The plan has three parts
This client noticed his facial droop 36 hours ago and has type 2 diabetes. The correct plan combines oral prednisolone started now, closer blood glucose checks, and eyelid taping at night. Each part answers a specific problem: the steroid treats the nerve inflammation, glucose monitoring handles the steroid's effect on his diabetes, and taping protects an eye that cannot close.
Why a corticosteroid, and why now
In Bell palsy the facial nerve swells inside its narrow bony canal, and the swelling compresses the nerve further. Oral corticosteroids started within 72 hours of onset reduce this inflammation and improve the chance of full recovery. At 36 hours this client is well inside the 72-hour window, so the steroid should be started without delay. The distractor that withholds the steroid because more than 24 hours have passed uses the wrong cutoff. The window is 72 hours, and every hour of delay within it still matters.
Diabetes is a reason to monitor, not to withhold
Corticosteroids raise blood glucose by increasing hepatic glucose production and reducing insulin sensitivity. In a client taking metformin, a short course can cause noticeable hyperglycemia, especially in the afternoon and evening. The safe response is to check glucose more often and adjust diabetes treatment as ordered, not to deny him a treatment that improves facial nerve recovery. Antiviral drugs such as acyclovir may be added to a steroid in severe cases, but antivirals are not used alone for Bell palsy, so the option offering acyclovir instead of the steroid is incorrect.
| Option element | Correct? | Reason |
|---|
| Prednisolone now | Yes | Within the 72-hour window |
| Glucose checks | Yes | Steroids raise blood glucose |
| Night eyelid taping with ointment | Yes | Eye stays open during sleep |
| Daytime patch only | No | Night is when the cornea is most exposed |
| Acyclovir alone | No | Antivirals are only an add-on in severe cases |
Eye protection at night
Because the eyelid cannot close, the cornea dries and can be scratched, leading to exposure keratitis or corneal ulcer. During the day the client can blink partly and use artificial tears. At night the eye stays open during sleep, so lubricating ointment and taping the lid closed are the key protective measures. A patch worn only during the day misses the period of greatest risk. The nurse also teaches him to wear glasses or protective eyewear outdoors and to report eye pain, redness, or blurred vision.
Exam takeaway
Key point Bell palsy within 72 hours of onset: start the oral steroid, monitor glucose if the client has diabetes, and protect the eye, especially at night.