DISORDERS OF CRANIAL NERVES

Disorder Nursing Olfactory NerveI Head trauma Intracranial tumor Intracranial surgery Optic NerveII Optic neuritis Increased intracranial pressure Pituitary tumor Oculomotor NerveIII Trochlear NerveIV Abducens NerveVI Vascular Brain stem ischemia Hemorrhage and infarction Neoplasm Trauma Infection Clinical Manifestations Unilateral or bilateral anosmia (temporary or persistent) Diminished taste for food Lesions of optic tract producing homonymous hemianopsia Interventions Assess sense of smell. Assess for cerebrospinal uid rhinorrhea if patient has sustained head trauma. Assess visual acuity. Restructure environment to prevent injuries. Teach patient to accommodate for visual loss.

Dilation of pupil with loss of light reex on one side Impairment of ocular movement Diplopia Gaze palsies Ptosis of eyelid

Assess extraocular movement and for nonreactive pupil.

Trigeminal NerveV Trigeminal neuralgia Head trauma Cerebellopontine lesion Sinus tract tumor and metastatic disease Compression of trigeminal root by tumor

Pain in face Diminished or loss of corneal reex Chewing dysfunction

Assess for pain and triggering mechanisms for pain. Assess for difculty in chewing. Discuss trigger zones and pain precipitants with patient. Protect cornea from abrasion. Ensure good oral hygiene. Educate patient about medication regimen. 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

Facial NerveVII Bells palsy Facial nerve tumor Intracranial lesion Herpes zoster

Facial dysfunction; weakness and paralysis Hemifacial spasm Diminished or absent taste Pain

hygiene. Provide emotional support for changed appearance of face. Vestibulocochlear NerveVIII Tumors and acoustic neuroma Vascular compression of nerve Mnires syndrome Tinnitus Vertigo Hearing difculties 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. Assess for paroxysmal pain in throat, decreased or absent swallowing, and gag and cough reexes. Monitor for dysphagia, aspiration, and nasal dysarthric speech. Position patient upright for eating or tube feeding.

Glossopharyngeal NerveIX Glossopharyngeal neuralgia from neurovascular compression of cranial nerves IX and X Trauma Inammatory conditions Tumor Vertebral artery aneurysms

Pain at base of tongue Difculty in swallowing Loss of gag reex Palatal, pharyngeal, and laryngeal paralysis

Vagus NerveX Spastic palsy of larynx; bulbar paralysis; high vagal paralysis Guillain-Barr syndrome Vagal body tumors Nerve paralysis from malignancy, surgical trauma such as carotid endarterectomy Spinal Accessory NerveXI Spinal cord disorder Amyotrophic lateral sclerosis Trauma Guillain-Barr syndrome

Voice changes (temporary or permanent hoarseness) Vocal paralysis Dysphagia

Assess for airway obstruction/provide airway management. Prevent aspiration. Support patient having voice reconstruction procedures.

Drooping of affected shoulder with limited shoulder movement Weakness or paralysis of head rotation, exion, extension; shoulder elevation

Support patient undergoing diagnostic tests.

Hypoglossal NerveXII Medullary lesions Amyotrophic lateral sclerosis Polio and motor system disease, which may destroy hypoglossal nuclei Multiple sclerosis Trauma

Abnormal movements of tongue Weakness or paralysis of tongue muscles Difculty in talking, chewing, and swallowing

Observe swallowing ability. Observe speech pattern. Be aware of swallowing or vocal difculties. Prepare for alternate feeding methods (tube feeding) to maintain nutrition.

Source:Brunner and Suddharths Med-Surgical Nursing 12th Edition p.1971