Guillain-Barre’ Syndrome

Concept Map: Selected Topics in Neurological Nursing PATHOPHYSIOLOGY Traumatic Brain Injury Spinal Cord Injury Specific Disease Entities: Amyotropic Lateral Sclerosis Multiple Sclerosis Huntington’s Disease Alzheimer’s Disease Myasthenia Gravis Guillian-Barre’ Syndrome Meningitis Parkinson’s Disease ASSESSMENT Physical Assessment Inspection Palpation Percussion Auscultation ICP Monitoring “Neuro Checks” Lab Monitoring PHARMACOLOGY --Decrease ICP --Disease / Condition Specific Meds Care Planning Plan for client adl’s, Monitoring, med admin., Patient education, more…based On Nursing Process: A_D_P_I_E Nursing Interventions & Evaluation Execute the care plan, evaluate for Efficacy, revise as necessary

Biggest Issue … Respiratory Failure from intercostal and diapragmatic muscle paralysis RAPID progression: 25% will need ventilator within 18 days!

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

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

Motor & Sensory Neurons

Triggers? Recent History of: Viral illness Vaccination Surgery Acute Illness

S & S’s 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)

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

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

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

Nursing Care Maintain Patent Airway HOB elevated C&DB Q2H / spirometry / chest physiotherapy Monitor Vitals vigilently Pain management

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

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