Guillain-Barre Syndrome PDF

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GB syndrome ...

Description

GuillainBarre Syndrome What is it? 

Autoimmune attack of the peripheral nerve myelin

Result: acute, rapid segmental demyelination of peripheral and cranial nerves. - Ascending weakness - Dyskinesia (impaired ability to execute voluntary movement) - Hyporeflexia - Paresthesias  An infection usually precedes the development Epstein-Barr, HIV, Campylobacter jejuni, cytomegalovirus, mycoplasma pneumoniae, H. influenza

Pathophysiology:  Myelin – Covers the nerve providing insulation and speed for conduction from the cell body to the dendrite  Schwann cells produce myelin (which is not destroyed in the disease and allows for remyelination)  GBS- results in cell mediated and humoral immune attack of the myelin proteins Causing inflammation and demyelination Theory:the infectious organism contains a protein that mimics that of the myelin protein in the periphery Therefore, since the body cannot distinguish between the two proteins, it attacks both. The immune system attack causes macrophages and other immune mediated agents to influx into the area Inflammation, myelin destruction, interruption of nerve conduction, axonal loss

Clinical Manifestations:  Usually antecedent is 2 weeks before disease begins

 Weakness and hyporeflexia will begin in the legs and spread to the arms  Weakness and paralysis in the intercostal muscles and the diaphragm can lead to

respiratory failure -Mechanical ventilator Sensory symptoms:  Parasthesias  Pain- due to demyelination of the sensory fibers May affect the cranial nerves  Vagus- autonomic dysfunction, instability of cardiac system (Tachycardia, bradycardia, hypertension, hypotension)  Optic nerve- blindness  Glossyopharyngeal and Vagus nerve – inability to swallow and clear secretions (Bulbular muscle weakness)

Medical Management:  Patient will be in the ICU setting due to rapid progression  Elective intubation is recommended  Patient is weaned of ventilator when they are having spontaneous respirations and can maintain adequate O2  Prevent immobility complications  Plasmapheresis and IVIG Decrease the circulating antibodies, improves recovery time IVIG – fewer S/E  When treating autonomic dysfunction- make sure to use short term solutions

Nursing Diagnoses:

Does not affect cognitive or LOC Recovery may take up to 2 years some of the changes may be permanent Assessment:  Look for a recent viral illness, with a sudden changes including: -Symmetric weakness -Diminished reflexes -Upward progression of weakness  The progression of the disease is sudden  Watch for progression and complication  Complications: DVT, PE, respiratory failure, cardiac dysrhythmias, autonomic dysfunction

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Ineffective breathing pattern and impaired gas exchange R/T rapidly progressing weakness and impending respiratory failure Impaired physical mobility related to paralysis Imbalanced nutrition, less than body requirements, R/T inability to swallow Impaired verbal communication R/T cranial nerve dysfunction Fear and anxiety R/T loss of control and paralysis

Goals and Interventions: Improve respiratory function  Monitor for changes in vital capacity and negative inspiratory forces- If they fall, patient will need a ventilator  Discuss ventilator on admission – decrease anxiety  Inability to swallow and clear secretions may also cause respiratory failure- frequent suctioning needed  Autonomic dysfunction is assessed and treated as needed Increase mobility  Must enhance mobility and prevent complications of immobility Improve nutritional status  Gastrostomy tubes may be placed if the patient cannot swallow  Patient may develop a paralytic ileus – due to lack of parasympathetic activity ……parenteral nutrition may become necessary  Monitor for bowel sounds and gag reflex Effective communication  The patient will not be able to talk, laugh, or cry due to paralysis  Establish a system of communication (Blinking eyes, cards) Decrease fear and anxiety  Sudden, life threatening disease  Allow the family to participate in daily care  Patient may fell isolation, loneliness, and fear Absence of complications  Assess respiratory function frequently because changes may be sudden  Respiratory rate, quality, vital capacity  S/S of impending respiratory failure: breathless while speaking, shallow an irregular breathing, use of accessory muscles, tachycardia, weak cough, changes in respiratory pattern  Autonomic dysreflexia  Treat changes with short acting solutions Teaching: most patients make a complete recovery...