Affects cranial nerve VII (facial) and causes ipsilateral flaccid paralysis of the entire half of the face including the forehead, distinguishing it from central (stroke) causes that spare the forehead.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A child with rubella (German measles) typically has which characteristic finding in addition to a mild maculopapular rash?
Answer: B. Rubella is often accompanied by postauricular and suboccipital (back of head) lymphadenopathy along with a mild pink maculopapular rash and low-grade fever. The illness is usually mild in children.
Question 2 of 3
A newborn weighed 4200 grams at birth after a difficult shoulder dystocia. The nurse notes the affected arm is adducted and internally rotated with the forearm extended. What injury does the nurse suspect?
Answer: A. Erb palsy (Erb-Duchenne, brachial plexus injury) results from stretching of the upper brachial plexus during a difficult delivery such as shoulder dystocia. The arm hangs limply, adducted and internally rotated, with the forearm pronated, and the Moro reflex is absent on that side.
Question 3 of 3
A nurse assesses a client newly diagnosed with Parkinson disease. Which classic finding does the nurse expect to observe?
Answer: B. The cardinal motor features of Parkinson disease are tremor (often a pill-rolling resting tremor), rigidity, bradykinesia, and postural instability. A resting tremor that diminishes with purposeful movement is classic. Intention tremor is seen in cerebellar disease, hyperreflexia points to upper motor neuron lesions, and ascending flaccid paralysis suggests Guillain-Barre.
Keep the streak going with more questions like these, each with a full rationale.
What is bell palsy?
It produces a sudden one-sided facial droop, inability to close the eye, and loss of the forehead wrinkle on the affected side. Unlike a stroke, it involves the WHOLE half of the face including the forehead. Most cases resolve within weeks to months.
Key points to remember
- Affects cranial nerve VII (facial) and causes ipsilateral flaccid paralysis of the entire half of the face including the forehead, distinguishing it from central (stroke) causes that spare the forehead.
- Hallmark signs: drooping mouth, inability to close the eye, flattened nasolabial fold, drooling, and loss of taste on the anterior two-thirds of the tongue.
- Often preceded by a viral illness; herpes simplex virus is the most common associated cause.
- Corticosteroids (prednisone) started within 72 hours of onset improve recovery; antivirals (acyclovir) may be added for moderate-to-severe cases.
- Most patients recover fully within 3 to 6 months without permanent deficit.
Signs & symptoms
- Unilateral facial droop
- Can't close eye, drooling
- Loss of taste, ↓ tearing
Nursing priorities
- Protect the affected eye: apply artificial tears during the day, lubricating ointment and an eye patch or taping the lid shut at night to prevent corneal drying and abrasion.
- Administer prescribed corticosteroids early and teach the importance of starting within 72 hours.
- Assess ability to chew and swallow; provide soft foods and have the patient chew on the unaffected side to prevent aspiration and pocketing.
- Encourage facial muscle exercises and warm moist heat to maintain muscle tone and reduce discomfort.
- Provide emotional support and reassurance that most cases resolve, addressing body-image concerns.
Patient teaching
- Use artificial tears during the day and tape or patch the eye closed at night to prevent corneal damage.
- Chew food on the unaffected side and eat soft foods to avoid choking and food pocketing.
- Perform gentle facial massage and exercises in front of a mirror several times a day.
- Take the full course of steroids as prescribed and do not stop abruptly.
- Reassure that recovery usually takes weeks to a few months and is typically complete.
Red flags: report now
- Eye pain, redness, or vision changes signaling corneal abrasion or ulceration from inadequate eye protection.
- New bilateral facial weakness, limb weakness, or other focal neuro deficits suggesting stroke or Guillain-Barre rather than Bell palsy.
References
Clinical references for this topic
