Nursing Diagnosis and plan of care

A nurse working with a patient with trigeminal neuralgia may diagnose the patient with any of the following:

• Risk for suicide 
• The pain of this disease may become so unbearable that it drives a person to take their own life.
• Acute pain
• Constant or intermittent pressure on the nerve will cause bouts of unbearable pain.
• Risk for ineffective coping related to pain
• The patient may feel that they cannot take the pain, may put aside other necessary activities, and may not be able to  handle normal activities of daily living.
• Risk for activity intolerance
• Acute can can be debilitating.  Instead of participating in a healthy level of activity, patient's who suffer from trigeminal neuralgia are often doing all that they can to deal with their bouts of pain.
• Readiness for enhanced power
• A patient who has come in to be diagnosed with trigeminal neuralgia may be looking for a way to better handle and/or heal their pain and re-take control of their life.

Diagnosis	Acute pain
Related to:	Compression of trigeminal nerve by surrounding blood vessels
As evidenced by:	Patient's self-report of pain
Plan	Patient will remain pain free
Outcome	Patient will remain comfortable Patient will report no pain Patient will be aware of triggers and be able to properly manage pain Patient can describe nonanalgesic methods of pain management Patient can perform activities of daily living with ease Describe management regimen of unrelieved pain State ability to obtain sleep and rest
Nursing Intervention	Continuous assessment to determine triggers Assessment of pain level and characteristics of pain Determine patient's current medication use Steady analgesic management Develop treatment plan with patient Assess patient's knowledge of triggers and pain management Include family in teaching surrounding pain management

References:

https://evolve.elsevier.com/Resources/100530_global_0001#/content/289099256

Nursing Care

Most of the nursing care for trigeminal neuralgia is done pre- and post-operatively.  However, once a patient is diagnosed with TN, they may need some help to cope with the pain until a treatment pathway can be decided upon. TN is often referred to as 'the suicide disease' due to the fact that the extreme pain and lack of immediate signs as to the cause of the pain has caused many of those afflicted to take their own lives.  As more information is gained surrounding this affliction, that number is going down.  When the diagnosis of trigeminal neuralgia is made, a nurse may be able to help the patient with the following items:

1.  Join an online support group. - Those suffering from trigeminal neuralgia are not alone!  There are several websites in which patients can discuss their disease, ask questions, gather information on different coping mechanisms and treatments and support one another.
2.  Make a list of  positive aspects of life.  - Because the pain can be so severe, having a running list of things that add to happiness are often very helpful.  Whether it is photos of friends and families, motivational quotes, something the patient wants to learn, etc., being able to concentrate on a positive item can help these patients make it through the bouts of pain.  .
3. Keep a diary of your experiences. - This can help to suss out triggers for trigeminal neuralgia.  Maybe the pain occurs on the left side of the face every time the teeth are brushed with cold water.  Or perhaps it occurs when chewing on the right side of the mouth.  This information can help those suffering to avoid these triggers but also help their doctor to determine the best course of action.
4. Practice healthy habits. - Good health habits will lead to better health.  They may also help patients to avoid triggers or simply bear with the pain.  
5. Research TN and the treatment options. - A good knowledge base will help one who is suffering take control of their illness, and potentially, their pain.  There are many different websites which outline the disease, potential triggers and treatment options.  

A nurse can help to explain these items to someone who is suffering from trigeminal neuralgia and set them up on a path to success.  

References:

http://www.mayoclinic.org/diseases-conditions/trigeminal-neuralgia/basics/definition/con-20043802

http://fpa-support.org/trigeminal-neuralgia-support/?gclid=CjwKEAjw65GqBRCj3fLFwK2SpWoSJABa3E3cjn2QkHDjn5HYJoaSRzzt4l5rlYgXSDVIzDTLKR6uyxoC9-rw_wcB


1. Create a table to summarize the nursing care for individuals with your disease. 2. Briefly state why a particular website provides a critical collection that informs nurses. 2. Post links to that website on your blog.

Treatment

There are many people who suffer from Trigeminal Neuralgia and never have it diagnosed.  For those that do, there are a number of different treatments and procedures that can help.  These treatments fall in one of three categories: avoidance of triggers, medication or surgery.  Each of these can help to some degree.  The category chosen is likely decided upon due to the severity of the symptoms, the number of occurences of trigeminal neuralgic attack and the degree to which quality of life is hindered.  Below is a table outlining these treatments other than surgery:

Treatment	Method of action	Adverse Effects	Best for...	Cost
Avoiding Triggers	Avoiding things such as: Spicy foods Extreme hot or cold beverages Drafty or windy places	Few side effects Missing out on pleasures	People with mild or infrequent bouts of TN	Free
Medication	Anticonvulsants are the first line of treatment in TN.  This medication slows the nerve impulses that send pain.  The drug of choice is Carbamazepine.	Blurred or double vision Confusion Drowsiness Irritability Chest Pain Insomnia And many more...	People with moderate to severe episodes of TN that occur more frequently	Without insurance covering this med, the cost can be greater than $60 per month.
Complementary and Alternative Medicines	Acupuncture Biofeedback Capsaicin (active component in chili peppers) Homeopathy Nutritional Therapy etc.	Time and energy spent on these.  Adverse effects will vary.	Anyone suffering from TN who wants to try an alternative or adjuvant medicine	Widely varied range

For those suffering from severe and frequent bouts of TN, surgery may seem like a good solution.  There are several different surgeries that can be performed, as well.  The most popular surgeries are:

Surgery	Specific Procedure	Invasive?	Drawback
Microvascular Decompression (MVD)	Cushion is placed between the nerve and compressing vessel through a small incision behind the ear.	Yes	Invasive
Balloon Compression	Catheter with balloon tip is inserted through a puncture in the cheek and inflated to selectively squeeze and damage nerves which mediate light touch.	Yes	Damage to the nerve
Glycerol Injection	Glycerol is injected into the trigeminal ganglion (where the three trigeminal branches come together) and bathes the demyelinated fibers.	Mildly	Pain may return
Radiofrequency Lesioning	A needle is passed through the cheek and through an opening in the skull.  The area of the TN pain is isolated by a small electrical current and that portion of the nerve is destroyed.	Mildly	Potential destruction of surrounding nerves
Radiosurgery (GammaKnife, CyberKnife)	A head frame is attached and beams of radiation are directed to the area of the brainstem where the trigeminal nerves exit.  This causes a lesion and disrupts transmission of pain.	No	May take months for pain relief

Watch a Microvascular Decompression surgery below!

References:

http://www.healthline.com/health/cost-epilepsy-medications#Overview1

http://fpa-support.org/treatment-options-trigeminal-neuralgia/

Signs and Symptoms

What does trigeminal neuralgia feel like?

Trigeminal neuralgia is extreme facial pain.  As previously mentioned, trigeminal neuralgic pain is typically caused by a vein or artery that is putting pressure on the nerve.  The pain often occurs in repeated short bursts lasting a few seconds each but can last more than a minute.  It is described as: zapping, shooting, stabbing, lightning-burst, and excruciating.  The pain can be felt anywhere from the forehead to the jaw but is most often felt in the cheek alongside the nose or in the jaw on one side of the face.  It can be so severe that is will cause the person to cry out, wince and/or stop whatever it is they are doing. 

How does the pain start?
 
The affected area of the face becomes extremely sensitive with such minor stimulation.  This minor stimulation includes such triggers as: a light breeze, cold temperature, water from a shower, washing the face, shaving, or even eating.  The pain can occur spontaneously but is often triggered by touching certain 'trigger spots' on the face, lips, or tongue.

How long does it last?

Trigeminal neuralgic pain usually lasts only seconds but can last up to two minutes and can occur more than 100 times in a day.  The pain will resolve on its own, but reoccur often.  Even after being pain-free for an extended period of time, the pain could potentially return if a more permanent solution is tried.


References:

 http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/headache/conditions/trigeminal_neuralgia.html

http://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/cranial-nerve-disorders/trigeminal-neuralgia 

 neurosurgery.ucsf.edu/index.php/pain_treatment_trigeminal_neuralgia.html