Done-Cranial Nerve Disorder-Mom Heny-Jumat,20 Nov 2013

8/19/2019 Done-Cranial Nerve Disorder-Mom Heny-Jumat,20 Nov 2013

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Askep Cranial Nerve Disorder

Heny Suseani Pangastuti, SKp.,M.Kes

Jumat, 20 November 2015


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A. TRIGEMINAL NEURALGIA (TIC DOULOUREUX)

• Adanya gangguan pada saraf

kranial ke V yang ditandaiadanya nyeri paroxymal pada

daerah yang diinervasi oleh 3cabang saraf, tetapi paling


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sering terjadi pada cabang ke2 dan ke 3

(Maloni, 2! cit" #runer $suddart

• penyakit kronik pada saraftrigeminal yang menyebabkannyeri %ajah berat denganpenyebab yang tidak diketahui

Karakerisik n!eri

• &yeri muncul dan hilang tiba'

tiba, digambarkan sebagaisensasi nyeri tusuk atausengatan listrikditembak yangunilateral pada satu sisirahang atau pipi"

• )ada beberapa penderita,mata, telinga atau langit'langitmulut dapat pula terserang"

• )ada kebanyakan penderita,nyeri berkurang saat malamhari, atau pada saat penderitaberbaring

•

*apat muncul kontraksi ototfasialis involuntary yangmenyebabkan menutupnyamata atau t%itch of themouth

• intense skin surface pain +

timesday or a fe% times ayear

• tarts peripherally andadvances centrally

• ome trigger -ones initiate

pain

• = tic ou!oureu" (painful

t%itch!"

• .arly attacks, appearing mostoften in the /fth decade of life,usually mild and brief"

• )ain'free intervals may be

measured in terms of minutes,hours, days, or longer"

• 0ith advancing years, the

painful episodes tend tobecome more fre1uent andagoni-ing"

•

he patient lives in constantfear of attacks"

pen!e"a"

• idak pasti

• Mungkn krn kompresi atau

iritasi dari saraf trigeminalatau perubahan degeneratifpada ganglion gasserian

•

)enyebab lain tekanan padapembuluh darah karenaabnormalitas (!oop o# anartery !, gangguan pada saraftrigeminal, gasserian gang!ion,or root entry $one

• )aroxysms can occur %ith anystimulation of the terminals ofthe a4ected nerve branches

such as %ashing the

face, shaving,

brushing the teeth,

eating, and drinking"

A draft of cold air and

direct pressure againstthe nerve trunk

• 5ertain areas are called trigger

points because the slightesttouch immediately starts a

paroxysm or episode"

• o avoid stimulating theseareas, patients %ith trigeminalneuralgia try not to touch or%ash their faces, shave, che%,or do anything else that mightcause an attack"

• hese behaviors are a clue todiagnosis"

#$ARMACOLOGIC T$ERA#%


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• Antisei-ure agents

– such as carbama-epine

(egretol!

•

relieve pain byreducing thetransmission ofimpulses atcertain nerveterminals"

• 5arbama-epine istaken %ith meals"

• erum levels

must be

monitored toavoid toxicity inpatients %hore1uire highdoses to controlthe pain"

• ide e4ects

include nausea,di--iness,dro%siness, andaplastic anemia"

• he patient ismonitored forbone marro%depression duringlongterm therapy"

– 6abapentin (&eurontin!and baclofen (7ioresal!are also used for paincontrol"

– 8f pain control is still not

achieved, phenytoin(*ilantin! may be usedas adjunctive therapy(9o%land, 2!"

– Alcohol or phenol

injection of thegasserian ganglion andperipheral branches ofthe trigeminal nerve

relieves pain for severalmonths" :o%ever, the

pain returns %ith nerveregeneration"

&URGICAL MANAGEMENT

• Microvascular *ecompression

of the rigeminal &erve"

• )aercutaneous 9adiofre1uency rigeminal 6angliolysis"

Eviden'e....Revie o *+ s,dies-

- microvascular decompression(MV*!

- he e;cacy of MV* andpercutaneous balloonmicrocompression ()#5!%ere similar (!, andtheir e4ects %eresuperior to those of theother modalities () @"+!"

- radiofre1uencythermorhi-otomy (9'

9!

- Although 9'9provided a high initialpain relief, its average

pain free rate %as>"BC for a meanfollo%'up of > years"

- he recurrence rate %ashigh after 9'9 (BDC!,%hile the lo%estrecurrence rate (+E"3C!%as after MV* () @"+!"


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- 0ithin the long'termfollo%'up periodrecurrence of paina4ects at least +FC ofpatients %ho undergoany surgical treatmentfor &"

CONCLU&ION&-

- he study suggests thateach surgical techni1uefor treatment oftrigeminal neuralgia has

merits and limitations"

- MV* provides thehighest rate of long'term patientGsatisfaction %ith thelo%est rate of painrecurrence"

atli M, atici


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• Anjurkan klien untuk

tidak mengunyah padasisi yang terkena hinggarasa kebal hilang

•


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• one sided paralysis of facial muscles and upper eyelid,

• loss of taste on a4ected side,

• increased tearing of eye on a4ected side

3ell4s pals! is 'onsidered "! so/e o represen a !pe o press,re

paral!sis.

Manae/en

• he objectives to maintain the muscle tone of the face and to prevent or

minimi-e denervation"

• reassured that no stroke has occurred and that spontaneous recovery

occurs %ithin 3 to > %eeks in most patients"

• :eat may be applied to the involved side of the face to promote comfort

and blood o% through the muscles"


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• .lectrical stimulation may be applied to the face to prevent muscle

atrophy"

• Although most patients recover %ith conservative treatment, surgical

exploration of the facial nerve may be indicated in patients %ho are

suspected of having a tumor or for surgical decompression of the facial

nerve and for surgical treatment of a paraly-ed face"

TREATMENT

• 5orticosteroid therapy (prednisone!

– to reduce inammation and edema

– this reduces vascular compression and permits restoration of blood

circulation to the nerve"

– .arly administration of corticosteroid therapy appears to diminish

the severity of the disease, relieve the pain, and prevent or

minimi-e denervation"

• antiviral medications

• acial pain is controlled %ithanalgesic agents"

D1. Keperaaan

• 9isk for injury

• Acut pain

• disturbed body image

• 8mbalance nutrition less than

body re1uirements

NOC-

- Hno%ledge personal safety

- 9isk control Visual impairment

- issue integrity skin $ mucousmembran

NIC-

- :ealth education

Keepin 5e ineri! o 5e'ornea -

- )lace an eye patch on thea4ected eye during sleep tokeep it shut"

- .ncourage patient to reportimmediately any painexperienced around the eye,

reporting the level of pain andits location"

- Assess the condition of theeye including redness and anydischarges"

- each the patient toadminister arti/cial tears orophthalmic ointment asordered"

Alleviain 5e pain

• 8nstruct the patient to placemoist heat on the face"

• )erform routine massage onthe face to relieve musclepain"

• each the patient toadminister corticosteroids tominimi-e the inammationand non'narcotic analgesics todecrease the pain


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#ROMOTING $OME ANDCOMMUNIT%63A&ED CARE -Tea'5in #aiens &el6Care.

• 0hile the paralysis lasts, the

involved eye must beprotected"

• re1uently, the eye does not

close completely and the blinkreex is diminished, so the "

• 5orneal irritation andulceration may occur if theeye is unprotected"

• *istortion of the lo%er lid

alters the proper drainage oftears"

• o prevent injury, the eye

should be covered %ith aprotective shield at night"

• he eye patch may abrade thecornea, ho%ever, becausethere is some

• di;culty in keeping the

partially paraly-ed eyelidsclosed"

• he application of eye

ointment at bedtime causesthe eyelids to adhere to oneanother and remain closedduring sleep"

• he patient can be taught toclose the paraly-ed eyelidmanually before going tosleep"

• 0rap'around sunglasses orgoggles may be %orn todecrease normal evaporationfrom the eye"

Co/pli'aions

• Jlceration of the cornea

• 8mpairment of vision

• N,rsin Aler7

Heratitis, or the inammationof the cornea, is one of themost dangerous complicationsfor a patient %ith #ellLs palsy"As a precautionary measure,the nurse must ensure that thecornea is still protected even if the eyelids %onLt close"

8UI9 TIME -

+" Apakah perbedaan antara#ellLs )alsy dan troke O

Kelaskan P

2" #erikut merupakan diagnosakepera%atn yang dapatditegakkan pada pasien #ellL s

)alsy, kecuali """"a" 9isk for injuryb" Acut painc" disturbed body imaged" gangguan maenelan

8"vascular ischemia,88" viral disease (herpes simplex,

herpes -oster!,888" autoimmune disease,8V" paparan A5

3" yang merupakan kemungkinanpenyebab dari #ellLs )alsyadalah """

B" #erikut yang merupakan terapipembedahan untuk pasien

%&'()M'N*+ N)&*+('* adalah """a" Micro analitic nerve

trigeminal &euralgiab" Microvascular

*ecompressionc" 9adiotherapy pada cranial

d" Masage pada daerah facial>" Kelaskan beberapa Hriteria

nyeri pada pasien rigelmia&euralgia P

Kunci Ja-aban

1. Paa pasien stro/e,/e!umpuanpara!ysis tia/anya terai paa aerauni!atera! -aa namun uga

paa anggota gera/ yaitu

tangan an /a/i paasebagian sisi atau


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/ese!uruan, seang/an paa pasien 3e!!4s Pa!sy para!ysisanya terai i aera -aa.

2. .

6. *.

7. 3.

5. 8+iat NS9 seniri /a-an :

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Done-Cranial Nerve Disorder-Mom Heny-Jumat,20 Nov 2013