trigeminal neuralgia
What is the best method to assess a patient with trigeminal neuralgia (tic douloureux)? A. Ask the patient what the triggering factors are. B. Have the patient open and close the jaw while palpating the mandible. C. Instruct the patient to touch the examiner's finger and then the patient's nose. D. Look at the optic disk with an ophthalmoscope
A. Ask the patient what the triggering factors are. The main symptom is spasms of severe, unilateral facial pain. Palpating the face may trigger a painful episode; touch is a common trigger. The other options do not reveal information about the trigeminal nerve effect.
What is a common treatment for trigeminal neuralgia? A. Warm, moist compressions B. Carbamazepine (Tegretol) C. Ice packs applied intermittently D. Vitamin D
B. Carbamazepine (Tegretol) Carbamazepine (Tegretol) or oxcarbazepine (Trileptal) is the usual first-line therapy for trigeminal neuralgia. By acting on sodium channels, these drugs lengthen the time needed for neuron repolarization and decrease neuron firing. Some patients take megavitamins as an adjunct therapy. Temperature extremes are often a trigger for painful episodes.
What is characteristic of trigeminal neuralgia (tic douloureux)? A. Unilateral facial drooping B. Inability to hear whispered speech C. One-sided facial stabbing pain D. Attacks of severe dizziness
C. One-sided facial stabbing pain Trigeminal neuralgia is usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of the trigeminal nerve. Unilateral facial drooping is found in Bell's palsy or facial nerve pathology (cranial nerve [CN] VII). Inability to hear indicates pathology of the acoustic nerve (CN VIII). Attacks of severe dizziness do not occur in trigeminal neuralgia.
What is a predominant causative trigger for the painful episodes in trigeminal neuralgia? A. Staphylococcus aureus cellulitis B. Misaligned bite of molar teeth C. Direct trauma to transmandibular joint D. Touching along the lower jaw
D. Touching along the lower jaw Touch and tickle predominate as causative triggers. Others include chewing, tooth brushing, hot or cold blast of air on the face, washing the face, yawning, or talking. The other options are not significant causative factors.
During assessment of the patient with trigeminal neuralgia, what should you do (select all that apply)? A. Inspect all aspects of the mouth and teeth. B. Assess the gag reflex and respiratory rate and depth. C. Lightly palpate the affected side of the face for edema. D. Test for temperature and sensation perception on the face. E. Ask the patient to describe factors that initiate an episode.
a, d, e Assessment of the attacks, including the triggering factors, characteristics, frequency, and pain management techniques, helps the nurse plan for patient care. Painful episodes are usually triggered by light cutaneous stimulation at a specific point (i.e., trigger zone) along the distribution of the nerve branches. Precipitating stimuli include chewing, tooth brushing, a hot or cold blast of air on the face, washing the face, yawning, or talking. Touch and tickle seem to predominate as causative triggers, rather than pain or changes in ambient temperature. The nursing assessment should include the patient's nutritional status, hygiene (especially oral), and behavior (including withdrawal). As a result of the attacks, the patient may eat improperly, neglect hygienic practices, wear a cloth over the face, and withdraw from interaction with others.
