MEDICAL SURGICAL NURSING

LESSON PLAN ON
BELL’S PALSY
SUBMITTED TO, SUBMITTED BY,
Mr. Arunkumar.V.N. Ms. Priyanka Deorukhkar
Associate Professor First Year M.Sc. Nursing
Medical Surgical Nursing Samarth Nursing College,
Samarth Nursing College, Dervan.
Dervan.

SUBMITTED ON,
15/05/2021
 IDENTIFICATION DATA

 Name of the student teacher : Ms. Priyanka R. Deorukhkar.

 Course : First Year M.Sc. Nursing
 Subject : Medical Surgical Nursing
 Unit :
 Topic : Bell’s Palsy
 Date :
 Venue :
 Time :
 Number of students : 03
 Method of teaching : Lecture cum discussion
 A.V. Aids : Black board, power point, chart, palm plates.
 Previous knowledge of students : A group having less knowledge regarding Bell’s palsy.
 GENERAL OBJECTIVES
At the end of this lesson plan students will be able to gain the knowledge about Bell’s palsy in-detailed.

SPECIFIC OBJECTIVES
After completion of this lesson plan students will be able to;
 Introduce the Bell’s palsy.
 Define Bell’s palsy.
 Know the incidence of Bell’s palsy.
 Explain the aetiology of Bell’s palsy.
 Enlist the clinical manifestation of Bell’s palsy.
 Explain the pathophysiology of Bell’s palsy.
 Describe the diagnostic evaluation of Bell’s palsy.
 Describe medical management of Bell’s palsy.
 Know the surgical management of Bell’s palsy.
 Explain the nursing management of Bell’s palsy.
 Describe the complications of Bell’s palsy.

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2min Introduce the  INTRODUCTION:

topic
Bell's palsy is named after Sir Charles Bell (1774-1842), who
has long been the first to describe idiopathic facial paralysis in the
early 19th century. Bell's palsy is characterised by an acute, unilateral,
partial, or complete paralysis of the face, which may occur with mild
pain, numbness, increased sensitivity to sound, and altered taste.

4min Define Bell’s  DEFINITION: Lecture cum Palm Define Bell’s

palsy discussion plate palsy?
Bell’s palsy is a condition that causes a temporary weakness
or paralysis of the muscles in the face. It can occur when the nerve that
controls your facial muscles becomes inflamed, swollen, or
compressed.

Bell’s palsy is a form of facial paralysis resulting from a

dysfunction of the cranial nerve VII (the facial nerve) that results in the
inability to control facial muscles on the affected side

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3min Know the  INCIDENCE: Lecture cum Power What is the

incidence of discussion point incidence of
Bell’s palsy Bell’s palsy affects about 30,000 - 40,000 people a year in Bell’s palsy?
the United States. Most population studies generally show an
annual incidence of 15–30 cases per 100,000 population. Bell’s
palsy is thought to account for approximately 60–75% of cases
of acute unilateral facial paralysis, with the right side affected
63% of the time. It can also be recurrent, with a reported
recurrence range of 4–14%.

3min Explain the  FACIAL NERVE ANATOMY: Lecture cum Power What is the
facial nerve discussion point anatomy of facial
anatomy. The 7th cranial nerve is mixed nerve containing both nerve?
sensory and motor components. It emerges from the brainstem
between the pons and the medulla, and controls the muscles of
facial expression, and functions in the conveyance of taste
sensations from the anterior two-thirds of the tongue and oral
cavity. Seventh cranial nerve also supplies preganglionic
parasympathetic fibers to several head and neck ganglia. The
motor part of the 7th cranial nerve arises from the facial nerve
nucleus in the pons. While the sensory part of the 7th cranial
nerve arises from the nervus intermedius.

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Facial Nerve:

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 CAUSES:
4 min Explain the Lecture cum Chart What are the
Although the exact reason Bell's palsy occurs isn't clear,
causes of discussion causes of Bell’s
Bell’s palsy it's often related to having a viral infection. Viruses that have been palsy?
linked to Bell's palsy include viruses that cause:

 Cold sores and genital herpes (herpes simplex)

 Chickenpox and shingles (herpes zoster)

 Infectious mononucleosis (Epstein-Barr)

 Cytomegalovirus infections

 Respiratory illnesses (adenovirus)

 German measles (rubella)

 Mumps (mumps virus)

 Flu (influenza B)

 Hand-foot-and-mouth disease (coxsackievirus)

- Trauma to facial nerve, this also another cause.

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3min Enlist the risk  RISK FACTORS: Lecture cum Power What are the risk
factors of discussion point factors of Bell’s
Bell’s palsy palsy?
Bell's palsy occurs more often in people who:

 Are pregnant, especially during the third trimester, or who

are in the first week after giving birth.

 Have an upper respiratory infection, such as the flu or a

cold.

 Have diabetes.

 Family history of recurrent attack of Bell’s palsy.

 People aged 15 to 60 years.

4 min Know the Lecture cum Power

 CLINICAL MANIFESTATION: What are the
clinical discussion point clinical
manifestation manifestations
of Bell’s palsy of Bell’s palsy?
 Drooling appearance on one side of the face.

 Inability to open or close eye on the affected side.

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 Difficulty eating and drinking

 An inability to make facial expressions, such as smiling or

frowning

 Facial weakness

 Muscle twitches in the face

 Dry eye and mouth

 Headache

 Sensitivity to sound

 Irritation of the eye on the involved side

5 min Explain the  PATHOPHYSIOLOGY: Lecture cum Power Explain the

pathophysiolog discussion point pathophysiology
y of Bell’s palsy. Etiology Inflammation of facial nerve of Bell’?

The inflamed, oedematous nerve becomes compressed to the point of

damage, or its blood supply is occluded.
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Producing ischemia

Necrosis of facial nerve

Paralysis of facial nerve

Bell’s palsy

4 min Describe the

diagnostic  DIAGNOSTIC EVALUATION: Lecture cum Power What is the
evaluation of discussion point diagnostic
Bell’s palsy. 1. Bell’s palsy can be diagnosed just by taking a health history and evaluation of
doing a complete physical examination. Bell’s palsy?
2. History to determine previous illness, onset of paralysis and
associated symptoms.
3. Exclusion of lesions that mimic Bell’s palsy, such as tumor,
infection (Lyme disease, Meningitis) trauma, stroke or other
conditions.
4. Neurological examination.
5. CT-scan and EMG
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5 min Explain the  MEDICAL MANAGEMENT: Lecture cum Power What is the
medical discussion point medical
management The objectives of treatment are to maintain the muscle tone of management of
of Bell’s palsy. the face and to prevent or minimize denervation. Bell’s palsy?
The patient should be reassured that no stroke has occurred
and that spontaneous recovery occurs within 3 to 5 weeks in most
patients.
1. Corticosteroid’s therapy may be started early to decrease
inflammation (e.g. Prednisone 1 mg/kg/day for 10 to 14
days.)
2. when using Corticosteroid’s therapy for the treatment of
bell’s palsy, take cautions should be used client with TB,
peptic ulcer, DM, renal & hepatic dysfunction or
malignant hypertension.
3. Eye care is essential maintain lubrication and moisture if
unable to close the eye. May be need to be patched
during sleeping.
4. Physical therapy, electrical stimulation to maintain
muscle tone.
5. Bio- feedback as adjunct therapy.
6. Mild analgesics to relieve pain.
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4 min Know the  SURGICAL MANAGEMENT: Lecture cum Power Explain the
surgical discussion point surgical
management 1. Nerve decompression (Internally or externally.) management of
Bell’s palsy. 2. Nerve anastomosis. Bell’s palsy?
3. Nerve grafting.

Lecture cum Palmplate What is the

4 min  NURSING MANAGEMENT: discussion
Explain the nursing
nursing management of
1. Take history of the pain, including duration, severity, and
management Bell’s palsy?
aggravating factors.
of Bell’s palsy.
2. Assess the nutritional status.
3. Assess for anxiety and depression, including problems with
sleep, social interaction etc.
4. Preventing pain.
5. Providing postoperative care:
-Postoperative neurologic assessments are conducted to
evaluate the patient for facial motor and sensory deficits in
each of the three branches of the trigeminal nerve.
- If the surgery results in sensory deficits to the affected side of
the face, the patient is instructed not to rub the eye, because
pain will not be felt if there is injury.
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 NURSING DIAGNOSIS:
1. Self-care deficit related to slowness of movement and
muscle rigidity.
2. Risk for injury related to postural instability and
muscular rigidity.
3. Impaired verbal communication related to slowness of
movement.
4. Altered nutrition related to poor muscle control.
5. Knowledge deficit related to complexity of and
fluctuations in treatment regimen.
6. Ineffective coping related to progressive nature of
illness.

3 min Describe the  COMPLICATIONS: Lecture cum Handout What are the
complications discussion complications of
of Bell’s palsy. 1. Corneal ulcerations Bell’s palsy?
2. Impairment of vision
3. Psychosocial adjustment to prolonged paralysis
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3 min Summarised SUMMARY

the topic
Bell’s palsy. In this lesson plan we have discussed, regarding definition
of Bell’s palsy, causes, incidence of Bell’s palsy, pathophysiology,
clinical manifestation, diagnostic evaluation and in management,
medical management, surgical management and nursing management
of Bell’s palsy and their complications.

CONCLUSION

After this lesson plan, I have concluded that, differential

diagnosis for acute unilateral facial paralysis includes more than just
Bell Palsy. Majority of patients with Bell palsy do well with “masterly
inactivity”. Corticosteroids DO significantly improve facial nerve
outcomes (HB 1 or 2) over placebo. Maybe the jury is still out on
antivirals. Surgery significantly benefits a small group of patients with
severe Bell palsy.