DISORDERS OF CRANIAL NERVESDisorder Nursing Clinical Manifestations InterventionsOlfactory Nerve—IHead trauma Intracranial tumor Intracranial surgery

Unilateral or bilateral anosmia (temporary or persistent) Diminished taste for food

Assess sense of smell.Assess for cerebrospinal fluid rhinorrhea ifpatient has sustained head trauma.

Optic Nerve—IIOptic neuritis Increased intracranial pressure Pituitary tumor

Lesions of optic tract producing homonymous hemianopsia

Assess visual acuity.Restructure environment to prevent injuries.Teach patient to accommodate for visual loss.

Oculomotor Nerve—IIITrochlear Nerve—IVAbducens Nerve—VIVascular Brain stem ischemia Hemorrhage and infarction Neoplasm TraumaInfection

Dilation of pupil with loss of light reflex on one side Impairment of ocular movementDiplopiaGaze palsiesPtosis of eyelid

Assess extraocular movement and fornonreactive pupil.

Trigeminal Nerve—VTrigeminal neuralgia Head trauma Cerebellopontine lesion Sinus tract tumor and metastatic disease Compression of trigeminal root by tumor

Pain in face Diminished or loss of corneal reflex Chewing dysfunction

Assess for pain and triggering mechanisms forpain.Assess for difficulty in chewing.Discuss trigger zones and pain precipitants withpatient.Protect cornea from abrasion.Ensure good oral hygiene.Educate patient about medication regimen.

Facial Nerve—VIIBell’s palsy Facial nerve tumor Intracranial lesion Herpes zoster

Facial dysfunction; weakness and paralysis Hemifacial spasm Diminished or absent taste Pain

Recognize facial paralysis as emergency; referfor treatment as soon as possible.Teach protective care for eyes.Select easily chewed foods; patient should eatand drink from unaffected side of mouth.Emphasize importance of oral

hygiene.Provide emotional support for changedappearance of face.

Vestibulocochlear Nerve—VIIITumors and acoustic neuroma Vascular compression of nerve Ménière’s syndrome

Tinnitus Vertigo Hearing difficulties

Assess pattern of vertigo.Provide for safety measures to prevent falls.Ensure that patient can maintain balancebefore ambulating.Caution patient to change positions slowlyAssist with ambulation.Encourage use of assistive devices.

Glossopharyngeal Nerve—IXGlossopharyngeal neuralgia from neurovascular compression of cranial nerves IX and X Trauma Inflammatory conditions Tumor Vertebral artery aneurysms

Pain at base of tongue Difficulty in swallowing Loss of gag reflex Palatal, pharyngeal, and laryngeal paralysis

Assess for paroxysmal pain in throat, decreasedor absent swallowing, and gag and coughreflexes.Monitor for dysphagia, aspiration, and nasaldysarthric speech.Position patient upright for eating or tubefeeding.

Vagus Nerve—XSpastic palsy of larynx; bulbar paralysis; high vagal paralysis Guillain-Barré syndrome Vagal body tumors Nerve paralysis from malignancy, surgical trauma such as carotid endarterectomy

Voice changes (temporary or permanent hoarseness) Vocal paralysis Dysphagia

Assess for airway obstruction/provide airway management.Prevent aspiration.Support patient having voice reconstructionprocedures.

Spinal Accessory Nerve—XISpinal cord disorder Amyotrophic lateral sclerosis Trauma Guillain-Barré syndrome

Drooping of affected shoulder with limited shoulder movementWeakness or paralysis of head rotation, flexion,extension; shoulder elevation

Support patient undergoing diagnostic tests.

Hypoglossal Nerve—XIIMedullary lesions Amyotrophic lateral sclerosis Polio and motor system disease, which may destroy hypoglossal nuclei Multiple sclerosis Trauma

Abnormal movements of tongue Weakness or paralysis of tongue muscles Difficulty in talking, chewing, and swallowing

Observe swallowing ability.Observe speech pattern.Be aware of swallowing or vocal difficulties.Prepare for alternate feeding methods (tubefeeding) to maintain nutrition.

Source:Brunner and Suddharth’s Med-Surgical Nursing 12th Edition p.1971