Guillain-Barre

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Guillain-Barre Syndrome
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Concept Map Selected Topics in Neurological
Nursing
PATHOPHYSIOLOGY Traumatic Brain Injury Spinal
Cord Injury Specific Disease Entities
Amyotropic Lateral Sclerosis Multiple
Sclerosis Huntingtons Disease
Alzheimers Disease Huntingtons Disease
Myasthenia Gravis Guillian-Barre Syndrome
Meningitis Parkinsons Disease
PHARMACOLOGY --Decrease ICP --Disease /
Condition Specific Meds
ASSESSMENT Physical Assessment Inspection
Palpation Percussion
Auscultation ICP Monitoring Neuro Checks Lab
Monitoring
Care Planning Plan for client adls, Monitoring,
med admin., Patient education, morebased On
Nursing Process A_D_P_I_E
Nursing Interventions Evaluation Execute the
care plan, evaluate for Efficacy, revise as
necessary
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Biggest Issue

• Respiratory Failure from intercostal and
  diapragmatic muscle paralysis
• RAPID progression 25 will need ventilator
  within 18 days!

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Guillain-Barre Syndrome

• Autoimmune Disorder
• Inflammatory Version also
• Guillain-Barre syndrome is a rare disorder
• Not hereditary
• Cause unknown

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Guillain-Barre Syndrome

• Immune system attacks peripheral nerve cell
  myelin proteins (Rarely involves the brain)
• Causes varying degrees of muscle weakness and
  paralysis
• Spares the Schwann cells which produce myelin ---
  remyelinazation and recovery

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Motor Sensory Neurons
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Triggers?

• Recent History of
• Viral illness
• Vaccination
• Surgery
• Acute Illness

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S Ss

• SEVERE weakness and numbness in legs and arms
• PAIN d/t demyelinization
• Ascending weakness with dyskinesia (inability to
  move voluntarily)
• Loss of feeling movement (paralysis)
• Severe Bradycardia (pacemaker sometimes)

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DIAGNOSTICS

• Lumbar Puncture (LP) - cerebrospinal fluid with
  elevated protein level
• Electromyogram (EMG) records muscle activity
  which can show loss of reflexes d/t the
  disease's characteristic slowing of nerve
  responses
• Nerve Conduction Velocity (NCV) Performed with
  EMG, and together, they are often referred to as
  EMG/NCV studies. NCV records the speed at which
  signals travel along the nerves

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Severe GBS Medical Emergency

• Total paralysis
• Potentially dangerous fluctuations in Pulse and
  BP
• 25 unable to breathe without respiratory
  assistance
• Muscles for eye movement, speaking, chewing and
  swallowing also may become weak or paralyzed
• Often need long-term rehabilitation to regain
  normal independence
• As many as 15 experience lasting physical
  impairment
• In 3 8 can be fatal d/t complications

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Treatment

• Plasmapheresis to decrease circulating antibodies
• EKG monitoring for Autonomic Dysfunction
• Immunoglobulin therapy
• Hormonal therapy
• Physical therapy (to increase muscle flexibility
  and strength)

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Nursing Care

• Maintain Patent Airway
• HOB elevated
• CDB Q2H / spirometry / chest physiotherapy
• Monitor Vitals vigilently
• Pain management

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Collaborative Goals

• Reducing and/or managing symptoms
• Preventing complications
• Provide adaptive devices to increase mobility and
  self-care

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Prognosis

• Most people (85) recover from even the most
  severe cases of GBS with minimal residual
  symptoms
• Quick diagnosis treatment may lessen the
  severity of GBS and reduce recovery time
• The signs and symptoms of GBS may last days,
  weeks or months before muscle sensation begins to
  return. Regaining pre-illness strength and
  functioning is slow, sometimes requiring months
  or years. However, most people with GBS return to
  normal within months