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DISORDERS OF CRANIAL NERVES
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Disorder Nursing
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Clinical Manifestations
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Interventions
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Olfactory
Nerve—I
Head trauma
Intracranial tumor
Intracranial surgery
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Unilateral or bilateral anosmia
(temporary or persistent) Diminished taste for food
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Assess sense of smell.
Assess for cerebrospinal fluid rhinorrhea if
patient has sustained head trauma.
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Optic
Nerve—II
Optic neuritis
Increased intracranial pressure
Pituitary tumor
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Lesions of optic tract producing
homonymous hemianopsia
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Assess visual acuity.
Restructure environment to prevent injuries.
Teach patient to accommodate for
visual loss.
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Oculomotor
Nerve—III
Trochlear
Nerve—IV
Abducens
Nerve—VI
Vascular
Brain stem ischemia
Hemorrhage and infarction
Neoplasm
Trauma
Infection
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Dilation of pupil with loss of light reflex on one side Impairment of ocular movement
Diplopia
Gaze palsies
Ptosis of eyelid
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Assess extraocular movement and for
nonreactive pupil.
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Trigeminal
Nerve—V
Trigeminal neuralgia
Head trauma
Cerebellopontine lesion
Sinus tract tumor and metastatic
disease Compression of trigeminal root by tumor
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Pain in face
Diminished or loss of corneal reflex Chewing dysfunction
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Assess for pain and triggering mechanisms for
pain.
Assess for difficulty in chewing.
Discuss trigger zones and pain precipitants with
patient.
Protect cornea from abrasion.
Ensure good oral hygiene.
Educate patient about medication
regimen.
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Facial
Nerve—VII
Bell’s palsy
Facial nerve tumor
Intracranial lesion
Herpes zoster
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Facial dysfunction; weakness and paralysis
Hemifacial spasm
Diminished or absent taste Pain
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Recognize facial paralysis as emergency; refer
for treatment as soon as possible.
Teach protective care for eyes.
Select easily chewed foods; patient should eat
and drink from unaffected side of mouth.
Emphasize importance of oral hygiene.
Provide emotional support for changed
appearance of face.
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Vestibulocochlear
Nerve—VIII
Tumors and acoustic neuroma
Vascular compression of nerve
Ménière’s syndrome
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Tinnitus
Vertigo
Hearing difficulties
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Assess pattern of vertigo.
Provide for safety measures to prevent falls.
Ensure that patient can maintain balance
before ambulating.
Caution patient to change positions slowlyAssist with ambulation.
Encourage use of assistive devices.
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Glossopharyngeal
Nerve—IX
Glossopharyngeal neuralgia from
neurovascular compression of cranial nerves IX and X
Trauma
Inflammatory conditions
Tumor
Vertebral artery aneurysms
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Pain at base of tongue
Difficulty in swallowing
Loss of gag reflex
Palatal, pharyngeal, and laryngeal
paralysis
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Assess for paroxysmal pain in throat, decreased
or absent swallowing, and gag and cough
reflexes.
Monitor for dysphagia, aspiration, and nasal
dysarthric speech.
Position patient upright for eating or tube
feeding.
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Vagus
Nerve—X
Spastic palsy of larynx; bulbar paralysis; high
vagal paralysis
Guillain-Barré syndrome
Vagal body tumors
Nerve paralysis from malignancy, surgical
trauma such as carotid endarterectomy
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Voice changes (temporary or permanent hoarseness)
Vocal paralysis
Dysphagia
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Assess for airway obstruction/provide airway
management.
Prevent aspiration.
Support patient having voice reconstruction
procedures.
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Spinal
Accessory Nerve—XI
Spinal cord disorder
Amyotrophic lateral sclerosis
Trauma
Guillain-Barré syndrome
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Drooping of affected shoulder with limited shoulder movement
Weakness or paralysis of head rotation, flexion,
extension; shoulder elevation
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Support patient undergoing diagnostic tests.
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Hypoglossal
Nerve—XII
Medullary lesions
Amyotrophic lateral sclerosis
Polio and motor system disease, which may
destroy hypoglossal nuclei
Multiple sclerosis
Trauma
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Abnormal movements of tongue Weakness
or paralysis of tongue muscles Difficulty in talking, chewing, and swallowing
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Observe swallowing ability.
Observe speech pattern.
Be aware of swallowing or vocal difficulties.
Prepare for alternate feeding methods (tube
feeding) to maintain nutrition.
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