be documented in the medical chart . In 2013 , a patient successfully sued an ED physician for $ 2 million because no offer to perform this exam was made after being given a BP diagnosis and discharge instructions to followup with a neurologist ( Wahlberg , 2013 ). Eleven days after ED discharge , the man had a stroke where 95 % of the carotid artery was found to be blocked .
Swallow Screen
A swallow screen will test for dysphagia and should be performed by a RN before the patient receives medication , food , or liquids by mouth . Hospitals have an institutional swallow screen protocol to utilize . The facial nerve innervates several muscles and affect deglutition ( Secil , Aydogdu , & Ertekin , 2002 ). Often the problems related to swallowing in patients with facial palsies are clinically underestimated ( Secil , Aydogdu , & Ertekin , 2002 ). If the patient fails the test , an evaluation by a speech therapist and an appropriate diet order is warranted .
Prevention of Long-Term Sequelae with Medication
BP is generally a self-limiting illness for a maximum of six months for about 90 % to 94 % of those afflicted who first presented with partial facial paralysis and sought medical care ( Baugh et al ., 2013 ; Fujiwara et al ., 2017 ). About 10 % of patients will develop sequelae and complete facial paralysis ( Fujiwara et al ., 2017 ), which requires follow-up care . Double-blind placebo studies show that there is a good prognosis with treatment that includes taking oral corticosteroids within 72 hours of the time the patient was last known to be asymptomatic . This is often referred to as the last known well time . These guidelines do not apply to patients under 16 years of age , diabetics , and some pregnant patients ( Baugh et al ., 2013 ). Oral antiviral therapy in conjunction with steroids is an option since there is the possibility of a link to a viral etiology . However , the AAO-HNSF issued a strong recommendation against the use of ( stand-alone / monotherapy ) oral antiviral therapy without concurrent steroid treatment because of evidence-based research relating to the guidelines ( Baugh et al ., 2013 ).
To sum up : Oral steroids taken within 72 hours of the onset of the signs and symptoms of BP can be very effective for most patients 16 years and older . Although oral antiviral monotherapy is not recommended , oral antiviral medication with oral steroids as a combination therapy is considered an effective option ( Baugh et al ., 2013 ; Sullivan et al ., 2016 ).
Prophylactic Eye Care
Care must be taken to ensure that eyes remain lubricated with eye drops or ointment on a regular basis for patients with incomplete eye closure and paralysis of the lacrimal apparatus ( Mooney , 2013 ). Sunglasses or safety glasses may also be worn to protect the cornea from debris and trauma ( Harvard Women ’ s Health Watch , 2010 ). Work and sports , particularly outdoors and in cold weather , should be curtailed or ceased . RNs instruct patients to sleep with the eyelid carefully taped shut to keep it from drying out ; care must be taken to ensure that the tape and dressing material do not scratch the cornea ( Mooney , 2013 ). RNs should teach patients how to properly tape the eye shut before being discharged from the hospital .
Psychological Care
According to Fu , Bundy , and Sadiq ( 2011 , p . 1326 ), “ Treating the functional problems of facial palsy is not enough ” because people who suffer from facial disfigurement , even temporarily , tend to become self-conscious , anxious , embarrassed , and depressed . This is especially true of women in a society that has placed greater emphasis on physical features and cosmetic appearance ( Kuehner , 2003 ).
The inability to smile or show emotion can be distressing . The face is central to human communication and social skills . Any alteration is apt to cause psychosocial tribulations . Very few studies have examined quality of life or stigmatization related to facial injuries or disfigurement ( Halioua , Williams , Murray , Skalko , & Vogelsong , 2011 ; Hultcrantz , 2016 ). Therefore RNs should be prepared to provide information regarding psychological support and counseling to patients who display excessive depression or angst about cosmetic disfiguration .
Issue 3 2017 Pennsylvania Nurse 10