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03.07 Miscellaneous Nerve Disorders

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Overview

Other disorders can affect the nervous system, both in the CNS and the PNS

Nursing Points

General

  1. Trigeminal Neuralgia
    1. Damage to 5th cranial nerve
    2. Tumor, Multiple Sclerosis, Trauma
  2. Bell’s Palsy
    1. Sudden weakness in muscles on half of face
    2. Commonly caused by virus → swelling around facial nerve
  3. Guillain-Barre
    1. Autoimmune disorder attacks PNS
    2. Commonly caused by infection or possibly the flu vaccine
  4. West Nile Virus
    1. Carried by mosquitoes
    2. Symptoms develop 3-14 days after being bitten

Assessment

  1. Trigeminal Neuralgia
    1. Severe pain to cheeks, lips, gums
    2. Exacerbated by extreme temperatures
  2. Bell’s Palsy
    1. Drooping eyelid
    2. Asymmetrical facial movements
    3. Can mimic stroke symptoms – nothing else affected except face
    4. May experience drooling
    5. May experience dry eye due to inability to close eye all the way
  3. Guillain-Barre
    1. Begins as numbness, tingling
    2. Progressive weakness → paralysis
    3. Recovery may take 2 weeks – a year
  4. West Nile Virus
    1. Fever
    2. Headache
    3. Tremors, Seizures
    4. Vision Loss
    5. Coma

Therapeutic Management

  1. Trigeminal Neuralgia
    1. Analgesics
    2. Avoid hot or cold foods/fluids
    3. Scarves when cold outside
  2. Bell’s Palsy
    1. Steroids and antivirals
    2. Usually resolves in 6 months
    3. Protect eyes (eye patch or drops)
    4. Guillain-Barre
    5. Ventilatory support if respiratory muscles affected.
    6. Plasmapheresis
    7. Immunoglobulin therapy
    8. Physical Therapy / Rehab
  3. West Nile Virus
    1. Consult Infectious Disease
    2. Supportive Therapy

Nursing Concepts

  1. Intracranial Regulation / Cognition
    1. Assess neurological status
      1. Pupils
      2. LOC
      3. Strength
    2. Seizure precautions if applicable
  2. Comfort
    1. Administer Analgesics
    2. Provide community resources for chronic pain support
  3. Safety
    1. Seizure precautions
    2. Monitor and protect airway

Patient Education

  1. Trigeminal Neuralgia
    1. Medication instructions
    2. Avoid hot / cold extremes
  2. Bell’s Palsy
    1. Coping mechanisms
    2. Chew food on unaffected side
  3. Guillain-Barre
    1. Use of Incentive Spirometry
  4. West Nile Virus
    1. DEET repellent spray
    2. Mosquito nets when in high-risk area

Reference Links

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Video Transcript

We just wanted to cover a few other miscellaneous nerve disorders that you’ll see commonly in the clinical setting and will also likely see on the NCLEX.

With any neurological disorder, it’s helpful to think of it like an electrical shortage in a house. This could cause anything from flickering lights and nonfunctioning switches, to sparking wires and a full-on house fire. The same is true about neurological disorders. Depending on the severity, the symptoms range from simple numbness and tingling or weakness, to full paralysis, seizures, or coma. So let’s dive into these four disorders and give you the most important things you need to know.

The first is trigeminal neuralgia. Let’s break this down – we know that neur indicates nerves, right? Algia usually refers to pain. So in this case it’s pain in the trigeminal nerve. This is caused by some sort of damage to the trigeminal or 5th cranial nerve. You can see here how the trigeminal nerve comes down the cheek to the lips, gums, and cheeks. So these patients will have severe pain in those areas. This is a chronic condition with not very many treatment options. It can be exacerbated by extreme temperatures like hot or cold, so we teach patients to avoid their triggers like very hot or very cold food or drinks, and to use a scarf to bundle up their face when it’s cold outside. And then we can give analgesics or other medications like Gabapentin to help ease the discomfort. Unfortunately, beyond that, there isn’t much we can do, so we’ll refer to any community resources for chronic pain to help them out.

Next is Bell’s Palsy. This is sudden weakness on one half of the face. It can be caused by any viral illnesses that cause swelling around the facial nerve, so primary treatment is antivirals and steroids. Patients will present with facial drooping, asymmetrical facial features, and a drooping eyelid. They may even experience problems with drooling because of the weakness in their mouth and lips. Now, this can mimic stroke-like symptoms, so it’s important to note that Bell’s Palsy ONLY affects the face. If they have aphasia or any extremity weakness, we need to evaluate further for a stroke. If we’re sure it’s just Bell’s Palsy, we encourage them to protect their eyes from dryness since sometimes the affected eye is hard to close all the way – this might mean using eye drops or an eye patch. We also teach them to chew food on the unaffected side to prevent drooling and losing food out of the weak side. Bell’s Palsy usually resolves within about 6 months on its own, but it’s still frustrating in the meantime.

You’ve probably heard the term Guillain-Barre Syndrome a million times already if you’re close to the end of nursing school. The most common time we talk about it is when we discuss the flu vaccine, but a lot of people don’t even really know what it is. Essentially it’s an autoimmune disorder where the body’s antibodies attack the peripheral nervous system, causing demyelination of the neurons. Remember this myelin helps with impulse transmission – without it impulse transmission is slow or stopped. So we see symptoms begin as numbness and tingling and over the course of 48-72 hours, the weakness will progress as severe as complete paralysis. Most commonly it comes on after some sort of infectious process, but again, can also be caused by the flu vaccine – that’s why it’s a contraindication. The MAIN concern is that when they are progressively losing the use of their muscles, they can lose control of their respiratory muscles, so we HAVE to pay attention to their respiratory status and intervene when necessary. Usually we will do some sort of immunotherapy, but the rest is supportive care while we wait for them to recover. Recovery can take 2 weeks to a year. In rare cases, some people never fully recover all of their muscle function.

Finally, we wanted to include West Nile Virus because its symptoms are primarily neurological. This is something we test for when everything else we’ve tested has come back negative. A lot of times we find that the patient had actually been bitten by an infected mosquito within the last 2 weeks and they’re now presenting with these symptoms. They’ll have a fever and headache, they might have some vision loss. It can progress to tremors, seizures, and all the way to a coma. There is not really any effective treatment, the best method is prevention altogether with DEET bug spray or mosquito nets like the one you see here. But make sure you get the Infectious Disease team involved to make sure things are being taken care of appropriately.

Priority nursing concepts for a patient with any neurological disorder like these would be intracranial regulation or cognition – that would be assessing their neuro status and strength and monitoring for any changes in LOC. Comfort because damaged nerves can be extremely painful and frustrating for the patient. And finally safety because they are at risk for seizures as well as issues with airway protection if those muscles are affected. So we will utilize seizure precautions and monitor their respiratory status closely.

So remember that many neurological disorders have symptoms in common like altered LOC (which is why we assess their neuro status frequently), weakness (we need to monitor their strength and facial symmetry and make sure they’re able to perform necessary functions like breathing and eating), and nerve pain – we need to be especially mindful of this chronic pain and make sure we’re providing analgesics as needed. Finally, many of these disorders require mostly supportive care while we protect their airway and help them learn how to cope with any residual deficits from their disorder.

So that’s it for neurological disorders, we hope you’ve learned something and feel comfortable assessing for these problems and caring for them. Let us know if you have any questions. Now, go out and be your best selves today. And, as always, happy nursing!!

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