Nursing Clinical Practice Guide
Clinical Scenario: You are a nurse on a medical-surgical unit. Mr. Johnson, a 45-year-old teacher, was admitted yesterday with a diagnosis of right-sided Bell's palsy. He reports waking up two days ago with a "funny feeling" on the right side of his face and noticing his smile was crooked when he looked in the mirror. He is anxious and says, "Do I have a stroke? Am I going to look like this forever?"
Nursing Intervention Strategy:1. Assessment: Perform a focused neurological assessment. Observe for right-sided facial droop, flattening of the nasolabial fold, and pooling of saliva in the right cheek. Test his ability to close his right eye completely, raise his eyebrows, smile, and puff out his cheeks. Assess for any pain behind the ear. Ask about changes in taste.2. Nursing Diagnosis & Planning: Key nursing diagnoses include Risk for corneal injury related to inability to close eyelid, Impaired verbal communication related to facial muscle weakness, Body image disturbance related to visible facial changes, and Anxiety.3. Implementation:• Eye Care is the PRIORITY: Administer preservative-free artificial tears every 2-4 hours during the day. Apply a lubricating ointment and tape the eyelid shut or use a moisture chamber/eye patch at night. Teach the patient to do this himself.• Medication Administration: Administer oral prednisone as ordered, emphasizing the importance of taking it with food and not stopping abruptly. Administer antiviral if prescribed.• Support & Education: Reassure the patient that Bell's palsy is not a stroke and that most people experience significant recovery within weeks to months. Teach gentle facial massage and exercises (e.g., smiling, frowning in front of a mirror) once the acute inflammation subsides. Provide a straw for drinking and suggest eating soft, easy-to-chew foods.4. Evaluation: Monitor for signs of corneal abrasion (redness, pain, photophobia). Evaluate the patient's ability to perform eye care independently. Assess for reduction in anxiety and improvement in facial muscle function over time.
Patient Safety and Precautions: The open eye is vulnerable. Never neglect eye lubrication. Monitor for medication side effects of corticosteroids (hyperglycemia, mood changes, GI upset).
Nursing Procedure & Medication Flow
• Eye Protection Procedure: 1) Wash hands. 2) Instill 1-2 drops of artificial tears into the lower conjunctival sac of the affected eye. 3) At bedtime, apply a ribbon of ophthalmic ointment along the inner lower lid. 4) Gently close the eyelid and secure it with paper tape or apply a hydrogel eye patch.• Medication: Prednisone: A typical regimen may start at 60-80 mg daily for 5-7 days, then tapered. Key Point! Administer in the morning with food to mimic the body's natural cortisol rhythm and minimize GI irritation. Teach the patient to report black, tarry stools (sign of GI bleeding) or significant mood swings.
A Word from Your Senior Nurse
"Bell's palsy can be frightening for patients because it changes their appearance so suddenly. As a nurse, your calm reassurance and expert eye care are everything. Remember, your assessment is key—being able to confidently tell a patient, 'The fact that you can't raise your eyebrow points more toward Bell's palsy than a stroke' can provide immense relief. In clinical practice and on the NCLEX, always prioritize the eye. A corneal ulcer is a painful, preventable complication. You are their first line of defense!"