably more common in BELL’S PALSY diabetics and possibly in hypertensive than in the normal population. Bell's idiopathic peripheral facial palsy is Idiopathic defined by the abrupt onset of unilateral may be associated with viral infections weakness of upper and lower muscles of herpes simplex (HSV) one side of the face with no apparent cause. varicella zoster Bell's palsy is a dysfunction of the facial Exposure to cold nerve, as it lies within the facial canal; it is usually unilateral paralysis, rarely usually unilateral. bilateral and may occur repetitively. ANATOMY RISK FACTORS 1. DIABETES - Higher risk due to nerve The 7th cranial nerve (facial n.) is mainly a damaĀe and poor blood ÿlow ÿrom hiĀh motor nerve supplying all the muscle blood suĀar levels. concerned with facial expressions 2. PREGNANCY - Increased risk, especially A complete interruption oÿ the ÿacial nerve in the third trimester, due to hormonal at the stylomastoid ÿoramen paralyzes all chanĀes and ÿluid retention. muscles of facial expression. 3. HYPERTENSION - Elevated risk possibly linked to blood vessel damaĀe and reduced blood ÿlow to the ÿacial nerve. 4. VIRAL INFECTIONS - Previous inÿections like herpes simplex or varicella- zoster can reactivate,causinĀ, nerve inÿlammation. 5. AGE - Most common in people aĀed 20-30 and 60-70, showinĀ bimodal distribution. 6. FAMILY HISTORY - Genetic predisposition may increase the likelihood oÿ developinĀ Bell’s palsy. Nervus Intermedius 7. OBESITY - Associated with diabetes and a part of the facial nerve (CN VII) which hypertension, which are risk ÿactors ÿor contains somatic sensory, special Bell’s palsy. sensory, and visceral motor 8. COLD EXPOSURE - Sudden exposure to (secretomotor) fibers. cold may trigger the condition, potentially affecting blood flow and nerve function. PATHOPHYSIOLOGY EPIDEMIOLOGY mc. disease of the facial nerve This disorder affects men and women more CLINICAL MANIFESTATION or less equally and occurs at all aĀes and all STYLOMASTOID times oÿ the year. Paralysis of Facial m. increased incidence in women durinĀ the Saliva may dribble on the corner of 3rd trimester oÿ preĀnancy mouth Food collects between teeth and cheeks. || 1 BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 Pt. complains of a heaviness or reports difficulty closing his right eye, a numbness and sometimes an aching drooping mouth, and issues with speaking and pain in the face. drinking. Carl notes that his symptoms beĀan Sensory loss can usually not be the previous evening and feels anxious about demonstrated. his appearance and the impact on his work as a Taste sensation is intact, because the customer service representative. lesion is beyond the site where the chorda tympani has separated ÿrom the ASSESSMENT main trunk of the facial nerve. SUBJECTIVE DATA: Carl reports feeling embarrassed and CHORDA TYMPANI worried about how his appearance Loss of taste on ant. 2/3 of tongue on affects his job, where he interacts with same side customers daily. He mentions discomfort when drinking STAPEDIUS and chewing on the affected side. Hyperacusis He expresses fear that his face may remain this way permanently. GENICULATE GANGLION OBJECTIVE DATA: Lacrimation Right-sided facial droop, including Salivation inability to close his right eye fully. CN VIII may be affected causing: Difficulty in forming words clearly and CN VIII may be aÿÿected causing: slight drooling noted. Deafness Eye appears dry and has occasional Tinnitus tearing. Dizziness DIAGNOSIS INTERNAL AUDITORY MEATUS Impaired Physical Mobility related to Hyperacusis facial muscle paralysis as evidenced by Facial Weakness inability to close the right eye and CN VIlI affectation difficulty with ÿacial movements. Impaired Verbal Communication related INTRAPONTINE LESION to weakness in ÿacial muscles affecting Loss of taste on ant. 2/3 of tongue on speech clarity. the same side. Risk for Injury related to inability to fully close the right eye. DIFFERENTIAL DIAGNOSIS Disturbed Body Image related to visible Bell’s palsy presents with acute ÿacial facial asymmetry. nerve (cranial nerve VII) paralysis, oÿten Anxiety related to uncertainty about on one side. Several conditions can recovery and impact on work. mimic its symptoms, so a differential diagnosis is crucial to rule out other PLANNING causes. Goal #1: Carl will demonstrate improvement in 1. Stroke (Cerebrovascular Accident) facial muscle control through facial exercises. 2. Ramsay Hunt Syndrome (Herpes Zoster Goal #2: Carl will prevent eye dryness or Oticus) injury through consistent eye care practices. 3. Lyme Disease (Neuroborreliosis) Goal #3: Carl will communicate effectively 4. Guillain-Barré Syndrome (GBS) with minimal frustration or need for repetition. 5. Tumors (Parotid Gland, Acoustic Goal #4: Carl will express acceptance on his Neuroma) temporary appearance changes and develop a 6. Multiple Sclerosis (MS) positive outlook on recovery. 7. Melkersson-Rosenthal Syndrome Goal #5: Carl will demonstrate reduced anxiety 8. Chronic Otitis Media or Mastoiditis and improved coping with his condition. 9. Melkersson-Rosenthal Syndrome 10. Diabetes-Related Neuropathy INTERVENTIONS FOR IMPAIRED PHYSICAL MOBILITY: CASE SITUATION Intervention: Teach Carl facial exercises to Patient: Carl, a 50-year-old male help stimulate the affected facial muscles, Presentation: Carl presents to the clinic with including trying to raise his eyebrow, close his sudden onset of right-sided facial weakness. He eye, and smile. || 2 BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 Rationale: Facial exercises may help retain Goal #5 (Anxiety): muscle tone and potentially speed up recovery Carl states he feels calmer after practicing by stimulating the nerve and muscle function. relaxation techniques and has a clearer understanding of his recovery path. FOR RISK FOR INJURY: Intervention: Instruct Carl to apply lubricating SPINAL CORD INJURY eye drops every few hours and use a thicker Spinal cord injury occurs when there is eye ointment at night to keep his eye moist. any damage to the spinal cord that Rationale: Prevents corneal abrasions and blocks communication between the brain irritation due to incomplete eye closure. and the body. After a spinal cord injury, a person’s sensory, motor and reflex FOR IMPAIRED VERBAL COMMUNICATION: messages are affected and may not be Intervention: Encourage Carl to speak slowly, able to get past the damage in the spinal pronounce words carefully, and take pauses if cord. he feels fatigued. In general, the higher on the spinal cord Rationale: Slower speech allows clearer the injury occurs, the more dysfunction articulation and may reduce his frustration the person will experience. Injuries are when communicating. referred to as complete or incomplete, based on whether any movement and FOR DISTURBED BODY IMAGE: sensation occurs at or below the level of Intervention: Offer support by actively injury. listening to Carl’s concerns and providing a safe environment for him to express his feelings. ANATOMY Rationale: Discussing concerns openly can PRIMARY ASCENDING TRACTS help him process emotions and reduce feelings These are sensory tracts that deliver of self-consciousness. information to the brain. Major Sensory Tracts: FOR ANXIETY: Dorsal Column Tract (Medial Lemniscus) Intervention: Provide relaxation techniques conveys proprioception, vibratory such as deep breathing exercises, meditation, sensation, deep touch, and or guided imagery to manage his anxiety. discriminative touch from the opposite Rationale: Relaxation techniques can reduce side of the body. stress and promote a sense of control over his health. Anterolateral System consists of spinothalamic, spinoreticular, EVALUATION and spinotectal tracts that convey pain, Goal #1 (Physical Mobility): temperature sensation, and crude touch Carl is performing facial exercises daily with to cerebrum minor improvements in movement, which gives Dorsal and Ventral Spinocerebellar Tracts him a sense of progress. conveys unconscious proprioception to the cerebellum. Goal #2 (Eye Protection): Carl is applying eye drops regularly and uses an 2. PRIMARY DESCENDING TRACTS eye patch at night; he reports no eye dryness Motor tracts that transmit motor or irritation. commands in response to sensory information delivered & received. Goal #3 (Verbal Communication): Lateral Corticospinal Carl feels more confident speaking with family for voluntary movement; conscious and reports feeling understood, indicating control over skeletal muscles. improved communication. Anterior Corticospinal for voluntary movement of axial Goal #4 (Body Image): muscles, minimal clinical significance Carl expresses a better understanding of his due to small size; for conscious control condition, feels hopeful about recovery, and has over skeletal muscles. joined a support group. Medial Vestibulospinal || 3 BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 sends information from the inner ear to Sports and Recreational Injuries: control and monitor proper positioning of Activities like diving, football, or extreme head and neck from the vestibular sports can lead to nuclei. SCI. Lateral and medial vestibulospinal Violence: Gunshot wounds, stabbings, or used for posture and balance. Lateral physical assault can damage the spinal and medial reticulospinal cord for posture, balance, automatic gait related movements; causes eye movement and Non-Traumatic Causes: activates respiratory muscles. These injuries occur without an external Rubrospinal tract physical trauma but are instead caused - for movement of limbs; receives information by internal factors affecting the spinal for flexor and extensor muscles. cord. Common causes include: EPIDEMIOLOGY Degenerative Diseases: Conditions like Focuses on studying the patterns, spinal stenosis or degenerative disc causes, and effects of SCI within disease can gradually compress or populations. It involves analyzing data to damage the spinal cord. understand how frequently SCI occurs, Tumors: Growth of tumors in or near the identifying risk factors, and examining spine can exert pressure on the spinal the demographics most affected. cord. Infections: Diseases like meningitis or EFFECTS OF THE DISORDER tuberculosis can affect the spinal cord. Physical Health Impacts: SCI often leads to Inflammatory Diseases: Conditions such permanent loss of sensation below the injury as multiple sclerosis or transverse site, affecting mobility, sensation, and bodily myelitis can cause damage to spinal cord function. tissues. Mental Health Challenges: The sudden and Congenital Disorders: Conditions present significant lifestyle changes following an SCI at birth, like spina bifida, can lead to can lead to depression, anxiety, and spinal cord malformations. post-traumatic stress. Social and Economic Impacts: SCI often RISK FACTORS necessitates long-term or lifetime care, 1. AGE - Younger adults (particularly males affecting employment, social roles, and aged 16-30) are at higher risk of economic independence. Many individuals may traumatic SCIs due to activities like face job loss or limitations in career driving, sports, and work related opportunities due to reduced mobility. incidents. Older adults, especially those Impact on Healthcare Systems: SCI cases over 65, are more susceptible to SCI place a significant demand on healthcare from falls. systems, as 2. GENDER - Males account for the individuals require specialized treatments, majority of SCIs, especially in younger regular follow-up care, and rehabilitation age groups, due to higher participation services in risky activities and professions. ETIOLOGY 3. HIGH RISK ACTIVITIES - Engagingin it refers to the underlying causes or high-impact sports (e.g. football, origin of the injury rugby, gymnastics) or extreme sports TWO MAIN ETIOLOGIES IN SCI (e.g., diving, skydiving) increases the Traumatic Causes: risk of traumatic spinal cord injuries. These are injuries resulting from a sudden 4. SUBSTANCE USE - Alcohol and drug external physical force that damages the spinal use are significant factors in many cord. traumatic SCIs, as they impair Common causes include: judgment, coordination, and reaction Motor Vehicle Accidents: The most time, increasing the likelihood of common cause of traumatic SCIs, accidents. particularly in younger 5. PRE-EXISTING CONDITIONS - adults. Conditions like osteoporosis, arthritis, or Falls: Especially prevalent among older degenerative spinal diseases can weaken adults. the spine, making it more prone to injury even from minor trauma or falls. || 4 BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 6. OCCUPATION - Jobs involving physical loss of autonomic sympathetic control of labor, heavy machinery, or working at the following: heights (e.g., construction, roofing) i. cutaneous blood flow carry a higher risk of injury due to [(-) vasoconstriction to cold; (-) potential falls or accidents. vasodilatation to heat] 7. VEHICLE ACCIDENT - Motor vehicle ii. sweatinĀ accidents are a leading cause of SCI, compensatory diaphoresis (excessive particularly in individuals who frequently sweatinĀ) occurs above level of lesion drive or ride motorcycles, bicycles, or if incomplete lesion – spotty areas of ATVs, especially without proper safety sweating measures iii. shivering 8. GEOGRAPHICAL & SOCIOECONOMIC more frequent in cervical lesions FACTORS - Certain regions or usually long-term impairment in communities may have limited access to tetraplegia safety regulations, medical care, or T8 – highest level at which pt can education on injury prevention, leading maintain rectal temp of 37°C to higher rates of SCIs. if hiĀher level – poikilothermic (body temperature varies and is influenced by PATHOPHYSIOLOGY external environment like a cold-blooded animal) RESPIRATORY IMPAIRMENT acute and chronic respiratory ÿailure due to: i. instability of coastal insertions of the diaphragm ii. increased work of breathing 2° to increased intra-abdominal pressure caused by unusually large excursions of the diaphragm life-threatening manifestation of SCI brings about 2° pulmonary complications responsible for high mortality rate in CLINICAL MANIFESTATION early stages of tetraplegia SPINAL SHOCK varies considerably depending on level of period of areflexia immediately following lesion SCI inspiration due to sudden withdrawal of connections in thoracic lesions – intercostals are may last from several hours to weeks affected (decreased chest expansion) but typically subsides within 24 hours in higher lesions – diaphragm and early resolution is a good prognostic sign accessory muscles of inspiration are ends when (+) bulbocavernosus reflex is affected elicited expiration may be (+) before DTR’s in LE’s return normally passive through recoil of lung and thorax MOTOR AND SENSORY IMPAIRMENTS in thoracic lesions – abdominis and motor function is either partially or internal intercostals are affected completely lost below the level of the (lowered expiratory volume) lesion due to disruption of descending additional factors that may impair tracts respiratory function sensation is either impaired or absent i. additional trauma sustained at the below the level of the lesion due to time of injury disruption of ascending tracts ii. pre-morbid respiratory problems clinical manifestation of motor and sensory impairments is dependent of SPASTICITY specific features of the lesion due to release of intact reflex areas from all CNS control IMPAIRED TEMPERATURE CONTROL characterized by: i. hypertonicity || 5 BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 ii. hyperactive stretch reflexes Central Cord Syndrome iii. clonus Aortic Dissection typically occurs below level of lesion Subdural Infections after spinal shock subsides Vertebral Fracture Gradually increased by internal and external stimuli CASE SITUATION if minimal or moderate involvement – Patient: Rosmar, a 27-year-old female has positive effects on ADL: Presentation: Rosmar was involved in a car i. at times assist in functional activity accident resulting in a T6 spinal cord injury. She [e.g. provides knee stability in upright has paraplegia, meaning no motor or sensory position (reflex basis) function below the T6 level. She experiences ii. expulsion of urinary bladder content challenges with mobility, bowel and bladder iii. maintains bone density by torque control, and adjusting emotionally to her new force on bone limitations. Rosmar is anxious about her if strong involvement – affects many independence and worried about her future aspects of rehabilitation and ADL ASSESSMENT BLADDER DYSFUNCTION Subjective Data: occurs in 66% of paraplegics and 70% of Rosmar expresses anxiety about her tetraplegics independence and fears about her Urinary Tract Infection (UTI) – most long-term frequent medical complication during quality of life. initial rehabilitation period She reports frustration with her inability Flaccid urinary bladder – during spinal to move her lower body and difficulty shock adjusting to new routines for bowel and conus medullaris – spinal integration bladder care. center for micturition (S2, S3, S4) Objective Data: UMNL* – lesion above conus medullaris Complete loss of motor and sensory LMNL* – lesion to conus medullaris or function below the T6 cauda equina level. *applies to bladder, bowel and sexual Reduced bowel and bladder control, dysfunctions requiring assistance with types: elimination. i. Reflex Neurogenic Bladder (UMNL) Physical limitations leading to an spastic bladder – reflexes are intact increased risk of pressure injuries. ii. Autonomous / Non-reflex Neurogenic Bladder (LMNL) DIAGNOSIS Flaccid bladder – reflex action of Impaired Physical Mobility related to loss detrusor muscle is absent of motor function below the T6 level as evidenced by inability to move lower BOWEL DYSFUNCTION extremities. develops after spinal shock subsides Impaired Urinary Elimination related to types: neurogenic bladder secondary to spinal i. Reflex Neurogenic Bowel (UMNL) cord injury. ii. Autonomous / Non-reflex Risk for Impaired skin integrity related Neurogenic Bowel (LMNL to immobility and loss of sensation. Constipation related to decreased bowel DIFFERENTIAL DIAGNOSIS mobility secondary to spinal cord injury. Differential diagnosis for spinal cord Disturbed Body Image related to loss of injury (SCI) includes a variety of physical function and changes in conditions that can mimic or accompany mobility. the symptoms of SCI. Anxiety related to uncertainty about Differential Diagnosis: recovery and potential dependency on Stroke others. Cysts Epidural Hematoma PLANNING Tumors Goal #1: Rosmar will demonstrate techniques Epidural Abscess to optimize mobility within her limitations and Anterior Cord Syndrome prevent complications from immobility. || 6 BS NURSING LEVEL 1: THEORETICAL FOUNDATIONS IN NURSING (NCM 100) NERVOUS DISEASE: BELL’S PALSY & SPINAL CORD INJURY GROUP 2 Goal #2: Rosmar will maintain intact skin with Goal #3: Pain Control no signs of breakdown. Assess the effectiveness of pain Goal #3: Rosmar will establish an effective management interventions, considering urinary elimination pattern with minimal risk of both pharmacological and infection. non-pharmacological approaches. Goal #4: Rosmar will maintain regular bowel Adjust the pain management plan based movements with minimal discomfort. on the patient’s reported pain levels and Goal #5: Rosmar will verbalize acceptance of overall well being. body changes and begin developing a positive Goal #4: Functional Independence self-image. Evaluate the patient’s progress in Goal #6: Rosmar will express reduced anxiety achieving functional independence and and gain conÿidence in managing her condition. performing ADLs. Collaborate with the rehabilitation team INTERVENTION to assess improvements in mobility, IMMOBILIZE INITIALLY WITH COLLAR strength, and overall functional AND SPINAL PRECAUTIONS outcomes. Maintain full spinal precautions until cleared by a neurosurgeon. This involves Regular evaluation is essential to ensure a c-collar to immobilize the neck, the effectiveness of interventions, monitor keeping the HOB flat, and using a strict patient progress, and make necessary log-roll technique for turning. Any twist adjustments to optimize outcomes for or bend of the spine could cause further individuals with spinal cord injuries. The damage to the spinal cord. collaborative effort of the healthcare team is MANAGE AND MAINTAIN HALO BRACE, crucial in achieving positive results and INCLUDING PIN CARE TWICE DAILY enhancing the overall quality of life for the Halo brace is used to immobilize the patient. cervical spine with unstable vertebral fractures. Four pins are inserted into the REFERENCES skull – pin care should be done twice *GROUP 2 PPT* daily to prevent infection at the pin sites. A wrench should be kept at the bedside to remove the vest in the case that chest compressions are needed. ADMINISTER MEDICATIONS ANALGESICS MUSCLE RELAXANTS Patients may experience pain from the initial trauma as well as neuropathic pain due to the nerve injuries. Muscle relaxants like cyclobenzaprine and gabapentin can also help ease any muscle spasms or nerve pain. EVALUATION Goal #1: Neurological Status Regularly assess and document changes in neurological status, including improvements or deterioration in motor and sensory function. Use standardized assessments to quantify progress and inform adjustments to the care plan. Goal #2: Respiratory Function Evaluate respiratory function through ongoing monitoring and assessment of respiratory status. Assess the effectiveness of respiratory interventions and adjust strategies as needed. || 7