GuillainBarre Syndrome 1 Concept Map Selected Topics in

Guillain-Barre’ Syndrome 1

Concept Map: Selected Topics in Neurological Nursing ASSESSMENT Physical Assessment Inspection Palpation Percussion Auscultation ICP Monitoring “Neuro Checks” Lab Monitoring PATHOPHYSIOLOGY PHARMACOLOGY Traumatic Brain Injury Spinal Cord Injury Specific Disease Entities: Amyotropic Lateral Sclerosis Multiple Sclerosis Huntington’s Disease Alzheimer’s Disease Huntington’s Disease Myasthenia Gravis Guillian-Barre’ Syndrome Meningitis Parkinson’s Disease Care Planning Plan for client adl’s, Monitoring, med admin. , Patient education, more…based On Nursing Process: A_D_P_I_E --Decrease ICP --Disease / Condition Specific Meds 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! 3

Guillain-Barre’ Syndrome § Autoimmune Disorder § Inflammatory Version also § Guillain-Barre syndrome is a rare disorder § Not hereditary § Cause unknown 4

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 5

Motor & Sensory Neurons 6

Triggers? Recent History of: • • Viral illness Vaccination Surgery Acute Illness 7

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) paralysis § Severe Bradycardia (pacemaker sometimes) 8

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 9

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 become weak or paralyzed may § 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 10

Treatment § Plasmapheresis to decrease circulating antibodies § EKG monitoring for Autonomic Dysfunction § Immunoglobulin therapy § Hormonal therapy § Physical therapy (to increase muscle flexibility and strength) 11

Nursing Care § Maintain Patent Airway § HOB elevated § C&DB Q 2 H / spirometry / chest physiotherapy § Monitor Vitals vigilently § Pain management 12

Collaborative Goals § Reducing and/or managing symptoms § Preventing complications § Provide adaptive devices to increase mobility and self-care 13

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 14