Nursing Management of Trigeminal Neuralgia

        Nursing Management 

Fig. Patient having pain due to trigeminal neuralgia 

1. Nursing Assessment :

• Detailed history and physical examination : it should include detailed patient history , medical past   history , chief complaints of sudden unilateral , severe , stabbing , paroxysmal and recurrent pain. Physical examination of ear , mouth , teeth and temporal mandibular joint.
• Look thoroughly for SWEET criteria. 
• Assessment of nutritional status and dehydration
• Assess patient's anxiety and depression 

2. Nursing Diagnosis and Interventions :

a) Chronic pain related to activation of trigger zones along the nerve pathways .

1.  Assess current pain management strategies and effectiveness .It is done for measuring the      effectiveness of new pain strategies. 
2.  Assess patient's knowledge of specific trigger activities for pain.This is done to identify factors that can be manipulated by pain control interventions . 
3. Explore acceptability of cognitive and behavioural strategies to use in pain management.      The patient must believe that non-pharmacologic strategies can be effective adjuncts to pain management. 
4. Proper consultation with physician , pain management service regarding drug therapy, a multidisciplinary approach for management is important. 
5. Encourage patient to take medicines at regular intervals  and to use analgesics at the first sign of pain . Steady blood levels increase drug effectiveness and analgesics work effectively if administered before pain reaches severe levels. 

b) Imbalanced nutrition pattern: less than body requirements related to fear of triggering pain with eating.

1. Complete 24 hour recall assessment of dietary intake . This provides objective data to determine adequacy of diet.
2. Explore dietary modifications to increase nutrient intake without exacerbating pain                     ( consistency, texture , liquid supplements , adding skim milk or powders to food.) An inadequate diet can be supplemented with powders and formula to increase nutrient intake without substantially increasing volume.
3. Avoid empty calories . Since eating triggers pain, all foods ingested should be nutritious .
4. Add liquid multivitamin supplement to food / fluid.
5. Assist patient in exploring ways to avoid pain while eating ( mechanically soft foods, well balanced liquid supplementation )
6. Place food in unaffected side of mouth.
7. Teach patient to self weigh weekly and maintain weight record to track progress in meeting nutritional goals.

c) Impaired oral mucous membrane related to inadequate oral hygiene secondary to fear of pain .

1. Inspect oral tissue on each visit for evaluation of progress or problems.
2. Assess patient's current practice for oral care and evaluate effectiveness. This provides baseline data for planning.
3. Explore alternatives for oral care ( swabs, mouthwashes ) for achievement of mouth care goals.
4. Encourage patient to rinse after eating. This helps to  reduce mouth odour from retained food particles. 
5. Encourage patient to perform thorough oral hygiene between pain episodes.
6. Refer to dentist for regular assessment and care for identification of early infections. 

Note : If you need rationals on any of the point , kindly post it on comment section . I will try my best to make you understand .Thankyou . 
                                                                                                Dawa Lhomu Sherpa (Yangla)
                                                                                                         RN  /  Bsc.Nurse