Pennsylvania Nurse, Front Page 2017 Issue 3 | Page 9

The condition got its name from
Sir Charles Bell (1774-1842), a
Scottish neurologist and physi-
ologist who fi rst described it and
published about the functions
of the cranial nerves (Aminoff,
2017). It is also referred to as Bell
palsy, idiopathic facial paralysis,
facial nerve palsy, and seventh
nerve palsy (Gagyor et al., 2015;
Mueller et al., 2017; Rizvi et al.,
2016; Sullivan, Daly, & Gagyor,
2016).
Medical treatment is based on
theories and conjecture about
why BP causes its signs, symp-
toms, and sequelae. However,
recent research has been contra-
dictory. This disease is considered
idiopathic despite being fi rst
described by Bell more than two
centuries ago (Aminoff, 2017).
Per the ambulance service’s stan-
dard operating procedure, which
uses the National Stroke Asso-
ciation’s Act FAST criteria, the
ambulance crew declares a code
stroke alert, notifi es the receiv-
ing hospital, and transports the
patient to the nearest primary
stroke certifi ed hospital (Ameri-
can Heart Association, 2011;
National Stroke Association, n.d.;
The Joint Commission, 2017)
The hospital’s code stroke alert,
among other things, makes the
patient’s care a top priority and
clears the computed tomography
(CT) scanner for the arriving pa-
tient. A neurologist is paged and
alerted to the imminent arrival
of a possible stroke patient. The
phlebotomy team is mobilized to
meet the patient in the emergency
department (ED) to process ur-
gent blood work.
Case Study
An ambulance is dispatched to
the loading dock of a local steel
manufacturer for a report of
a 27-year-old male with facial
droop and trouble speaking. The
slightly overweight long-haul
tractor-trailer driver reports that
his “tongue feels thick.” The
patient has trouble closing his
right eye. The symptoms started
an hour ago while driving. Except
for a slight headache, there are no
complaints of pain.
The driver smokes two packs of
cigarettes a day and denies ingest-
ing alcohol or taking illegal drugs.
He had a cold last week. There is
no signifi cant past or recent medi-
cal history of hospital admission.
The man denies head trauma or
nausea.
Upon arrival to the hospital, the
ED staff meets the patient near
the ambulance bay. The patient
has no complaints of chest pain
or diffi culty breathing. Drooling
and garbled speech are noted.
Questions are answered; the
patient is alert and oriented. The
exam reveals tactile sensation
detected on the right side of the
face (although it “feels numb”).
There is facial drooping to the
right and an unequal smile is
observed. The skin is warm and
dry. Ptosis is exhibited, as well
as diffi culty closing the right eye.
The patient’s pupils are equal, as
well as reactive to light and ac-
commodation.
Faint wheezing is heard in the
upper bilateral lung fi elds upon
auscultation. The patient moves
all extremities and has strong
bilateral hand grip strength.
Radial pulses in both arms are
strong and equal. Capillary refi ll
is less than one second in each
extremity. The patient is asked to
hold both hands away from the
body with palms facing upward.
His arms are still and do not drift
unequally downward. An electro-
cardiogram shows a normal sinus
rhythm of 88 beats per minute.
Blood pressure is 138/88 and
respirations are 16 breaths per
minute. The pulse oximeter reads
96% on room air. Blood glucose
level reported by the ambulance
crew is 90 mg/dl.
The ED attending physician
makes a clinical diagnosis of BP
based on the patient’s physical
exam, history of present illness,
and the National Institutes of
Health Stroke Scale (NIHSS)
evaluation tool (National Insti-
tutes of Health, 2003).
The code stoke alert is canceled.
The neurologist is no longer
acutely needed for this patient
and continues seeing other clients.
The canceled alert also allows
patients with a higher level of
distress to resume use of hospital
resources.
Pathophysiology
McCormick (1972) proposed that
herpes simplex virus-1 (HSV-1)
exists in the geniculate ganglion
of the seventh cranial nerve and
is reactivated from its latent state
to cause BP. This theory has been
widely accepted as the reason
for swelling and infl ammation of
the facial nerve. This nerve takes
a tortuous route from the pons
of the brain through the narrow
Issue 3 2017 Pennsylvania Nurse 7