Nerve and Pain Disorders

8/3/2019 Nerve and Pain Disorders

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With Bells palsy, impulses from the

seventh cranial nerve - the nerve

responsible for motor innervations of

the facial muscles are blocked.


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Corneal ulceration

Blindness

Impaired nutrition

Psychosocial problems


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Pain on the affected side

Difficulty eating on the affected side

Difficulty speaking clearly

Drooping mouth or drooling

Distorted taste perception over the affectedanterior portion of the tongue.

Inability to raise the eyebrow, smile, show

teeth, or puff out the cheek on the affected

side.

Difficulty closing eye on the affected side; if

attempted, the eye rolls upward (bells

phenomenon) and shows excessive tearing.


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Diagnosis is based on clinical

presentation.

Electromyography


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Administration of corticosteroidsAnalgesics

Moist heat applied to the affected side

Lubricants or an eye ointment may beneeded to protect the eye; patching

during sleep may also be necessary.

Electrotherapy


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Provide psychological support to the

patient. Reassure him/her that he/shehasnt had s stroke. Tell him/her that

spontaneous recovery usually occurs

within 8 weeks. These should help

decrease anxiety and help adjust to thetemporary change in his body image.

Administer medications and monitor for

adverse reactions.

Monitor serum glucose levels during

corticosteroid therapy.

Apply moist heat to the affected side of

the face, as ordered.


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Massage the patients face with a gentleupward motion two to three times dailyfor 5 to 10 minutes; teach massage to thepatient.

Apply a facial sling, if necessary, toimprove lip alignment.

Provide frequent and complete mouth

care, taking special care to removeresidual food that collects between thecheek and gums.

Provide a soft, nutritionally balanced

diet, eliminating hot foods and fluids.Provide preoperative and postoperative

care, as appropriate.

Provide appropriate education to the

patient an his family before discharge.


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Dysfunction affects cranialnerves III, IV, and VI. These

nerves are responsible for

innervating eye movements.


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Diabetes neuropathy

Trauma

Pressure from an aneurysm or abrain tumor

Other: vary depending on the cranial

nerve involved


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Diplopia

Ptosis

StrabismusNystagmus

Ocular torticollis


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Recent onset of diplopia

Torticolliswith CN III palsy:

Ptosis

Extropia

Papillary dilation and unresponsiveness to

light and accommodation

Inability to move the eye

Inability to move the eye downward andupward

Estropia


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Diagnosis is based on neuro-

opthalmologic examination

Blood studies

CT-scan, MRI, or skull x-rays

Angiography

C&s tests


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Appropriate treatment varies depending

on the cause, such as:Neurosurgery may be necessary for a

brain tumor or an aneurysm.

Massive doses of antibiotics may be

appropriate for infection

After treating the primary condition, the

patient may need to perform exercises

that stretch the neck muscles to correctacquired torticollis (wry neck).

Other care and treatments depend on

residual symptoms.


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Provide emotional support to help

minimize the patients anxiety about

the cause of the motor nerve palsy.

Provide treatment appropriate for

the specific cause of the palsy.

Encourage neck exercise if

torticollitis is present.

Provide appropriate education to the

patient before discharge.


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Also called multiple neuritis,peripheral neuropathy, andpolyneuritis, is the inflammatory

degeneration of peripheral nervesthat primarily supply the distalmuscles of the extremities.

It results in muscle weakness with

sensory loss and atrophy anddecreased or absent deep tendonreflexes.


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Exact cause is unknown; it is thought

to be mediated by inflammation,ischemia, and demyelination of the

larger peripheral nerves

Drugs that may cause peripheralneuritis include:

thalidomide (Talomid)

metronidazole (Flagyl)phenytoin (Dilantin)


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Peripheral neuritis is damage to

nerves that run from the spinal cord

to the rest of the body, which

impairs function of the sensory,motor, and autonomic nerves.


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Chronic pain

Depression

Drug dependence


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Symptoms vary according to which

type of nerve is affected and may

include:

Altered sensations or paresthesia

Impaired balance when standing

or walking

Difficulty maintaining a grip on

objects

Muscle weakness


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Patient history and physical

examination delineate characteristic

distribution of motor and sensory

deficits.

Electromyography

Nerve biopsy and nerve conduction

tests


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Supportive measures to relieve pain

Adequate bed rest

Physical, vocational, andoccupational therapy

Orthopedic interventions to promote

independence

OTC analgesics or prescription pain

medications may be needed to

control nerve pain.


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Anticonvulsants (phenytoin,

carbamazepine) or tricyclic

antidepressants

duloxetine (Cymbalta) may beprescribed specially for the

treatment of diabetic

neuropathy


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For patients with bladder

dysfunction, manual expressionof urine (pressing over thebladder with the hands),

intermittent catheterization, ormedications, may be necessary.

Others:

acupuncture,plasmapheresis andIV gamma globulin, electricalnerve stimulation, andbiofeedback.


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Encourage participation in physicaltherapy. Provide ROM exercises, ifnecessary. Teach use of assistive

device, if appropriate.Assess affected areas frequently for

bruises, open skin areas, or otherinjuries and provide appropriatecare.

Provide safety measure to preventinjury.


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Reposition the patient every 2 hoursor teach to change position

frequently if nerve damage preventsadequate sensation of pressure.

Provide small, frequent meals ifappropriate.

Assist the patient with bladderdysfunction with manual expressionof urine and intermittent

catheterization, as necessary.Provide appropriate education to the

patient and his family duringdischarge.


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Also known as tic douloureux, is

a disorder of one or morebranches of the 5th cranial

nerve.


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Typical trigeminal neuralgia (also

known as classical, idiopathic, and

essential trigeminal neuralgia)

Atypical trigeminal neuralgia

Pre-trigeminal neuralgia

MS-related trigeminal neuralgia

Secondary trigeminal neuralgia

Post traumatic trigeminal neuralgia

Failed trigeminal neuralgia


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Intractable pain

Lack of self-careDepression


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Localized searing or burning that

occurs lightning-like jabs and last from

1-2 minutes (pain is usually initiated by

a light touch to a hypersensitive area,

such as the tip of the nose, cheeks, orgums. Pain may also follow a draft of

air, exposure to heat or cold, eating,

smiling, talking, or drinking hot or cold

beverages)

Constant, dull ache

Splinting of the affected area


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Skull x-rays, CT-scan, andMRI


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carbamezipine(Tegretol)

oxcarbezapine

Nerve block injectionsPercutaneous surgery (through

the cheek) to open skull surgery

Pin-point radiation


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Provide emotional support to the patientand family.

Observe and record the characteristics ofeach attack, including the patientsprotective mechanism.

Provide small, frequent meals at a room

temperature to maintain adequatenutrition.Assist the patient in identifying factors

that precipitate an attack, and urge thepatient to avoid stimulation (air, heat,cold) to trigger zone (lips, cheeks, gums).

Administer medications, as ordered, andmonitor for adverse effects.

Provide appropriate preoperative and

postoperative care, as appropriate.


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Also known as reflex sympathetic

dystrophy (CRPS1) or causalgia

(CRPS2) is a chronic pain disorderthat results from abnormal healing

after an injury -either minor or

major- to a bone, muscle, or nerve.


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Stage I (acute)

Stage II (subacute or dystrophic)

Stage III (chronic or atrophic)


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Specificity

Intensity

Pattern

Neuromatrix

Gate control


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Chronic pain

Depression

Drug dependence


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Severe and constant pain

Altered blood flow to the affectedarea

Discoloration, sweating, or swellingof the affected area (may also bewarm or cool to the touch)

Skin, hair, and nail changesImpaired mobility and muscle

wasting (if adequate treatment isdelayed)


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Diagnosis is based on the

patients history and clinical

findingsBone x-rays

Bone scans, nerve conduction

studies, and thermography


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Typically consists of acombination of therapies,

including administration of anti-

inflammatory, antidepressant,

vasodilator, and analgesic agents

Corticosteroids may beprescribed for some patients

Physical therapy


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Application of hot and coldUse of transcutaneous electrical

nerve stimulation (TENS) unit

Nerve or regional blocks

Surgical sympathectomy


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Administer medications, monitor

their effects and adverse effects.

Assist with ROM exercises. Provide

rest period as needed.

Provide emotional support.

Consult a pain care specialist to

provide additional options for the

patient and help manage

discomfort.

Nerve and Pain Disorders

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