Surigao Education Center

Km.2, Surigao City

Of
1
PRESENTORS:
ALBERCA, Michelle J.
BAROTAC, Razil L.
COMPRA, Anne rose J.
EUSALA, eene E.
L!O"#, ris Madeline E.
LLAMERA, Joac$i%% A.
M!"AR&O, Shen' #.
PAC(A"O. Ana Mae O.
PARE&ES, Riza Mae M.
S!"CO, Mar$ e)in #.
Table of Contents
!. &edication i
2
!!. Ac$no*ledge%ent ii
!!!. !ntroduction +
!,. Re)ie* o- Related Literature .
,. Anato%' and Ph'siolog' +/
,!. Patient0s (ealth (istor' .1
A. Biogra2hic &ata .3
B. (istor' o- Present !llness .4
C. Past (ealth (istor' .5
a. Childhood !llness .5
6. !%%unization .5
c. (istor' o- (os2italization .5
d. Surgical (istor' .5
e. Accidents and !n7uries .5
-. Allergic and T'2e o- Reaction .5
g. 8a%il' (ealth (istor' .5
h. Personal (ealth (istor' .9
+. Li-est'le .9
+.+ Personal ha6its .9
+.. &iet .9
+./ Slee2 and rest:2attern .;
+.1 Eli%ination Pattern .;
+.3 Acti)ities o- &ail' Li)ing <A&L= .;
+.4 Recreation and (o66ies />
i. Social &ata />
+. Occu2ational &ata />
7. En)iron%ental &ata />
$. Ps'chological &ata />
l. Patterns o- (ealth Care />
,!!. Re)ie* o- S'ste% /+
a. !ntegu%entar' S'ste% /+
6. (ead, E'es, Ears, "ose, Throat< (EE"T= /+
c. "ec$ /+
d. Breast and A?illae /+
e. Thora? and Lungs /+
-. Cardio)ascular S'ste% /+
g. #astrointestinal S'ste% /+
h. Musculos$eletal S'ste% /+
i. "eurologic S'ste% /.
7. Urinar' S'ste% /.
$. Re2roducti)e S'ste% /.
l. (e%atologic /.
%. Endocrine /.
3
n. Ps'chiatric /.

,!!!. Ph'sical Assess%ents //
a. #eneral Sur)e' //
6. ,ital signs //
c. !ntegu%entar' S'ste% //
d. (air //
e. "ails //
-. (ead /1
g. E'es and )ision /1
h. Ears and hearing /1
i. "ose and sinusitis /1
7. Oro2har'n? <%outh and throat= /1
$. "ec$ /3
l. Thora? and lungs /3
%. Breast and A?illae /3
n. A6do%en /3
o. Musculos$eletal s'ste% /3
2. Cardio)ascular s'ste% /4
@. Urinar' s'ste% /4
r. #astrointestinal s'ste% /4
s. "eurologic s'ste% /4
a. Cranial ner)es !: A!! /5
6. #lass Co%a Scale /;
c. Muscle Strength 1+
!A. &octor0s Order <detailed= 1.
A. La6orator' &ata 11
t. Urinal'sis 11
u. (e%atolog' 11
A!. &rug Stud' 13
A!!. Patholog' and Ph'siolog' o- #BS 3>
A!!!. "ursing Care Plan <"CP= 3.
A!,. &ischarge Plan <detailed= 44
A,. A22endi? 49
a. !, Record 49
6. #enogra% 4;
A,!. &e-inition o- Ter%s 5>
A,!!. Re-erences 54
Introdution
4
Be ha)e ner)es that li)e outside the central ner)ous s'ste% <the 6rain and
s2inal cord=, and deal *ith our 6od'Cs senses and %o)e%ents. These are called our
2eri2heral ner)es.
#uillain:Barre s'ndro%e <also $no*n as acute in-la%%ator' or 2ost:in-ecti)e
2ol'radiculoneuro2ath'= is a rare 6ut serious disease o- the 2eri2heral ner)ous s'ste%.
!t %a$es the 6od's o*n i%%une s'ste% attac$ the ner)es, causing *ides2read
in-la%%ation that leads to a tingl', nu%6ing sensation in the ar%s and legs. This can
e)entuall' result in a short:ter% loss o- -eeling and %o)e%ent <te%2orar' 2aral'sis=.!t is
slightl' %ore co%%on in %en than *o%en, and can a--ect 2eo2le o- an' age, e)en
children. Bhat e?actl' causes the condition is unclear and there is no *a' to 2in2oint
*ho %a' 6e %ost at ris$. (o*e)er, in %ost cases o- #uillain:Barre s'ndro%e the
2erson had a )irus or 6acterial in-ection in the last -our *ee$s.
Most 2eo2le *ill %a$e a -ull reco)er' *ithin a -e* *ee$s or %onths, *ith no
-urther trou6le. So%e cases ta$e longer to reco)er -ro% and there is a 2ossi6ilit' o-
2er%anent ner)e da%age.
Patient R is a +4 'ears old %ale, single *ho resides at Es2eranza, Loreto,
&inagat !sland is an e%6odi%ent o- rare 2eo2le *ho ha)e #BS. (e *as ad%itted at
Caraga Regional (os2ital last Se2te%6er .3, .>>; *ith the chie- co%2laint o- sudden
onset o- *ea$ness o- le-t lo*er e?tre%ities then a-ter the right e?tre%ities -or al%ost /
*ee$s under the care o- &r. Asodisen.
Be chose 2atient R0s case -or our case stud' 6ecause *e thin$ it is interesting
though it0s rarel' seen .!t is a cul2rit condition that can cause te%2orar' 2aral'sis and
can a--ect our acti)ities o- dail' li)ing since in #BS *e can -eel *ea$ness and
nu%6ness in our 6od' that0s *h' 2atient couldn0t *al$ and ha)e li%ited range o- %otion.
!t0s not so de2ressing though there is a glint ho2e *ith the 2ro2er %edical attention, the
s'ndro%e %a' 6e re)ersed. Be are ho2ing that through this case stud' *e can i%2art
$no*ledge and 6etter understanding o- #BS to the co%%unit' -or the% to 6e a*are o-
the said s'ndro%e.
Re!ie" of Related #iterature
5
$%at is &uillain 'arre( Syndrome)
#uillain:Barre s'ndro%e is a serious disorder that occurs *hen the 6od'Cs
de-ense <i%%une= s'ste% %ista$enl' attac$s 2art o- the ner)ous s'ste%. This leads to
ner)e in-la%%ation that causes %uscle *ea$ness.
#uillain:BarrD s'ndro%e is an acute, usuall' ra2idl' 2rogressi)e in-la%%ator'
2ol'neuro2ath' characterized 6' %uscular *ea$ness and %ild distal sensor' loss.
Cause is thought to 6e autoi%%une.
#uillain:BarrD s'ndro%e is the %ost co%%on ac@uired in-la%%ator' neuro2ath'.
Although the cause is not -ull' understood, it is thought to 6e autoi%%une. There are
se)eral )ariants. !n so%e, de%'elination 2redo%inatesE others a--ect the a?on.
!n a6out
.
F
/
o- 2atients, the s'ndro%e 6egins 3 da's to / *$ a-ter a 6acterial
in-ectious disorder, surger', or )accination. !n-ection is the trigger in G 3>H o- 2atientsE
co%%on 2athogens include Ca%2'lo6acter 7e7uni, enteric )iruses, her2es )iruses
<including c'to%egalo)irus and E2stein:Barr )irus=, and M'co2las%a s2. A cluster o-
cases -ollo*ed the s*ine -lu )accination 2rogra% in +;53.
$%at are t%e auses)
#uillain:Barre s'ndro%e is an autoi%%une disorder <the 6od'Cs i%%une s'ste%
attac$s itsel-=. E?actl' *hat triggers #uillain:Barre s'ndro%e is un$no*n. The s'ndro%e
%a' occur at an' age, 6ut is %ost co%%on in 2eo2le o- 6oth se?es 6et*een ages />
and 3>.
!t o-ten -ollo*s a %inor in-ection, usuall' a lung in-ection or gastrointestinal
in-ection. Usuall', signs o- the original in-ection ha)e disa22eared 6e-ore the s'%2to%s
o- #uillain:Barre 6egin.
#uillain:Barre s'ndro%e causes in-la%%ation that da%ages 2arts o- ner)es. This
ner)e da%age causes tingling, %uscle *ea$ness, and 2aral'sis. The in-la%%ation
usuall' a--ects the ner)eCs co)ering <%'elin sheath=. Such da%age is called
de%'elination. &e%'elination slo*s ner)e signaling. &a%age to other 2arts o- the ner)e
can cause the ner)e to sto2 *or$ing.
#uillain:Barre s'ndro%e %a' occur along *ith )iral in-ections such asI
A!&S
6
(er2es si%2le?
Mononucleosis
!t %a' also occur *ith other %edical conditions such as s'ste%ic lu2us
er'the%atosus or (odg$inCs disease.So%e 2eo2le %a' get #uillain:Barre s'ndro%e
a-ter a 6acterial in-ection or certain )accinations <such as ra6ies and s*ine -lu=. A
si%ilar s'ndro%e %a' occur a-ter surger', or *hen criticall' ill.
$%at are t%e ris* fators)
#uillain:Barre s'ndro%e can a--ect all age grou2s, 6ut 'ouCre at greater ris$ i-I
JouCre a 'oung adult
JouCre an older adult
#uillain:Barre %a' 6e triggered 6'I
Most co%%onl', in-ection *ith ca%2'lo6acter, a t'2e o- 6acteria o-ten -ound in
undercoo$ed -ood, es2eciall' 2oultr'.
Surger'
E2stein:Barr )irus
(odg$inCs disease
Mononucleosis
(!,, the )irus that causes A!&S
Rarel', ra6ies or in-luenza i%%unizations
$%at are t%e sym+toms)
S'%2to%s o- #uillain:Barre can get *orse )er' @uic$l'. !t %a' ta$e onl' a -e*
hours to reach the %ost se)ere s'%2to%s, 6ut *ea$ness increasing o)er se)eral da's
is also co%%on.
Muscle *ea$ness or the loss o- %uscle -unction <2aral'sis= a--ects 6oth sides o-
the 6od'. !n %ost cases, the %uscle *ea$ness starts in the legs and then s2reads to the
ar%s. This is called ascending 2aral'sis.
Patients %a' notice tingling, -oot or hand 2ain, and clu%siness. !- the
in-la%%ation a--ects the ner)es to the dia2hrag%, and there is *ea$ness in those
%uscles, the 2erson %a' need 6reathing assistance.
T'2ical s'%2to%s includeI
Loss o- re-le?es in the ar%s and legs
7
Muscle *ea$ness or loss o- %uscle -unction <2aral'sis=
o !n %ild cases, there %a' 6e no *ea$ness or 2aral'sis
o Ma' 6egin in the ar%s and legs at the sa%e ti%e
o Ma' get *orse o)er .1 to 5. hours
o Ma' occur in the ner)es o- the head onl'
o Ma' start in the ar%s and %o)e do*n*ard
o Ma' start in the -eet and legs and %o)e u2 to the ar%s and head
"u%6ness, decreased sensation
Sensation changes
Tenderness or %uscle 2ain <%a' 6e a cra%2:li$e 2ain=
Uncoordinated %o)e%ent
Additional s'%2to%s %a' includeI
Blurred )ision
Clu%siness and -alling
&i--icult' %o)ing -ace %uscles
Muscle contractions
Pal2itations <sensation o- -eeling heart6eat=
E%ergenc' s'%2to%s <see$ i%%ediate %edical hel2=I
Breathing te%2oraril' sto2s
CanCt ta$e a dee2 6reath
&i--icult' 6reathing
&i--icult' s*allo*ing
&rooling
8ainting
8eeling light:headed *hen standing
8laccid *ea$ness 2redo%inates in %ost 2atientsE it is al*a's %ore 2ro%inent than
sensor' a6nor%alities and %a' 6e %ost 2ro%inent 2ro?i%all'. Relati)el' s'%%etric
*ea$ness *ith 2aresthesias usuall' 6egins in the legs and 2rogresses to the ar%s, 6ut
it occasionall' 6egins in the ar%s or head. !n ;>H o- 2atients, *ea$ness is %a?i%al at /
*$. &ee2 tendon re-le?es are lost. S2hincters are usuall' s2ared. 8acial and
oro2har'ngeal %uscles are *ea$ in G 3>H o- 2atients *ith se)ere disease. &eh'dration
and undernutrition %a' result. Res2irator' 2aral'sis se)ere enough to re@uire
endotracheal intu6ation and %echanical )entilation occurs in 3 to +>H.
A -e* 2atients <2ossi6l' *ith a )ariant -or%= ha)e signi-icant, li-e:threatening
autono%ic d's-unction causing BP -luctuations, ina22ro2riate A&( secretion, cardiac
arrh'th%ias, #! stasis, urinar' retention, and 2u2illar' changes. An unusual )ariant
<8isher )ariant= %a' cause onl' o2hthal%o2aresis, ata?ia, and are-le?ia.
8
,o" to o+e "it% &uillain 'arre Syndrome)
The e%otional i%2act o- #uillain:Barre s'ndro%e can 6e de)astating. !n se)ere
cases, #uillain:Barre s'ndro%e can trans-or% 'ou -ro% health' and inde2endent to
criticall' ill and 2h'sicall' hel2less K suddenl', and *ithout *arning.
Although %ost 2eo2le e)entuall' reco)er -ull', a diagnosis o- #uillain:Barre
s'ndro%e %eans con-ronting the 2ossi6ilit' o- long:ter% disa6ilit' or 2aral'sis. And
those *ho do de)elo2 these co%2lications %ust ad7ust to lasting, li%ited %o6ilit' and a
de2endence on others to hel2 %anage dail' acti)ities.
Tal$ing *ith a %ental health 2ro)ider can 2la' a criticall' i%2ortant role in hel2ing
'ou co2e *ith the %ental and e%otional strain o- this illness. !n so%e cases, 'our
thera2ist %a' reco%%end -a%il' counseling to hel2 'ou and 'our lo)ed ones ad7ust to
the changes caused 6' #uillain:Barre s'ndro%e.
Jou %a' also 6ene-it -ro% tal$ing *ith others *ho ha)e e?2erienced this illness.
As$ 'our doctor or %ental health 2ro)ider to reco%%end a su22ort grou2 -or 2eo2le and
-a%ilies co2ing *ith #uillain:Barre s'ndro%e.
$%en to Contat a -edial Professional)
See$ i%%ediate %edical hel2 i- 'ou ha)e an' o- the -ollo*ing s'%2to%sI
CanCt ta$e a dee2 6reath
&ecreased -eeling <sensation=
o &i--icult' 6reathing
o &i--icult' s*allo*ing
o 8ainting
o Loss o- %o)e%ent
Tingling that started in 'our -eet or toes and is no* ascending u2*ard through
'our 6od'
Tingling or *ea$ness thatCs s2reading ra2idl'
Tingling that in)ol)es 6oth 'our hands and -eet
&i--icult' catching 'our 6reath
Cho$ing on sali)a
#uillain:Barre s'ndro%e is a serious disease that re@uires i%%ediate hos2italization
6ecause o- the ra2id rate at *hich it *orsens. The sooner a22ro2riate treat%ent is
started, the 6etter the chance o- a good outco%e.
.lternati!e Names
Landr':#uillain:Barre s'ndro%eE #BSE Acute idio2athic 2ol'neuritisE !n-ectious
2ol'neuritisE Acute in-la%%ator' 2ol'neuro2ath'
9
$%at is t%e +re!ention)
Because so little is $no*n a6out *hat causes #BS to de)elo2, there are no $no*n
%ethods o- 2re)ention.
$%at is a /syndrome/)
A s'ndro%e is a %edical condition, characterized 6' a collection o- s'%2to%s
<that the 2atient -eels= and signs <that a doctor can o6ser)e or %easure=, rather than 6'
a s2eci-ic organis% that causes the disease.
"o one $no*s *hat causes #BS. S'%2to%s and signs can )ar' a great deal in
#BS 2atients, so%eti%es %a$ing it di--icult to diagnose, es2eciall' in the earl' stages.
0iagnosis
#uillain:Barre s'ndro%e can 6e di--icult to diagnose in its earliest stages. !ts
signs and s'%2to%s are si%ilar to those o- other neurological disorders and %a' )ar'
-ro% 2erson to 2erson.
The -irst ste2 in diagnosing #uillain:Barre s'ndro%e is -or 'our doctor to ta$e a
care-ul %edical histor' to -ull' understand the cluster o- signs and s'%2to%s 'ouCre
e?2eriencing.
A s2inal ta2 <lu%6ar 2uncture= and ner)e -unction tests are co%%onl' used to
hel2 con-ir% a diagnosis o- #uillain:Barre s'ndro%e.
S+inal ta+ 1lumbar +unture2
This 2rocedure in)ol)es *ithdra*ing a s%all a%ount o- -luid -ro% 'our s2inal
canal at 'our lo* 6ac$ <lu%6ar= le)el. This cere6ros2inal -luid is then tested -or a
s2eci-ic t'2e o- change that co%%onl' occurs in 2eo2le *ho ha)e #uillain:Barre
s'ndro%e.
Ner!e funtion tests
Jour doctor %a' *ant in-or%ation -ro% t*o t'2es o- ner)e -unction tests K
electro%'ogra2h' and ner)e conduction )elocit'I
Eletromyogra+%y reads electrical acti)it' in 'our %uscle to deter%ine i- 'our
*ea$ness is caused 6' %uscle da%age or ner)e da%age.
Ner!e ondution studies assess ho* 'our ner)es and %uscles res2ond to
s%all electrical sti%uli.
&iagnosis is 2ri%aril' clinical. Si%ilar acute *ea$ness can result -ro%
%'asthenia gra)is, 6otulis%, 2olio%'elitis <%ainl' outside the US=, tic$ 2aral'sis, Best
10
"ile )irus in-ection, and %eta6olic neuro2athies, 6ut these disorders can usuall' 6e
distinguished as -ollo*sI
M'asthenia gra)is is inter%ittent and *orsened 6' e?ertion.
Botulis% %a' cause -i?ed dilated 2u2ils <in 3>H= and 2ro%inent cranial ner)e
d's-unction *ith nor%al sensation.
Polio%'elitis usuall' occurs in e2ide%ics.
Tic$ 2aral'sis causes ascending 2aral'sis 6ut s2ares sensation.
Best "ile )irus causes headache, -e)er, and as'%%etric -laccid 2aral'sis 6ut
s2ares sensation.
Meta6olic neuro2athies occur *ith a chronic %eta6olic disorder.
Tests -or in-ectious disorders and i%%une d's-unction, including tests -or he2atitis and
(!, and seru% 2rotein electro2horesis, are done.
!- #uillain:BarrD s'ndro%e is sus2ected, 2atients should 6e ad%itted to a hos2ital
-or electrodiagnostic testing, CS8 anal'sis, and %onitoring 6' %easuring -orced )ital
ca2acit' e)er' 4 to 9 h. !nitial electrodiagnostic testing detects slo* ner)e conduction
)elocities and e)idence o- seg%ental de%'elination in .L/ o- 2atientsE ho*e)er, nor%al
results do not e?clude the diagnosis and should not dela' treat%ent.
CS8 anal'sis %a' detect al6u%inoc'tologic dissociation <increased 2rotein 6ut
nor%al BBC count=, 6ut it %a' not a22ear -or u2 to + *$ and does not de)elo2 in +>H
o- 2atients.
Prognosis
Although so%e 2eo2le can ta$e %onths and e)en 'ears to reco)er, %ost cases o-
#uillain:Barre s'ndro%e -ollo* this general ti%elineI
8ollo*ing the -irst s'%2to%s, the condition tends to 2rogressi)el' *orsen -or
a6out t*o *ee$s.
S'%2to%s reach a 2lateau and re%ain stead' -or t*o to -our *ee$s.
Reco)er' 6egins, usuall' lasting si? to +. %onths.
This s'ndro%e is -atal in M .H. Most 2atients i%2ro)e considera6l' o)er a 2eriod o-
%onths, 6ut a6out />H o- adults and e)en %ore children ha)e so%e residual *ea$ness
at / 'r. Patients *ith residual de-ects %a' re@uire retraining, ortho2edic a22liances, or
surger'.
11
A-ter initial i%2ro)e%ent, / to +>H o- 2atients de)elo2 chronic in-la%%ator'
de%'elinating 2ol'neuro2ath' <C!&PKsee 6elo*=.
Reco)er' can ta$e *ee$s or 'ears. Most 2eo2le sur)i)e and reco)er co%2letel'.
According to the "ational !nstitute o- "eurological &isorders and Stro$e, a6out />H o-
2atients still ha)e so%e *ea$ness a-ter / 'ears. Mild *ea$ness %a' 2ersist -or so%e
2eo2le.
A 2atientCs outco%e is %ost li$el' to 6e )er' good *hen the s'%2to%s go a*a'
*ithin / *ee$s a-ter the' -irst started.
Co%2lications o- #uillan:Barre s'ndro%e can includeI
'reat%ing diffiulties. A 2otentiall' deadl' co%2lication o- #uillain:Barre
s'ndro%e is that the *ea$ness or 2aral'sis can s2read to the %uscles that
control 'our 6reathing. Jou %a' need te%2orar' hel2 -ro% a %achine to 6reathe
*hen 'ouCre hos2italized -or treat%ent.
Residual numbness or ot%er sensations. Most 2eo2le *ith #uillain:Barre
s'ndro%e reco)er co%2letel' or ha)e onl' %inor, residual *ea$ness or a6nor%al
sensations, such as nu%6ness or tingling. (o*e)er, -ull reco)er' %a' 6e slo*,
o-ten ta$ing a 'ear or longer.
Breathing di--icult' <res2irator' -ailure=
Contractures o- 7oints or other de-or%it'
&ee2 )ein thro%6osis <6lood clots that -or% *hen so%eone is inacti)e or
con-ined to 6ed=
!ncreased ris$ o- in-ections
Lo* or unsta6le 6lood 2ressure
Per%anent loss o- %o)e%ent o- an area
Pneu%onia
Suc$ing -ood or -luids into the lungs <as2iration=
12
Treatment
ThereCs no cure -or #uillain:Barre s'ndro%e. But t*o t'2es o- treat%ents s2eed
reco)er' and reduce the se)erit' o- #uillain:Barre s'ndro%eI Bhen s'%2to%s are
se)ere, the 2atient *ill need to go to the hos2ital -or 6reathing hel2, treat%ent, and
2h'sical thera2'.
Plasma+%eresis. A %ethod called 2las%a2heresis is used to re%o)e 2roteins,
called anti6odies, -ro% the 6lood. The 2rocess in)ol)es ta$ing 6lood -ro% the 6od',
usuall' -ro% the ar%, 2u%2ing it into a %achine that re%o)es the anti6odies, then
sending it 6ac$ into the 6od'.
This treat%ent K also $no*n as 2las%a e?change K is a t'2e o- N6lood
cleansingN in *hich da%aging anti6odies are re%o)ed -ro% 'our 6lood. Plas%a2heresis
consists o- re%o)ing the li@uid 2ortion o- 'our 6lood <2las%a= and se2arating it -ro% the
actual 6lood cells. The 6lood cells are then 2ut 6ac$ into 'our 6od', *hich %anu-actures
%ore 2las%a to %a$e u2 -or *hat *as re%o)ed. !tCs not clear *h' this treat%ent *or$s,
6ut scientists 6elie)e that 2las%a2heresis rids 2las%a o- certain anti6odies that
contri6ute to the i%%une s'ste% attac$ on the 2eri2heral ner)es. Plas%a2heresis <see
Trans-usion MedicineI Plas%a2heresis= hel2s *hen done earl' in the s'ndro%eE it is
used i- O:glo6ulin is ine--ecti)e. Plas%a2heresis is relati)el' sa-e, shortens the disease
course and hos2ital sta', and reduces %ortalit' ris$ and incidence o- 2er%anent
2aral'sis. Plas%a2heresis re%o)es an' 2re)iousl' ad%inistered O:glo6ulin, negating its
6ene-its.
Intra!enous immunoglobulin. !%%unoglo6ulin contains health' anti6odies -ro%
6lood donors. (igh doses o- i%%unoglo6ulin can 6loc$ the da%aging anti6odies that
%a' contri6ute to #uillain:Barre s'ndro%e.
(igh:dose i%%unoglo6ulin thera2' <!,!g= is another treat%ent used to reduce the
se)erit' and length o- #uillain:Barre s'%2to%s. !n this case, the i%%unoglo6ulins are
added to the 6lood in large @uantit', 6loc$ing the anti6odies that cause in-la%%ation.
Other treat%ents are directed at 2re)enting co%2lications.
Blood thinners %a' 6e used to 2re)ent 6lood clots.
!- the dia2hrag% is *ee$, 6reathing su22ort or e)en a 6reathing tu6e and
)entilator %a' 6e needed.
Pain is treated aggressi)el' *ith anti:in-la%%ator' %edicines and narcotics, i-
needed.
Pro2er 6od' 2ositioning or a -eeding tu6e %a' 6e used to 2re)ent cho$ing during
-eeding i- the %uscles -or s*allo*ing are *ea$.
!ntensi)e su22orti)e care
13
Plas%a2heresis or !, i%%une glo6ulin
.
Each o- these treat%ents is e@uall' e--ecti)e. Mi?ing the treat%ents or
ad%inistering one a-ter the other is no %ore e--ecti)e than using either %ethod alone.
O-ten 6e-ore reco)er' 6egins, caregi)ers %a' need to %anuall' %o)e 'our ar%s
and legs to hel2 $ee2 'our %uscles -le?i6le and strong. A-ter reco)er' has 6egun, 'ouCll
li$el' need 2h'sical thera2' to hel2 regain strength and 2ro2er %o)e%ent so that 'ouCll
6e a6le to -unction on 'our o*n. Jou %a' need training *ith ada2ti)e de)ices, such as a
*heelchair or 6races, to gi)e 'ou %o6ilit' and sel-:care s$ills.
#ifestyle -easures
,o" to #i!e "it% &uillain 'arre Syndrome)
!nstructions
Ste2 +
8ind a good 2h'sical thera2' 2rogra% -ro% *hich 'ou can learn s2eci-ic
iso%etric, isotonic and resistance e?ercises to re6uild *ea$ened %uscles. Jou
%a' do these e?ercises on an out2atient 6asis and continue the% at ho%e.
Re%e%6er to 2ace 'oursel- and get ade@uate rest, as -atigue is to 6e e?2ected
*ith #uillain:Barre S'ndro%e.
Ste2 .
E?2lore occu2ational thera2' o2tions. Changes in 'our ho%e en)iron%ent can
aid in 'our reco)er' 6' %a$ing it easier -or 'ou to 6athe, dress and 2re2are
%eals *hile 'our %uscles return to nor%al le)els o- strength.
Ste2 /
Manage residual 2ain in the 6ac$, legs and -eet *ith %edication as needed.
#a6a2entin and car6a%aze2ine are o-ten 2rescri6ed to relie)e #uillain:Barre
S'ndro%e related 2ain. Both o- these %edications are anticon)ulsants and %a'
cause -atigue and dizziness in so%e 2eo2le.
14
Ste2 1
Bear co%-orta6le shoes and soc$s to hel2 soothe 2ain and 6urning -ro%
neuro2ath' in the -eet. !ns2ect 'our -eet o-ten to 6e sure there are no cuts or
6listers that 'ou %a' not ha)e noticed.
Ste2 3
8ollo* a health' eating 2lan *ith -resh, seasonal -ruits and )egeta6les , lean
%eat and -ish, *hole grains and 2lent' o- color-ul salads. Eating *ell %a' hel2
'ou to sustain 'our energ' and can 6oost 'our %ood.
Ste2 4
See$ e%otional su22ort to co2e *ith -eelings o- de2ression and an?iet' that are
2art o- li)ing *ith #uillain:Barre S'ndro%e. &iscuss antide2ressant %edication
*ith 'our doctor i- 'ou are ha)ing trou6le *ith acti)ities necessar' -or dail' li)ing.
Ste2 5
Connect *ith others *ho are learning to li)e *ith #uillain:Barre S'ndro%e in
-oru%s online. See the Resources section 6elo* -or lin$s.
,o" to Reogni3e t%e Sym+toms of &uillain4'arre Syndrome)
!nstructions
Ste2 +
Batch -or earl' s'%2to%s li$e tingling or ru66er' sensations in 'our -eet and
legs. !n %an' cases, #uillain:Barre S'ndro%e co%es on ra2idl', 6eginning in the
lo*er 2art o- the 6od' and cli%6ing to the ar%s and u22er torso *ithin hours.
Tingling around the %outh is co%%on as the s'%2to%s ascend.
Ste2 .
"ote an' di--icult' *ith -acial %uscles or %o)e%ent, such as trou6le %o)ing 'our
e'es, slo* s2eech and 2ro6le%s che*ing or s*allo*ing.
15
Ste2 /
Assess 6oth sides o- 'our 6od'. #uillain:Barre S'ndro%e a--ects 6oth sides,
unli$e a stro$e. Stro$es generall' 2aral'ze onl' one side.
Ste2 1
Test 'our re-le?es. #uillain:Barre S'ndro%e di%inishes the re-le? res2onse in the
legs -irst. So%e 2eo2le also lose -eeling in their e?tre%ities.
Ste2 3
Chec$ 'our heart rate and 6lood 2ressure . Both %a' dro2 *ith #uillain:Barre
S'ndro%e.
Ste2 4
E)aluate and re2ort an' changes in 6ladder or 6o*el -unction. #uillain:Barre
S'ndro%e i%2acts the %uscles that control 6ladder and intestinal -unction.
Ste2 5
Monitor 'our 6reathing, and get hel2 at once i- 6reathing see%s shallo*. #uillain:
Barre S'ndro%e can *orsen )er' ra2idl' and s2read to the %uscles that control
'our 6reathing. Man' 2eo2le *ith the s'ndro%e are te%2oraril' 2laced on
)entilators in order to 6reathe.
Ste2 9
Re)ie* 'our recent %edical histor'. Although scientists ha)en0t disco)ered a
single cause -or #uillaine:Barre S'ndro%e, %an' cases are lin$ed *ith recent
6acterial or )iral in-ections , )accinations or surgeries. !n-ection *ith
ca%2'lo6acter, a 6acteria -ound in undercoo$ed -ood, es2eciall' 2oultr', %a'
trigger #uillaine:Barre S'ndro%e.
Ste2 ;
Pa' attention to unusual or se)ere lo*er 6ac$ 2ain, *hich can signal #uillain:
Barre S'ndro%e.
16
.N.TO-5 .N0 P,5SIO#O&5
T,E NER6O7S S5STE-
Ty+ial Struture of a Ner!e
Cell
The ner)ous s'ste% is di)ided into theI
+eri+%eral ner!ous system <PNS=
entral ner!ous system <CNS=
17
A ner)e cell <neuron= consists o- a large cell 6od'
and ner)e -i6ersKone elongated e?tension <a?on=
-or sending i%2ulses and usuall' %an' 6ranches
<dendrites= -or recei)ing i%2ulses. Each large a?on
is surrounded 6' oligodendroc'tes in the 6rain and
s2inal cord and 6' Sch*ann cells in the 2eri2heral
ner)ous s'ste%. The %e%6ranes o- these cells
consist o- a -at <li2o2rotein= called %'elin. The
%e%6ranes are *ra22ed tightl' around the a?on,
-or%ing a %ultila'ered sheath. This %'elin sheath
rese%6les insulation, such as that around an
electrical *ire. "er)e i%2ulses tra)el %uch -aster in
ner)es *ith a %'elin sheath than in those *ithout
one. !- the %'elin sheath o- a ner)e is da%aged,
ner)e trans%ission slo*s or sto2s
The PNS consists o-
sensor' neurons running -ro% sti%ulus rece2tors that in-or% the C"S o- the
sti%uli
%otor neurons running -ro% the C"S to the %uscles and glands : called
e--ectors : that ta$e action.
The CNS consists o- the
s2inal cord and the
6rain
T,E PERIP,ER.# NER6O7S S5STE- IN 8OC7S
!n the 2eri2heral ner)ous s'ste%, neurons can 6e -unctionall' di)ided in three *a'sI
+. Sensory 1afferent2 : carr' in-or%ation !"TO the central ner)ous s'ste%
-ro% sense organs or motor 1efferent2 : carr' in-or%ation a*a' -ro% the
central ner)ous s'ste% <-or %uscle control=.
.. Cranial : connects the 6rain *ith the 2eri2her' or s+inal : connects the
s2inal cord *ith the 2eri2her'.
/. Somati : connects the s$in or %uscle *ith the central ner)ous s'ste% or
!iseral : connects the internal organs *ith the central ner)ous s'ste%
The +eri+%eral ner!ous system is su6di)ided into the
sensor':so%atic ner)ous s'ste% and the
18
autono%ic ner)ous s'ste%
T%e Sensory4Somati Ner!ous System
The sensor':so%atic s'ste% consists o-I
+. 2airs o- cranial ner)es and
/+ 2airs o- s2inal ner)es.
T%e Cranial Ner!es
Ner!es Ty+e 8untion
I
Ol-actor'
sensor' ol-action <s%ell=
II
O2tic
sensor'
)ision
<Contain /9H o- all the a?ons connecting to the 6rain.=
III
Oculo%otor
%otorP e'elid and e'e6all %uscles
I6
Trochlear
%otorP
e'e6all %uscles
6
Trige%inal
%i?ed
Sensor'I -acial and %outh sensation
MotorI che*ing
6I
A6ducens
%otorP e'e6all %o)e%ent
6II
8acial
%i?ed
Sensor'I taste
MotorI -acial %uscles and
sali)ar' glands
6III
Auditor'
sensor' hearing and 6alance
I9
#losso2har'ngeal
%i?ed
Sensor'I taste
MotorI s*allo*ing
9
,agus
%i?ed
%ain ner)e o- the
2aras'%2athetic ner)ous s'ste% <P"S=
9I
Accessor'
%otor s*allo*ingE %o)ing head and shoulder
9II
('2oglossal
%otorP tongue %uscles
P"oteI These do contain a -e* sensor' neurons that 6ring 6ac$ signals -ro% the %uscle
s2indles in the %uscles the' control.
19
T%e S+inal Ner!es
All o- the s2inal ner)es are N%i?edNE that is, the' contain 6oth sensor' and
%otor neurons.
All our conscious a*areness o- the e?ternal en)iron%ent and all our %otor
acti)it' to co2e *ith it o2erate through the sensor':so%atic di)ision o- the P"S.
T%e .utonomi Ner!ous System
The autono%ic ner)ous s'ste% consists o- sensor' neurons and %otor neurons that
run 6et*een the central ner)ous s'ste% <es2eciall' the h'2othala%us and %edulla
o6longata= and )arious internal organs such as theI
heart
lungs
)iscera
glands <6oth e?ocrine and endocrine=
!t is res2onsi6le -or %onitoring conditions in the internal en)iron%ent and 6ringing
a6out a22ro2riate changes in the%. The contraction o- 6oth s%ooth %uscle and cardiac
%uscle is controlled 6' %otor neurons o- the autono%ic s'ste%.
The actions o- the autono%ic ner)ous s'ste% are largel' in)oluntar' <in contrast to
those o- the sensor':so%atic s'ste%=. !t also di--ers -ro% the sensor':so%atic s'ste% is
using t*o grou2s o- %otor neurons to sti%ulate the e--ectors instead o- one.
The -irst, the 2reganglionic neurons, arise in the C"S and run to a ganglion in the
6od'. (ere the' s'na2se *ith
2ostganglionic neurons, *hich run to the e--ector organ <cardiac %uscle, s%ooth
%uscle, or a gland=.
The autono%ic ner)ous s'ste% has t*o su6di)isions, the
s'%2athetic ner)ous s'ste% and the
2aras'%2athetic ner)ous s'ste%.
T%e Sym+at%eti Ner!ous System
The 2reganglionic %otor neurons o- the s'%2athetic s'ste% arise in the
s2inal cord. The' 2ass into s'%2athetic ganglia *hich are organized into t*o chains
that run 2arallel to and on either side o- the s2inal cord.
The 2reganglionic neuron %a' do one o- three things in the s'%2athetic
ganglionI
20
s'na2se *ith 2ostganglionic neurons *hich then reenter the s2inal ner)e
and ulti%atel' 2ass out to the s*eat glands and the *alls o- 6lood )essels
near the sur-ace o- the 6od'.
2ass u2 or do*n the s'%2athetic chain and -inall' s'na2se *ith
2ostganglionic neurons in a higher or lo*er ganglion
lea)e the ganglion 6' *a' o- a cord leading to s2ecial ganglia <e.g. the solar
2le?us= in the )iscera. (ere it %a' s'na2se *ith 2ostganglionic s'%2athetic
neurons running to the s%ooth %uscular *alls o- the )iscera. (o*e)er, so%e
o- these 2reganglionic neurons 2ass right on through this second ganglion
and into the adrenal %edulla. (ere the' s'na2se *ith the highl':%odi-ied
2ostganglionic cells that %a$e u2 the secretor' 2ortion o- the adrenal
%edulla.
The neurotrans%itter o- the 2reganglionic s'%2athetic neurons is
acet'lcholine <ACh=. !t sti%ulates action 2otentials in the 2ostganglionic neurons.
The neurotrans%itter released 6' the 2ostganglionic neurons is
noradrenaline <also called nore2ine2hrine=.
The action o- noradrenaline on a 2articular gland or %uscle is e?citator' is
so%e cases, inhi6itor' in others. <At e?citator' ter%inals, ATP %a' 6e released
along *ith noradrenaline.=
The release o- noradrenaline
sti%ulates heart6eat
raises 6lood 2ressure
dilates the 2u2ils
dilates the trachea and 6ronchi
sti%ulates the con)ersion o- li)er gl'cogen into glucose
shunts 6lood a*a' -ro% the s$in and )iscera to the s$eletal %uscles,
6rain, and heart
inhi6its 2eristalsis in the gastrointestinal <#!= tract
inhi6its contraction o- the 6ladder and rectu%
and, at least in rats and %ice, increases the nu%6er o- AMPA
rece2tors in the hi22oca%2us and thus increases long:ter%
2otentiation <LTP=.
!n short, sti%ulation o- the s'%2athetic 6ranch o- the autono%ic ner)ous
s'ste% 2re2ares the 6od' -or e%ergenciesI -or N-ight or -lightN <and, 2erha2s,
enhances the %e%or' o- the e)ent that triggered the res2onse=.
Acti)ation o- the s'%2athetic s'ste% is @uite general 6ecause
21
a single 2reganglionic neuron usuall' s'na2ses *ith %an'
2ostganglionic neuronsE
The release o- adrenaline -ro% the adrenal %edulla into the 6lood
ensures that all the cells o- the 6od' *ill 6e e?2osed to s'%2athetic
sti%ulation e)en i- no 2ostganglionic neurons reach the% directl'.
T%e Parasym+at%eti Ner!ous System
The %ain ner)es o- the 2aras'%2athetic s'ste% are the tenth cranial ner)es, the
)agus ner)es. The' originate in the %edulla o6longata. Other 2reganglionic
2aras'%2athetic neurons also e?tend -ro% the 6rain as *ell as -ro% the lo*er ti2 o- the
s2inal cord.
Each 2reganglionic 2aras'%2athetic neuron s'na2ses *ith 7ust a -e*
2ostganglionic neurons, *hich are located near : or in : the e--ector organ, a %uscle or
gland. Acet'lcholine <ACh= is the neurotrans%itter at all the 2re: and %an' o- the
2ostganglionic neurons o- the 2aras'%2athetic s'ste%. (o*e)er, so%e o- the
2ostganglionic neurons release nitric o?ide <"O= as their neurotrans%itter.
Paras'%2athetic sti%ulation causes
slo*ing do*n o- the heart6eat
lo*ering o- 6lood 2ressure
constriction o- the 2u2ils
increased 6lood -lo* to the s$in and )iscera
2eristalsis o- the #! tract
!n short, the 2aras'%2athetic s'ste% returns the 6od' -unctions to nor%al a-ter
the' ha)e 6een altered 6' s'%2athetic sti%ulation. !n ti%es o- danger, the s'%2athetic
s'ste% 2re2ares the 6od' -or )iolent acti)it'. The 2aras'%2athetic s'ste% re)erses
these changes *hen the danger is o)er.
The )agus ner)es also hel2 $ee2 in-la%%ation under control. !n-la%%ation
sti%ulates near6' sensor' neurons o- the )agus. Bhen these ner)e i%2ulses reach the
%edulla o6longata, the' are rela'ed 6ac$ along %otor -i6ers to the in-la%ed area. The
acet'lcholine -ro% the %otor neurons su22resses the release o- in-la%%ator' c'to$ines,
e.g., tu%or necrosis -actor <T"8=, -ro% %acro2hages in the in-la%ed tissue.
Although the autono%ic ner)ous s'ste% is considered to 6e in)oluntar', this is
not entirel' true. A certain a%ount o- conscious control can 6e e?erted o)er it as has
long 6een de%onstrated 6' 2ractitioners o- Joga and Qen Buddhis%. &uring their
2eriods o- %editation, these 2eo2le are clearl' a6le to alter a nu%6er o- autono%ic
-unctions including heart rate and the rate o- o?'gen consu%2tion. These changes are
22
not si%2l' a re-lection o- decreased 2h'sical acti)it' 6ecause the' e?ceed the a%ount
o- change occurring during slee2 or h'2nosis.
I--7NE S5STE-
The i%%une s'ste% is co%2osed o- %an' interde2endent cell t'2es that
collecti)el' 2rotect the 6od' -ro% 6acterial, 2arasitic, -ungal, )iral in-ections and -ro% the
gro*th o- tu%or cells. Man' o- these cell t'2es ha)e s2ecialized -unctions. The cells o-
the i%%une s'ste% can engul- 6acteria, $ill 2arasites or tu%or cells, or $ill )iral:in-ected
cells. O-ten, these cells de2end on the T hel2er su6set -or acti)ation signals in the -or%
o- secretions -or%all' $no*n as c'to$ines, l'%2ho$ines, or %ore s2eci-icall'
interleu$ins.
T%e Organs of t%e Immune System
'one -arro" :: All the cells o- the i%%une s'ste% are initiall' deri)ed -ro% the 6one
%arro*. The' -or% through a 2rocess called he%ato2oiesis. &uring he%ato2oiesis,
6one %arro*:deri)ed ste% cells di--erentiate into either %ature cells o- the i%%une
s'ste% or into 2recursors o- cells that %igrate out o- the 6one %arro* to continue their
%aturation else*here. The 6one %arro* 2roduces B cells, natural $iller cells,
granuloc'tes and i%%ature th'%oc'tes, in addition to red 6lood cells and 2latelets.
T%ymus 44 The -unction o- the th'%us is to 2roduce %ature T cells. !%%ature
th'%oc'tes, also $no*n as 2roth'%oc'tes, lea)e the 6one %arro* and %igrate into the
th'%us. Through a re%ar$a6le %aturation 2rocess so%eti%es re-erred to as th'%ic
education, T cells that are 6ene-icial to the i%%une s'ste% are s2ared, *hile those T
cells that %ight e)o$e a detri%ental autoi%%une res2onse are eli%inated. The %ature T
cells are then released into the 6loodstrea%.
S+leen :: The s2leen is an i%%unologic -ilter o- the 6lood. !t is %ade u2 o- B cells, T
cells, %acro2hages, dendritic cells, natural $iller cells and red 6lood cells. !n addition to
ca2turing -oreign %aterials <antigens= -ro% the 6lood that 2asses through the s2leen,
%igrator' %acro2hages and dendritic cells 6ring antigens to the s2leen )ia the
6loodstrea%. An i%%une res2onse is initiated *hen the %acro2hage or dendritic cells
2resent the antigen to the a22ro2riate B or T cells. This organ can 6e thought o- as an
i%%unological con-erence center. !n the s2leen, B cells 6eco%e acti)ated and 2roduce
large a%ounts o- anti6od'. Also, old red 6lood cells are destro'ed in the s2leen.
#ym+% Nodes :: The l'%2h nodes -unction as an i%%unologic -ilter -or the 6odil' -luid
$no*n as l'%2h. L'%2h nodes are -ound throughout the 6od'. Co%2osed %ostl' o- T
cells, B cells, dendritic cells and %acro2hages, the nodes drain -luid -ro% %ost o- our
tissues. Antigens are -iltered out o- the l'%2h in the l'%2h node 6e-ore returning the
l'%2h to the circulation. !n a si%ilar -ashion as the s2leen, the %acro2hages and
23
dendritic cells that ca2ture antigens 2resent these -oreign %aterials to T and B cells,
conse@uentl' initiating an i%%une res2onse.

T%e Cells of t%e Immune System
T4Cells :: T l'%2hoc'tes are usuall' di)ided into t*o %a7or su6sets that are -unctionall'
and 2henot'2icall' <identi-ia6l'= di--erent. The T hel2er su6set, also called the C&1R T
cell, is a 2ertinent coordinator o- i%%une regulation. The %ain -unction o- the T hel2er
cell is to aug%ent or 2otentiate i%%une res2onses 6' the secretion o- s2ecialized
-actors that acti)ate other *hite 6lood cells to -ight o-- in-ection.
Another i%2ortant t'2e o- T cell is called the T $illerLsu22ressor su6set or C&9R T cell.
These cells are i%2ortant in directl' $illing certain tu%or cells, )iral:in-ected cells and
so%eti%es 2arasites. The C&9R T cells are also i%2ortant in do*n:regulation o-
i%%une res2onses. Both t'2es o- T cells can 6e -ound throughout the 6od'. The' o-ten
de2end on the secondar' l'%2hoid organs <the l'%2h nodes and s2leen= as sites
*here acti)ation occurs, 6ut the' are also -ound in other tissues o- the 6od', %ost
cons2icuousl' the li)er, lung, 6lood, and intestinal and re2roducti)e tracts.
Natural Killer Cells 4: "atural $iller cells, o-ten re-erred to as " cells, are si%ilar to the
$iller T cell su6set <C&9R T cells=. The' -unction as e--ector cells that directl' $ill certain
tu%ors such as %elano%as, l'%2ho%as and )iral:in-ected cells, %ost nota6l' her2es
and c'to%egalo)irus:in-ected cells. " cells, unli$e the C&9R <$iller= T cells, $ill their
24
targets *ithout a 2rior Ncon-erenceN in the l'%2hoid organs. (o*e)er, " cells that ha)e
6een acti)ated 6' secretions -ro% C&1R T cells *ill $ill their tu%or or )iral:in-ected
targets %ore e--ecti)el'.
' Cells 44 The %a7or -unction o- B l'%2hoc'tes is the 2roduction o- anti6odies in
res2onse to -oreign 2roteins o- 6acteria, )iruses, and tu%or cells. Anti6odies are
s2ecialized 2roteins that s2eci-icall' recognize and 6ind to one 2articular 2rotein that
s2eci-icall' recognize and 6ind to one 2articular 2rotein. Anti6od' 2roduction and
6inding to a -oreign su6stance or antigen, o-ten is critical as a %eans o- signaling other
cells to engul-, $ill or re%o)e that su6stance -ro% the 6od'.
&ranuloytes or Polymor+%onulear 1P-N2 #eu*oytes :: Another grou2 o- *hite
6lood cells is collecti)el' re-erred to as granuloc'tes or 2ol'%or2honuclear leu$oc'tes
<PM"s=. #ranuloc'tes are co%2osed o- three cell t'2es identi-ied as neutro2hils,
eosino2hils and 6aso2hils, 6ased on their staining characteristics *ith certain d'es.
These cells are 2redo%inantl' i%2ortant in the re%o)al o- 6acteria and 2arasites -ro%
the 6od'. The' engul- these -oreign 6odies and degrade the% using their 2o*er-ul
enz'%es.
-aro+%ages 4: Macro2hages are i%2ortant in the regulation o- i%%une res2onses.
The' are o-ten re-erred to as sca)engers or antigen:2resenting cells <APC= 6ecause
the' 2ic$ u2 and ingest -oreign %aterials and 2resent these antigens to other cells o- the
i%%une s'ste% such as T cells and B cells. This is one o- the i%2ortant -irst ste2s in the
initiation o- an i%%une res2onse. Sti%ulated %acro2hages e?hi6it increased le)els o-
2hagoc'tosis and are also secretor'.
0endriti Cells 44 Another cell t'2e, addressed onl' recentl', is the dendritic cell.
&endritic cells, *hich also originate in the 6one %arro*, -unction as antigen 2resenting
cells <APC=. !n -act, the dendritic cells are %ore e--icient a2cs than %acro2hages. These
cells are usuall' -ound in the structural co%2art%ent o- the l'%2hoid organs such as the
th'%us, l'%2h nodes and s2leen. (o*e)er, the' are also -ound in the 6loodstrea% and
other tissues o- the 6od'. !t is 6elie)ed that the' ca2ture antigen or 6ring it to the
l'%2hoid organs *here an i%%une res2onse is initiated. Un-ortunatel', one reason *e
$no* so little a6out dendritic cells is that the' are e?tre%el' hard to isolate, *hich is
o-ten a 2rere@uisite -or the stud' o- the -unctional @ualities o- s2eci-ic cell t'2es. O-
2articular issue here is the recent -inding that dendritic cells 6ind high a%ount o- (!,,
and %a' 6e a reser)oir o- )irus that is trans%itted to C&1R T cells during an acti)ation
e)ent.
25
An ani%al0s immune system 2rotects its 6od' -ro% intrudersI 6acteria, )iruses,
2arasites, cancer cells, etc. An i%%une s'ste% is 2resent in se)eral ani%al grou2s,
es2eciall' *ithin the )erte6rates. Ani%als ha)e 6oth non:s2eci-ic and s2eci-ic de-ense
%echanis%s to -ight in)aders. Be *ill 6e -ocusing on the hu%an i%%une s'ste%.
Non4s+eifi defense me%anisms *or$ against a *ide )ariet' o- in)aders.
These de-ense %echanis%s include the 6arrier -or%ed 6' our s*inE %emials in
2ers2iration, s$in oil, sali)a, tears, etc.E the %airs in our nostrilsE the iliary esalator
<the cilia and %ucus that clean out dust and de6ris -ro% our lungs and trachea= in our
res2irator' tractsE the inflammatory res+onse *hich is the dilation o- 6lood )essels
and accu%ulation o- BBCs at the site o- an in7ur' <the signs o- *hich are that the area
is red, hot, and s*ollen=E and fe!er, a raised 6od' te%2erature to inhi6it the gro*th o-
2athogens. "ote that a -e)er is caused 6' 'our 6od' to inhi6it the gro*th o- 6acteria,
etc., not 6' the Sger%sT the%sel)es, per se.
S+eifi defense me%anisms are e--ecti)e against s2eci-ic 2athogens. This
in)ol)es )arious BBCs called lym+%oytes or leu*oytes. There are se)eral $inds o-
BBCs in)ol)ed in the i%%une s'ste%, all o- *hich originate in the 6one %arro*.
#eu*emia is a cancer o- the 6one %arro*, thus it t'2icall' is treated 6' $illing all o- the
2erson0s 6one %arro*. Un-ortunatel', this lea)es the 2erson *ith no i%%une s'ste%, so
<s=he %ust 6e e?tre%el' care-ul during that ti%e to a)oid all 2ossi6le 2athogens. There
are t*o %ain t'2es o- s2eci-ic de-ense %echanis%s in)ol)ed in the i%%une s'ste%.
The ell4mediated immune system consists o- T4ells *hich originate in the 6one
%arro*, 6ut go to the T%ymus to -inish their de)elo2%ent.
26
T:cells are highl':s2ecialized cells in the 6lood and l'%2h to -ight 6acteria, )iruses, -ungi,
2rotozoans, cancer, etc. *ithin host cells and react against -oreign %atter such as organ
trans2lants.
There are three $inds o- T:cells. Cytoto:i T4ells directl' $ill in)aders. ,el+er T4ells
aid B and other T:cells to do their 7o6s, and (!, li)es in and $ills the%. Su++ressor T4
ells su22ress the acti)ities o- B: and other T:cells so the' don0t o)erreact. Allerg'
in7ections are su22osed to increase the nu%6er o- su2ressor T:cells to %a$e the 2erson
less sensiti)e to allergens.
Immunity is the a6ilit' to Sre%e%6erT -oreign su6stance 2re)iousl' encountered
and react again, 2ro%2tl'. There are t*o $inds o- i%%unit'I ati!e immunity, *hen the
6od' is sti%ulated to 2roduce its o*n anti6odies, and +assi!e immunity, *here the
anti6odies co%e -ro% outside the 2erson0s 6od'. Acti)e i%%unit' is usuall' 2er%anent,
and can 6e induced due to actual illness or )accination. Passi)e i%%unit' is not
2er%anent 6ecause the anti6odies are introduced -ro% outside the 6od', thus the B:
cells ne)er SlearnT ho* to %a$e the%. So%e e?a%2les o- 2assi)e i%%unit' include
anti6odies 2assed across the 2lacenta and in %il$ -ro% a %other to her 6a6', so%e
tra)elers0 shots, and the Rhoga% shots *e *e discussed earlier this @uarter. Because
anti6odies are onl' 2rotein, the' don0t last )er' long and %ust 6e re2laced i- the
i%%unit' is to continue.
Patient ,ealt% ,istory
,os+ital: Caraga Regional (os2ital
27
Room Number: Pediatric Bard, Miscellaneous
Case number: +3:>5:34
Name of t%e Patient: Patient R
.geI +4 'ears old
0ate of 'irt%I Octo6er .+, +;;/
Ci!il StatusI Single
Religion: !glesia 8ili2ina !nde2endiente
,ig%est Eduational .ttainmentI (igh School le)el
Ou+ationI "O"E
,ome .ddressI Es2eranza, Loreto, &inagat !sland, Surigao del "orte
,ealt% Care 8inaning and 7sual Soure of medial CareI 8a%il' inco%e
-ode of .dmission: carried 6' his -ather
0ate of .dmission: Se2te%6er .3, .>>;
Time of .dmission: +>I.3 a%
6ital Signs u+on .dmission:
Te%2eratureI /4.5Cc
Pulse RateI 9462%
Res2irator' RateI +9c2%
Blood PressureI +.>L5> %%(g

C%ief Com+lain: Present condition noted as sudden onset o- *ea$ness o- le-t lo*er
e?tre%ities -or al%ost / *ee$s, then a-ter right lo*er e?tre%ities a *ee$ a-ter

.dmitting 0iagnosis: #uillain BarreC S'ndro%e
8inal 0iagnosis: #uillain BarreC S'ndro%e
.ttending P%ysiian: &r. Asodisen <-ro% Se2te%6er .3:/>=
&r. Moleta < -ro% Octo6er +:4=
28
Name of Informant: PatientCs %other
0ate of 0is%argeI Octo6er 4, .>>;
Condition u+on 0is%arge: !%2ro)ed
Soure of Stability of 0ata gat%ered: Pri%ar' source <2atient=,
Secondar' Source <2atientCs SO and chart=
I'$ U ++9 ++9
:+> R+>
+.; : +.9 l6s 2atient is onl' +>/.4+ l6s, there-ore 2atient is under*eight
'-I U *eight <in $gs= L height <in %=
.
U 15 $g L <+.393 %=
.
U 15 L ..3+
U +9.5. 2atient0s BM! is nor%al
.. ,istory of Present Illness
29
On the .
nd
*ee$ o- August .>>;, 2atient stated that he e?2erienced a6do%inal
cra%2s and diarrhea *ith *ater' stool characterized *ith 'ello*:green in color *hich
lasted -or . da's a-ter he had eaten $inila*.
A-ter t*o *ee$s, 2atient started to co%2lain a tingling sensation or so%ething
li$e an electric current on his -eet and cli%6ed u2 to the thighs and a little nu%6. Patient
sus2ected that the cause o- this *as the usual 6athing o- legs a-ter ha)ing a *al$ -or
a22ro?i%atel' 1$%s e)er'da' going to school and 6ac$ ho%e.
On the .
nd
*ee$, 2atient e?2erienced *ea$ness, es2eciall' on his le-t leg that
%ade hi% not a6le to *al$ed and had li%ited range o- %otion. On the -ollo*ing da's, his
condition *orsens. (e -elt *ea$ness acco%2anied *ith tingling sensation *hich o-ten
attac$ earl' in the %orning and late a-ternoon and a cou2le o- ti%e during hour slee2 as
clai%ed 6' the 2atient. The da' a-ter, nu%6ness on lo*er e?tre%ities *ith uncontrolled
%o)e%entsLtre%ors occurs *hich last a6out ten %inutes. At that ti%e, he couldn0t sit on
his o*n and *hen he did sit u2 *ith assistance as *ell as in his eli%ination 2ur2oses.
(e -elt li$e an egg as stated 6' the 2atient.
Patient0s -a%il' sought ad)ice -ro% the local S%anghihilotT *ho %assaged the
a--ected area *ith his o*n:%ade %i?ture o- her6s. The latter 6elie)ed that 2atient
condition is caused 6' S6u'ag sa eng$antoT. The' also as$ed hel2 -ro% a
S%anta'ho2a'T *ho ga)e the sa%e i%2ression. (is %other -ollo*ed the instructions o-
the said 2ersons such as soa$ing his -eet *ith Snilagang sa%6ongT e)er' %orning and
at night 6e-ore slee2ing. (os2italization *as not 2ossi6le during the said s2an o- ti%e
6ecause o- -inancial constraints.
One da' 2rior to hos2italization, our 2atient *as seen 6' his %other cr'ing on the
-loor o- their sala. Patient stated that S gusto na na$o %ag2ahos2ital, nahadlo$ na a$o
6asin dili na a$o %a$ala$a* 2ag6ali$. That incident 2ro%2ted his %other to 6ring hi% to
Loreto &istrict (os2ital that da' 6ut *as re-erred directl' to Caraga Regional (os2ital
-or -urther assess%ent and %anage%ent.
Patient *as ad%itted to Caraga Regional (os2ital last Se2te%6er .3, .>>; at
e?actl' +>I.3 a% -or chie- co%2laintsI noted as sudden onset o- *ea$ness o- le-t lo*er
e?tre%ities -or al%ost / *ee$s, then a-ter right lo*er e?tre%ities a *ee$ a-ter

U2on con-ine%ent, the doctor 2rescri6ed the -ollo*ingI

!,8 &3!MB+>> V .3 gttsL%in

,ita%in B co%2le? + ca2 O&

('drocortisone +>>%g !,TT @9

>
La6orator' tests *ere also ordered 6' the attending 2h'sician such asI
(e%atolog'
Electrol'tes
Urinal'sis
30
'. Past ,ealt% ,istory
C%ild%ood Illness
Patient0s %other clai%ed that his son donCt ha)e an' childhood illnesses
li$e %u%2s, chic$en2o?, ru6ella and 2ertussis, etc. (e e?2erienced diarrhea last
Januar' .>>; *hich lasted -or al%ost . and a hal- da's characterized *ith *ater' stool
'ello*ish:green in color. A-ter that incidence he su--ered diarrhea again last Ma' .>>;
*ith the sa%e duration and -eature 6ut he *as not a6le to hos2italized. Patient
e?2erienced + *ee$ -e)er acco%2anied *ith 2roducti)e cough *ith thic$ 'ello* s2utu%
on the last *ee$ o- Jul' .>>;.

Immuni3ation
PatientCs %other clai%ed that onl' BC# had 6een i%%unized to her son
since health center is -ar a*a' -ro% their house.

,istory of ,os+itali3ation
Patient has no histor' o- hos2italizationE in -act this is his -irst ti%e o-
6eing ad%itted in the hos2ital.

Surgial ,istory
Patient clai%ed that he did not undergo an' surgical 2rocedure.

.idents and In;uries
A *ee$ 6e-ore he con-ined at Caraga Regional (os2ital, he stated that
*hen he *as ha)ing an e?ercise earl' in the %orning near6' shore a22ro?i%atel' 5:+>
%eters a*a' -ro% their house suddenl' he -elt *ea$ness on his legs and tingling
sensation acco%2anied 6' tre%ors that %ade hi% -all do*n to the ground. (e *as
tr'ing to drag hi%sel- going to their house that causes a6rasion and *ounds on his legs,
le-t -oot, right and le-t $nees. Until no* his *ounds are in the healing 2rocess, his
%other used her6al 2lants li$e %alunga' to treat his *ounds.

.llergi and Ty+e of Reation
Patient clai%ed that he donCt ha)e an' -ood allerg' or drug allerg'.


8amily ,ealt% ,istory
Patient *as the eldest o- -i)e. (is %other is 1/ 'ears old and in good
condition. (is -ather is 34 'ears old currentl' su--ering -ro% cough -or al%ost t*o *ee$s
and has arthritis. The usual sic$ness o- his si6lings e?2erienced, *ere colds and cough
*hich can 6e relie)ed 6' o)er the counter drugs such as 6iogesic, neoze2,
car6ocisteine and 2araceta%ol. The grand%otherL-ather in the %other side are ali)e
*ith no underl'ing illness. The grand-atherL%other in the -ather side *ere alread'
deceased. (is grand-ather died last +;;9 according to the% it *as 7ust sudden onset o-
s*elling on his lo*er e?tre%ities and a *ee$ a-ter the u22er e?tre%ities and de)elo2ed
into entire 6od'. (e *as not hos2italized and *as not diagnosed, in -act according to
31
their 6elie- and ru%ors his grand-ather *as Nna 6arangN. A-ter one %onth o- su--ering
-ro% generalized s*elling ha *as died l'ing on the 6ed unnoticel'. A-ter 5 'ears, that is
.>>3 his grand%other died as clai%ed 6' the 2atientCs %other, she died *ith the sa%e
case to her hus6and 6ecause o- generalized s*elling 6ut 2atientCs %other clai%ed that
she canCt recall i- *hat ha22ened to her %other:in:la* since the' *ere a2art -ro% here
*hen that ti%e ha22ened, all she $no*s is that a-ter one %onth also o- su--ering -ro%
s*elling she died.
Personal ,ealt% ,istory
#ifestyle
<. Personal ,abit
'efore ,os+itali3ation
Patient is a non:s%o$er and non:drin$er and donCt e)en used har%-ul
drugs. Be-ore he *as con-ined at hos2ital, he alread' -elt *ea$ness on his legs that
%ade hi% 7ust sta' on their house. (e 7ust *atched *o*o*ee and listening %usic and
*hen he got 6ored he 7ust sit near6' the *indo* and 7ust loo$ed around to his -riends
outside since he canCt *al$ and 7oin *ith the%. (e 7ust stud' his lesson 6' hi%sel- since
he sto2 going to school -or al%ost / *ee$s 6ecause o- his condition.
0uring ,os+itali3ation
Since 2atient *as *ea$ and canCt %o)ed his legs , he 7ust lied on the
6ed and so%eti%es sit 6ut still his legs *ere in straight and -lat 2osition. Patient has
li%ited %o)e%ent that %ade hi% unco%-orta6le. (e 7ust slee2 and so%eti%es a*a$e i-
tingling sensation occur. (e also used to ha)e little con)ersation to his -a%il'. (e 7ust
$ee2 on s%iling *hene)er there *ere 2eo2le loo$ed at hi%.

2. 0iet
'efore ,os+itali3ation
Patient t'2ical -ood is -ish since the' li)ed near6' the sea and his -ather
occu2ation is -ishing and also )egeta6les. Patient eats his %eals /? a da' 6ut
so%eti%es he doesn0t *ant to eat in the 6rea$-ast. Patient drin$s 9:+> glasses o- *ater
a da' he donCt ha)e an' s2ecial diet or an' -ood restriction. Patient *as -ond o- eating
S$inila*T *ith )inegar than coo$ed. (e eats / large %eals a da' and drin$s 3:4 glasses
o- *ater. Patient is -ond o- eating ra* egg *ith salt. (e eats 7un$ -oods as his snac$s.
(e drin$s co--ee and Milo so%eti%es i- it is a)aila6le on their $itchen.
0uring ,os+itali3ation
Patient eat the -ood that is 6eing ser)e in the hos2ital 6ut so%eti%es his
%other 6u' -ood outside li$e tinolang 6a$a and an' -ood that has sou2. (e also eats
-ruits li$e orange, 6anana and %ango. And earl' in the %orning his %other *ill %a$e
%il$L%ilo -or hi%. So%eti%es he re-uses to eat 6ecause he -elt -ullness, he drin$ /:1
glasses o- *ater a da'. (e doesn0t ha)e an' order o- -ood restriction or an' s2ecial diet
-ro% the dietician 6ut the doctor ordered + 6anana last Se2te%6er .4, .>>;.

32
=. Slee+ and Rest Pattern
'efore ,os+itali3ation
Patient usuall' slee2 at 92% and *a$e u2 4a%, 6e-ore the 2resent
illness he had no di--iculties in slee2ing, 6ut *hen he started to -elt *ea$ness and
tingling sensation he canCt slee2 a22ro2riatel' cause he canCt %o)ed his legs side 6'
side.
0uring ,os+itali3ation
Patient has di--icult' o- slee2ing and *a$es u2 a nu%6er o- ti%es during
hour slee2. (e clai%ed that his not co%-orta6le to slee2 in the hos2ital as *ell as his
2osition in slee2ing, he -elt heCs li$e a dead 2erson l'ing in a straight and -lat 2osition.
And so%eti%es heCs %other a*a$en hi% *hen uncontrolled %o)e%ents o- %uscle
occur since 2atient couldn0t -elt an' sense.
>. Elimination Pattern
'efore ,os+itali3ation
Patient urinate /? a da' characterized 6' large a%ount *ith 'ello* in
color and de-ecate once a da' characterized 6' scant' a%ount *ith 'ello*ishL6ro*nish
in color *ith no histor' o- di--icult' or 2ain in urinating and de-ecating. Patient did not
e?2erience consti2ation. Be-ore the 2resent illness , he eli%inate *ith hi%sel- 6ut
6ecause o- his condition he reall' needs assistance -or eli%ination 2ur2oses, usuall' his
-ather carried hi% in going to co%-ort roo%.
0uring ,os+itali3ation
Patient urinate 1:3? a da', *hen he )oid he 7ust sit on the 6ed and his
%other *ill o--er 2lastic container o- the !,8 since he canCt go 6' hi%sel- to the co%-ort
roo%. So%eti%es it ta$es /:1 da's 6e-ore he can de-ecate and his -ather carried hi%
going to the co%-ort roo%. (is last )oid is scant' and 'ello* in color and his -ecal is
hard stool, 'ello*ish in color.

?. .ti!ities of 0aily #i!ing
'efore ,os+itali3ation
E)en though 6e-ore hos2italization 2atient has di--icult' on his acti)ities
o- dail' li)ing 6ecause o- his condition he cant ta$e a 6ath and dress alone, his %other
has 6een al*a's there -or hi% in doing his groo%ing and h'giene as *ell as in his
eli%ination and loco%otion, he had li%ited %o)e%ents. The onl' thing he can do -or
hi%sel- is 7ust that *hen he eat or holds an' o67ect. (e couldn0t hel2 in household
chores unli$e 6e-ore.
0uring ,os+itali3ation
Patient doesn0t ha)e an' acti)ities, he 7ust lies on the 6ed. (e clai%ed
that he *as 6oredE he *ants to ha)e so%e e?ercise as *hat he usuall' did 6e-ore his
condition. (e 7ust has so%e con)ersation *ith his %other and a-ter that he -ined hi%sel-
slee2ing and a*a$ens -or a -e* hours.

@. Rereation and ,obbies
33
'efore ,os+itali3ation
Patient usual recreation and ho66ies *ere *atching tele)ision and listen
dra%a in the radio. (e used to read 2oc$et6oo$s *hen he got 6ored. Be-ore his
condition he e?ercised e)er'da' earl' in the %orning and s*i%%ing in the sea.
0uring ,os+itali3ation
Patient 7ust lies in the 6ed. Bhen the 2atient is in -ine %ood, he usuall'
chatt' and lights u2 *hen he is tal$ing to his )isitorsL2arents. (e al*a's *ar 6eauti-ul
s%iles on his -ace des2ite o- his condition.


A. Soial 0ata
The 2atient usuall' turns to his 2arents -or su22ort during ti%e o- stress
and school 2ro6le% es2eciall' a6out *hat he -elt on his -irst tri%ester o- illness. (e
re2orted to his 2arents -or e)er' detailed e)ent that ha22ened to his condition. Patient
does not 6elie)e in su2erstitious 6elie- or @uac$ doctors e)en though his 2arent do
so. Patient is currentl' stud'ing -irst 'ear high school 6ut e)entuall' sto22ed 6ecause o-
his condition.

B. Ou+ational .ti!ity
"ot a22lica6le. Patient is still stud'ing.
C. En!ironmental 0ata
Patient li)ed at Es2eranza, Loreto, &inagat !sland, S&". Their house is
located near6' the sea a22ro?i%atel' +>:+. %eters a*a' -ro% their house. Their house
is %ade o- *ood and ni2a hut. The' ha)e one sala, roo%, and $itchen and co%-ort
roo%. Their house is surrounded *ith 2lants and the' ha)e garden *herein the' 2lant
)egeta6les -or their -ood consu%2tion. And also a little chic$en 2oultr' -or their
consu%2tion o- eggs. The' ha)e a clean en)iron%ent *here in he can 6reathe -resh air
*ith no 2ollution.
<D. Psy%ologial 0ata
Patient %a7or stressor in li-e *as his condition no*, he *as *orried
a6out his legs i- it *ill 6e 6ac$ in nor%al again 6ut des2ite o- his 2ro6le% he *as tr'ing
to 6e strong and tend to 6e ha22' -or he 6elie)ed that he *ill 6e cured and nothing is
i%2ossi6le *ith #od.


<<. Pattern of ,ealt% Care
Patient is a non:%e%6er o- Phil (ealth, #S!S and SSS. Patient0s %other
used her6al 2lants and sought S@uac$ doctorsT and S%anghihilotT *hene)er his son got
sic$. The' used their 2ersonal -a%il' -und to sustain his need -or %edical care.
RE6IE$ O8 S5STE-
Integumentary system
34
Patient has no an' allergic reaction to certain -oods or %edication, he don0t ha)e
an' histor' o- itchiness. (e has lesions, a6rasions and scars in his lo*er e?tre%ities. "o
hair d'es, curling or strengthening 2re2aration.
,ead, Eyes, Ears, Nose, T%roat
Patient doesn0t -elt an' dizziness, lightheadedness and headache. So%eti%es
he e?2erienced seizures es2eciall' *hen it is cold and tingling sensation attac$. (e
doesn0t use an' e'eglasses. "o hearing 2ro6le% 2atient e?2erienced nasal stu--iness
so%eti%es.
Ne*
Patient clai%ed that he doesn0t ha)e an' nec$ lu%2s and *as not diagnose
*ith an' th'roid 2ro6le%.
'reast and .:illae
Patient did not e?2erience an' 2ain on his 6reast and a?illae.
T%ora: and #ungs
Patient e?2erienced 2roducti)e cough *ith thic$ 'ello* s2utu%. "o histor' and
d's2nea, asth%a, 2neu%onia, and e%2h'se%a. (e doesn0t -elt an' chest 2ain.
Cardio!asular System
Patient doesn0t ha)e an' histor' o- cardio)ascular disease.
&astrointestinal System
Patient e?2erienced a6do%inal cra%2s and h'2eracti)e 6o*el %o)e%ent *ith
*ater' stool characterized *ith 'ello*:green in color *hich lasted -or t*o da's. Patient
e?2erienced a6do%inal 2ain in the lo*er 2ortion o- the a6do%inal ca)it'E it 7ust lasted
-or -e* %inutes and di%inished. (e used to drin$ hot *ater to relie)e the 2ain, he also
e?2erienced -latulence -or 3? a da', -or that da' onl'. (e don0t an' ha)e di--icult' in
s*allo*ing.
-usulos*eletal System
Patient clai%ed that he e?2erienced li$e an electric current sensation on his
6oth legs. !t is gradual characterized -irst 6' the *ea$ness o- his legs -ollo*ed 6' the
tingling sensation and nu%6ness on his legs es2eciall' in the le-t leg. Because o- this,
he had li%ited range o- %otion and he can0t %o)e his 6oth legs. Tingling sensation o-ten
attac$ earl' in the %orning and late a-ternoon and a cou2le o- ti%e during hour slee2 as
clai%ed 6' the 2atient. (e also had loss o- -unction *ithout 2ain in her legs.
Neurologi System
35
Patient e?2erienced tingling sensation, nu%6ness and uncontrolled
%o)e%ents acco%2anied *ith tre%ors on his lo*er e?tre%ities. Patient can0t -eel light
2ressure onl' dee2 2ressure and 2ain through 2ointing 2oint o67ect.
7rinary System
Patient urinates .:/? a da', he ha)e di--icult' in urination 6ecause he need
assistance tot go to co%-ort roo%. But he doesn0t ha)e an' 2ain-ul urination.
,ematologi
Patient clai%s that he doesn0t ha)e an' histor' o- ane%ia.
Endorine System
Patient )er6alizes u2on assess%ent that he cannot tolerate *ar%
en)iron%ent since in their 2lace the' ha)e -resh air. (e doesn0t ha)e an' th'roid
2ro6le%s.
Psy%iatri
Patient can %anage the stress that his ha)ing no*. !n -act, he is a ha22'
2erson. (e has a good %e%or' and 6ut he also tend to get ner)ous easil' *hen
strange 2eo2le li$e us tal$ to hi% and he tend to 2ers2ire %ore.

P,5SIC.# .SSESS-ENT
36
&ate o- Assess%entI Se2te%6er .9:.;, .>>;
Ti%e o- assess%entI >3I132%
,ital signs u2on assess%entI
#eneral Sur)e'I
Patient is a*a$e
a22eared 2ale and his legs *ere nu%6 and *ea$, 2atient lies on 6ed in a su2ine
2osition. (e a22eared untid' *ith oil' -ace, hair *hich is not 2ro2erl' co%6ed and
tangled. Patient is coherent and res2onsi)e during our inter)ie*E he $ee2s in s%iling
and -elt sh' to ans*er our @uestions. Ongoing !,8 solution o- &3!MB *ith the dro2 rate
o- +3gttsL%in, 2atentl' hoo$ed at the right dorsal %etacar2al )ein.

!ntegu%entar' S'ste%I
S$inI
Patient has a -air s$in
#ood s$in turgor noted
Lesion noted in the lo*er e?tre%ities
Scar noted at the le-t $nee and le-t -oot
&r' s$in noted
(airI
(air is short, thic$ and reddishL6ro*nish in color, 6rittle hair
&oesn0t use hair d'es
"o lice in-estation noted
&andru-- noted
"ailsI
Untri%%ed, dirt' nails on 6oth -ingers and toes
Blanch ca2illar' re-ill test M/ seconds
Patients -ingernails and toenails are thic$
"ails are con)e? *ith an angle at a6out +4> degrees
(ead, E'es, Ears, "ose, Throat <(EE"T=
Se+tember 2B, 2DDC Se+tember 2C, 2DDC
T U /4.5WC T U /4.9WC
P U 99 62% P U ;> 62%
R U .> c2% R U +; c2%
'PU ++>L5> %%(g 'PU ++>L5> %%(g
37
S$ull and 8aceI
"or%oce2halic and s'%%etrical *ith -rontal, 2arietal, and occi2ital 2ro%inence
A6sence o- nodules and %asses u2on 2al2ation
Can -le? head *ithout su22ort
8acial -eatures and %o)e%ents are s'%%etrical
E'es and ,isionI

E'e6ro*s are thin, 6ut s'%%etricall' aligned
8re@uent e'e 6lin$ing
"o discharges, no discoloration and no %asses noted
Sun$en e'es and e'e 6ags noted
Pu2il E@uall' Round Reacted to Light and Acco%%odation
Ears and (earing
Auricles sa%e color as -acial s$in, s'%%etrical and are aligned *ith outer
canthus o- e'e
A6le to hear s2o$en *ords clearl'
A6le to hear *atch tic$ing in 6oth ears
Pinna is %o6ile, -ir% and not tender
Pinna recoils a-ter it is -olded
Presence o- ceru%en noted
"ose and Sinuses
E?ternal nose has sa%e color as -acial s$in e?ce2t -or sa%e 2arts *ith s%all
2ig%ents
"o discharges noted
"o tenderness and %asses noted
"o sinusitis noted
Oro2har'n? <%outh and throat=
Li2s are 2ale and dr'
"o s*elling o- the tongue noted
"o 2al2a6le nodules
Bad 6reath noted
"o 6leeding and s*elling o- gu%s noted
38
Pla@ues on teeth noted
"o tonsillitis noted
#ag Re-le? noted
"ec$I
Th'roid gland is not )isi6le
Patient can turn head le-t and right, u2 and do*n *ithout 2ain
"o 2al2a6le nodules
Thora? and Lungs
"o di--icult' o- 6reathing
"o a6nor%alities noted
Posterior Thora?
"or%al cur)ature
"o tenderness u2on 2al2ation
S'%%etric
Anterior Thora?
Chest is s'%%etric
"or%al 6reath sounds noted
"o e)idenced o- an' secretions
Breast and A?illae
"o discharges noted
S$in uni-or% in color, areola dar$en in color
"o e)idence o- enlarge%ent o- li)er and s2leen
Audi6le 6o*el sounds
Musculos$eletal S'ste%
Li%ited %o)e%ents in the lo*er e?tre%ities
Bea$ness o- his legs 6oth right and le-t
Tingling sensation, uncontrolled %o)e%ents
"u%6ness o- the legs 6oth right and le-t
39
Patient didn0t res2onse to light touch
Patient res2onse to dee2 2ressure onl'
li%ited a6ilit' to 2er-or% grossL-ine %otor s$ills,
di--icult' turning his 6od'
slo*ed %o)e%ent and uncoordinated %o)e%ent
2ostural insta6ilit',
ina6ilit' to %aintain acti)it'.
Cardio)ascular S'ste%
"o a6nor%alities noted
Lu6:du6 sounds noted u2on auscultation
"o ede%a
Urinar' S'ste%
Patient urinate /? a da'
Patient0s urine is 'ello*ish in color
#astrointestinal S'ste%
"o )o%iting
"o diarrhea
"o di--icult' in s*allo*ing
(ard stool noted
"eurologic S'ste%
Mental StatusI
Language
Patient does not ha)e an' s2eech 2ro6le%s. (e can understand and con)erse
*ell using Bisa'a dialect. (e used non:)er6al co%%unication such as e'e
%o)e%ents, gestures and interaction *ith the su22ort 2erson. (e had a
congruence o- non:)er6al and )er6al e?2ression.
Orientation
Patient is oriented to 2lace, ti%e and is a6le to ans*er our @uestions correctl'
during inter)ie*.
40
Me%or'
(e has good %e%or' and can recall *hat ha22ened in the 2ast.
Attention S2an
Patient is res2onsi)e and coherent.
CR.NI.# NER6E .SSESS-ENT
41
CRA"!AL "ER,E "AME RESULT
! Ol-actor' Patient is a6le to s%ell
and he can identi-' i-
*hat he s%ells.
!! O2tic (e *as a6le to read our
na%e2lates a6out +1
inches. (e has 6right
e'es and can see clearl'.
!!! Occulo%otor Patient0s 2u2il reacted to
light. Pu2ils constrict
*hen loo$ing at near
o67ect and dilate *hen
loo$ing -ar o67ect. !t also
con)erges *hen 2enlight
*as %o)ed to*ards his
nose.
!, Trochlear Bhen 2enlight *as
%o)ed at si? cardinal
-ields o- gaze using the
si? ocular %o)e%ents
na%el'I su2erior rectus,
lateral rectus, in-erior
rectus, su2erior o6li@ue,
%edial rectus and in-erior
o6li@ue 2atients 6oth
e'es *ere coordinated
and %o)ed in unison*ith
2arallel align%ent.
, Trige%inal Positi)e 6lin$ re-le? *ith3
6lin$sL%inute and can
deter%ine 6lunt and
shar2 ends.
,! A6ducens Using the si? ocular
%o)e%ents, he *as a6le
to %o)e e'e6alls laterall'
o- 6oth e'es *ith unison
and in 2arallel align%ent.
,!! 8acial Patient -lashed his s%ile
*hen as$ed o- so%ething
2ri)ate and 2ersonal. And
close his together and
a6le to raise e'e6ro*s.
,!!! AcousticLAuditor' Patient can hear clearl'
and onl' seldo%
@uestions *ill 6e
re2eated *hile *e *ere
inter)ie*ing hi%.
!A #losso2har'ngeal The 2atient *ill 6e a6le to
identi-' )arious taste
2laced on ti2 and sides o-
tongue. (e *as also a6le
to %o)e tongue -ro% side
to side and u2 and do*n
*hen as$ed to do.
Positi)e gag re-le?.
42
43
&lasgo" Coma Sale
8acult' Measured Res2onse
Score
E'e O2ening S2ontaneous:o2en *ith 6lin$ing at 6aselineXXXXXXXXXX12ts PPPP
To )er6al sti%uli, co%%and, s2eechXXXXXXXXXXXXXXXX/2ts
To 2ain onl'<not a22lied to -ace=XXXXXXXXXXXXXXXXXXX.2ts
"o res2onseXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX+2t
,er6al Res2onse OrientedXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX32ts
Con-used con)ersation, 6ut a6le to ans*er @uestionXXXX12ts PPPPP
!na22ro2riate *ordsXXXXXXXXXXXXXXXXXXXXXXXXXXXXX/2ts
!nco%2rehensi6le s2eechXXXXXXXXXXXXXXXXXXXXXXXXX.2tS
"o res2onseXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX+2t

Motor Res2onse O6e's co%%and -or %o)e%entXXXXXXXXXXXXXXXXXXXX42ts
Pur2ose-ul %o)e%ent to 2ain-ul sti%ulusXXXXXXXXXXXX32ts PPPP
Bithdra* in res2onse to 2ainXXXXXXXXXXXXXXXXXXXXX12ts
8le?ion in res2onse to 2ain<decorticate 2ositioning=XXX/2ts
E?tension res2onse to 2ain<dece6erate 2ositioning=XXX.2tS
"o res2onseXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX+2t
XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX
Total Score U +/L+3
44
-7SC#E STREN&T, SC.#E
> "o detection o- %uscular contraction
+ A 6arel' detecta6le -lic$er on trace o-
contraction *ith o6ser)ation in
2al2ation.
. Acti)e %o)e%ent o- 6od' 2art *ith
eli%inate o- gra)it'.
/ Acti)e %o)e%ent against gra)it' onl'
and not against resistance.
1 Acti)e %o)e%ent against gra)it' and
so%e resistance.
3 Acti)e %o)e%ent against -ull resistance
*ithout e)ident -atigue <nor%al %uscle
strength=
-7SC#E STREN&T,
Le-t Lo*er E?tre%ities Right Lo*er E?tre%ities
Plantar -le?ion > >
&orsi-le?ion > >
nee 8le?ors > >
nee E?tensors > >
(i2 8le?ors > >
(i2 E?tensors > >
!n)ersion and e)ersion > >
45
Re-le?I The 2atient0s Bice2s, Trice2s, Brachioradialis, Patellar and Achilles ha)e
the -ollo*ing grade o- res2onsesI R., R., R+, >, >, > res2ecti)el'.
Scale o- grading Re-le?I
>:+> re-le? res2onse
R+U %ini%al acti)it' <h'2oacti)e=
R.U nor%al res2onse
R/U %ore acti)e than nor%al
R1U %a?i%al acti)it' <h'2eracti)e=
SPatient RT
R!#(T LE8T
BRAC(!ORA&!AL!S BRAC(!ORA&!AL!S
R+ R+
B!CEPS B!CEPS
46
R. R.
TR!CEPS TR!CEPS
R. R.

"EE RE8LEAL PATELLAR "EE RE8LEAL PATELLAR
> >
A"LE RE8LEA A"LE RE8LEA
> >
47
0OCTOR(S OR0ER
>;L.3L>;
+>I.3 a%
Pls. ad%it 2t. to 2edia %isc.
TPR e)er' 1 hour
La6sI CBC, "a, Creatinine, uLa
Urinal'sis
A8B AST
Start &3!MB to -e* at +3
Monitor )Ls e)er' 1 hours
&r. PatiYo
++I13 a%
re-er result *hen in noted
ascending 2aral'sis
>;L.4L>;
TU /5..ZC
,it. B co%2le?
Eat + 6anana
8ollo* u2 !,8
&r. PatiYo
+>I3> 2%
('drocortisone +>>%g !,TT e)er' 9Z
>;L.5L>;
TU /5.+ZC
Continue %edication
>;L.9L>;
>;I+3a%
Continue %edication
+>I.1 2%
!,8 to -ollo* &3!MB 3>>%l
&r. Mantilla

*ar% co%2ression B!&
Continue %edication
8ollo* u2 !,TT *ith +3 gttsL%in.
&r.Mantilla
48
>;L/>L>;
continue %edication
Bisacod'l 2ediatric rectal su22ositor'
('drocortisone .3>%g e)er' 9 hours
+>L>+L>;
a-e6rile
continue %edication
-ollo* !,8 *ith &3LR !L +3gttsL%in.
+>L>.L>;
continue %edication
8ollo* !,8 *ith &3LR !L +3gttsL%in.
+>L>/L>;

continue %edication
8ollo* !,8 *ith &3LR !L +3gttsL%in.
&ecrease ('drocortisone to .3>g and !,TT e)er' +. hours
+>L>3L>;
continue %edication
8ollo* !,8 *ith &3LR !L +3gttsL%in.
+>L>4L>;
Ma' go ho%e
(o%e %edication
8ollo* u2 chec$ u2 at OP& a-ter . *ee$s
49
#.'OR.TOR5 TESTS
E#ECTRO#5TE
Se2te%6er .4,.>>;
E#ECTRO#5TES RES7#TS NOR-.# 6.#7ES SI&NI8IC.NCE
SO&!UM +1/%%olLL +/3:+13%%olLL "ORMAL
POTASS!UM 3.1 %%olLL /.3:3.3%%olLL "ORMAL

,E-.TO#O&5
Se2te%6er .4,.>>;
Criteria Result Normal 6alues Signifiane
(e%atocrit /3H MI1>:3.H
8I/4:19H
Reduced nu%6er
o- RBC in the
6lood <ane%ia=
Platelet A&E[UATE +3> \ 1>> "or%al
BBC 9.1 ? +>
;LL
1.> \ ++ "or%al
"eutro2hils 4> .3:53H "or%al
L'%2hoc'tes 1> +3:/3H L'%2hoc'tes
increased *ith
in-ectious
%ononucleosis,
)iral and so%e
6acterial in-ection
7rinalysis
Otober D=, 2DDC
Result "or%al Result Signi-icance
Color 'ello* A%6er 'ello* "or%al
Reaction 4.> 1.3:92h "or%al
Sugar negati)e negati)e "or%al
Trans2arenc' clear clear "or%al
S2. gra)it' +.>/> +.>+3U+.>/3 "or%al
Protein negati)e negati)e "or%al
PONCI.NO #I-C.N&CO, -0, 8PSP
50
Pathologist
0rug Study
'isaodyl
ClassifiationsI #astrointestinal AgentE Sti%ulant La?ati)e
.tion: E?2ands intestinal -luid )olu%e 6' increasing e2ithelial 2er%ea6ilit'.
Relie)es consti2ation. Sti%ulant la?ati)e that increases 2eristalsis, 2ro6a6l' 6'
direct e--ect on s%ooth %uscle o- the intestine, 6' irritating the %uscle or
sti%ulating the colonic intra%ural 2le?us. &rug also 2ro%otes -luid accu%ulation
in colon and s%all intestine
Indiation:
te%2orar' relie- o- acute consti2ation and
-or e)acuation o- colon 6e-ore surger', 2rostosco2ic, sig%oidosco2ic,
radiologic e?a%inations.
Also used to cleanse colon 6e-ore deli)er' and to relie)e consti2ation in
2atients *ith s2inal cord da%age.
Chronic consti2ationE 2re2aration -or child6irth, surger', or rectal or 6o*el
e?a%ination

0osage, Route of administration: !,TT e)er' 9 hours , rectal su22ositor'

Contraindiation:
Contraindicated in 2atients h'2ersensiti)e to drug or its
co%2onents and in those *ith rectal 6leeding, gastroenteritis, intestinal
o6struction, a6do%inal 2ain, nausea, )o%iting, or other s'%2to%s o-
a22endicitis or acute surgical a6do%en.
.d!erse ReationI
Mild cra%2ing
nausea,
diarrhea
-luid and electrol'tes distur6ances <es2eciall' 2otassiu% and calciu%=.
#!I nausea, )o%iting. A6do%inal cra%2s, diarrhea, 6urning sensation in
rectu%, 2rotein:losing entero2ath', la?ati)e de2endence
Meta6olicI al$alosis, h'2o$ale%ia
Musculos$eletalI %uscle *ea$ness, tetan'
51
Nursing Im+liation:
Add high:-i6er -oods slo*l' to regular diet to a)oid gas and diarrhea.
Ade@uate -luid inta$e includes at least 4:9glassesLd.
&o not 6reast-eed *hile ta$ing this drug *ithout consulting 2h'sician.
Bisco:La? %a' contain tartrazine
#i)e drug at ti%es that don0t inter-ere *ith scheduled acti)ities or
slee2. So-t, -or%ed stools are usuall' 2roduced +3 to 4> %inutes a-ter
rectal use.
Be-ore gi)ing -or consti2ation, deter%ine *hether 2t. has ade@uate
-luid inta$e, e?ercise, inta$e and diet.
Ta6lets and su22ositories are used together to clean the colon 6e-ore
and a-ter surger' and 6e-ore and a-ter surger' and 6e-ore 6ariu%
ene%a.
!nsert su22ositor'as high as 2ossi6le into the rectu% , and tr' to
2osition su22ositor' against the rectal *all. A)oid e%6edding *ithin
-ecal %aterial 6ecause doing so %a' dela' onset o- action.
52
&eneri name: .sorbi .id 16itamin C2
'rand names: .+o4C, .sorbia+, Cebid, eon, enolate, emin, 4s+an,
etane, es!ain
Classifiation: ,ita%in
.tion:
Bater:solu6le )ita%in essential -or s'nthesis and %aintenance o- collagen and
intercellular ground su6stance o- the 6od' tissues cell, 6lood )essels, cartilages, 6ones,
teeth, s$in, and tendons.
Indiation:
Pro2h'la?is and treat%ent o- scur)' and as a dietar' su22le%ent.
To 2re)ent )it. C de-icienc' in 2t. *L 2oor nutritional ha6its or increased re@uire%ents.
R&A
8ran$ and su6clinical scur)'
E?tensi)e 6urns, dela'ed -racture or *ound healing, 2osto2erati)e *ound healing,
se)ere -e6rile or chronic dse. State.
0osage, Route of administration: < tab O0, PO
Contraindiation:
Use o- sodiu% ascor6ate in 2atients on sodiu% restrictionE use in calciu%
ascor6ate in 2atients recei)ing digitalis.
.d!erse Reation:
"ausea, )o%iting, heart6urn, diarrhea, or a6do%inal cra%2s, acute he%ol'tic
ane%ia, sic$le cell crisis, headache or inso%nia, urethritis, d'suria, cr'stauria,
h'2erla?alunia, h'2erurice%ia, %ildness soreness at in7ection site, dizziness, te%2orar'
-aintness *ith ra2id !, ad%inistration
Nursing im+liationI
(igh doses o- )ita%in C are not reco%%ended during 2regnanc'.
Ta$e large doses o- )ita%in C in di)ided a%ounts 6ecause the 6od' uses
onl' *hat is needed at a 2articular ti%e and e?cretes the rest in urine.
Megadoses can inter-ere *ith the a6sor2tion o- )ita%in B+..
"oteI )ita%in C increases the a6sor2tion o- iron *hen ta$en at the sa%e
ti%e as iron rich:-oods.
&o not 6reast-eed *hile ta$ing this drug *ithout consulting 2h'sician.
Stress 2ro2er nutritional ha6its to 2re)ent recurrence o- de-icienc'.
Ad)ise s%o$ers to increase inta$e o- )ita%in C.
Bhen gi)ing -or urine acidi-ication, chec$ urine 2( to ensure e--icac'.
8or 2t. recei)ing )it. C !.M., e?2lain that M.!, route %a' 2ro%ote 6etter
utilization.
53
&eneri name: ,ydroortisone
'rand nameI Corte-, cortene%a, h'drocortone
ClassifiationI S$in and Mucous Men6rane AgentE Anti:!n-la%%ator'E s'nthetic
(or%oneE adrenal corticosteroidsE glucocorticoidE %ineralocorticoid
.tionI Short:acting s'nthetic steroid *ith 6oth glucocorticoid and
%ineralocorticoid 2ro2erties that a--ect nearl' all s'ste% o- the 6od'. ('drocortisone has
anti:in-la%%ator', i%%unosu22ressi)e, %etha6olic -unction in the 6od'.

IndiationI Re2lace%ent thera2' in adrenocortical insu--icienc'E to reduce seru%
calciu% inh'2ercalce%ia, to su22ress undesira6le in-la%%ator' or i%%une res2onses,
to 2roduce te%2orar' re%ission in nonadrenal disease, and to 6loc$ ACT( 2roduction
in diagnostic tests. Use as anti:in-la%%ator' or i%%unosu22ressi)e agent largel'
re2laced 6' s'nthetic glucocorticoids that ha)e %ini%al %ineralocortocoid acti)it'.
0osage, Route of administration:
+>> gra%s !,TT e)er' 9 hours
ContraindiationI ('2ersensiti)it' to glucocorticoids, idio2athic
thro%6oc'to2enic 2ur2ra, 2s'choses, acute glo%erulone2hritis, )iral or 6acterial
diseases o- s$in.
.d!erse Reation: eu2horia, inso%nia, 2s'chotic 6eha)ior, 2seudotu%or
cere6ri, seizures, heart -ailure, h'2ertension, ede%a. Arr'th%ias, thro%6oe%6olis%,
cataracts, glauco%a, 2e2tic ulceration, gastrointestinal irritation, increase a22etite,
2ancreatitis, h'2o$ale%ia, h'2ergl'ce%ia, car6oh'drate intolerance, %uscle *ea$ness,
gro*th su22ression in children, osteo2orosis, hirsutis%, dela'ed *ound healing, acne,
)arious s$in eru2tion, eas' 6ruising.
Nursing Im+liationI
Teach 2atient signs o- earl' adrenal insu--icienc'
Barn 2atient a6out eas' 6ruising
Ad)ise hi% to consider e?ercise or 2h'sical thera2'
Barn 2atient recei)ing long:ter% thera2' a6out cushingoid s'%2to%
&eter%ine *hether the 2t is sensiti)e to other corticosteroid.
#i)e oral dose *ith -ood *hen 2ossi6le.2t. %a' need another drug to 2re)ent #!
irritation.
Most ad)erse reaction to corticosteroids are dose:duration:de2endent.
Monitor 2t. *eight BP, and electrol'te le)el
Monitor 2t. cushingoid e--ects including %oon -ace, 6u--alo hu%2, central o6esit',
thinning hair, h'2ertension and increased susce2ti6ilit' to in-ection.
54
&ENERIC N.-E: 6IT.-IN ' CO-P#E9 4 OR.#
'R.N0 N.-E1S2: Surbe:, T%era!ite, 6ion4C, E4'e
7SES: ,ita%ins are the 6uilding 6loc$s o- the 6od'. The' are used to 2re)ent or treat a
)ita%in de-icienc' due to 2oor nutrition, certain illnesses or during 2regnanc'.
,O$ TO 7SE: Ta$e as directed. 8ood %a' a--ect the a6sor2tion o- certain )ita%in
2roducts. Consult 'our 2har%acist. Che*a6le ta6lets %ust 6e che*ed thoroughl'
6e-ore s*allo*ing -ollo*ed *ith a glass o- *ater. Ti%ed:release ca2sules or ta6lets
%ust 6e s*allo*ed *hole.
SI0E E88ECTS: This %edication %a' cause %ild nausea or un2leasant taste. Consult
'our doctor i- an' o- these e--ects 2ersist or 6eco%e se)ere. !- 'ou notice other e--ects
not listed a6o)e, contact 'our doctor or 2har%acist.
PREC.7TIONS: Be-ore using this %edication, tell 'our doctor or 2har%acist 'our
%edical histor', es2eciall' o-I dia6etes, 6lood disorders such as )ita%in B+. de-icienc'
<2ernicious ane%ia=. Tell 'our doctor i- 'ou are 2regnant 6e-ore using this %edication.
"o 2ro6le%s ha)e 6een re2orted in 2regnant or nursing *o%en *hen this %edication
*as used in nor%al doses.
0R7& INTER.CTIONS: Tell 'our doctor i- 'ou ta$e an' other %edication, including
non2rescri2tion. This %edication %a' a--ect certain urine la6 tests, including so%e urine
glucose tests. &o not start or sto2 an' %edicine *ithout doctor or 2har%acist a22ro)al.
O6ER0OSE: !- o)erdose is sus2ected, contact 'our local 2oison control center or
e%ergenc' roo% i%%ediatel'. US residents can call the US national 2oison hotline at +:
9>>:...:+.... Canadian residents should call their local 2oison control center directl'.
S'%2to%s o- o)erdose %a' include diarrhea, loss o- coordinationE nu%6ness o- the
hands or -eetE 7oint 2ain, or 2ain-ul urination.
55
56
Predis2osing -actorI P.T,OP,5SIO#O&5 Preci2itating -actorI
<&iagra%=
Infectious organism: invasion of Campylobacter jejuni via oral route
To cause gastrointestinal infection (iarr!ea " a#ominal cram$ing%
C. jejuni unergoes significant $!&siologic c!anges '(in t!e intracellular
environment to avoi mi)ture to l&sosomal en*&mes '(c coul eat " +ill
t!em
Immune s&stem 'ill res$onse to
t!e intracellular invasion of
microorganism
MOLECULAR MIMICRY
DUAL RECOGNITION
umoral
immunity
Cell!me"iate"
immunity
,ener: -ale
(-ale to female ratio is 1:5:1%
.ge: 16 &ears ol
(/oung aults age 15035 &0o%
(1lerl& age 50075 &0o%
2I1T: 13 eating uncoo+e foo
(es$3 $oultr& $roucts%
23 45inila'6
33 7a' eggs
2I.7781.
57
2ecrease m&elin $rouction
DEMYELINATION
Impaire"
tran#mi##ion o$
ner%e con"uction
Tingling sensation
9um#ness
:ea+ness of t!e
;1
&en#ory
an"
motor
lo##
<onsti$ation
Ina#ilit& to
$erform .2;
Immo#ilit& of t!e
;1
.scening $aral&sis
GUILLAIN 'ARRE &YNDROME
Lymp(o)ine# $rouce
macro$!ages activation
-ista+en immune
attac+ ma& arise
Inflammation of t!e nerve cells
=enetration of macro$!age an anti#oies into
#asement mem#rane aroun nerve fi#ers
T0cells release
l&m$!o+ines
Increase level of
l&m$!oc&tes level
.ctivates s$ecific T
l&m$!oc&tes or T0cells
Antibo"ie# 'ill
fig!t foreign
microorganisms
Inflame cells secrete c&toto)ic su#stances
t!at affect or amage t!e &c(*ann cell#
>ecrete
anti#oies
58
N7RSIN& C.RE P#.N F<
Se2te%6er .9, .>>;
Su67ecti)e cuesI
SPas%o ra %an da* ni sa $usog $a' %anhi%asa %an $o hu%an 6a$tasT as
)er6alized 6' the 2atient.
O67ecti)e cuesI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
A2ath' noted
Misinter2retation o- in-or%ation
&iagnosisI
Kno"ledge defiit related to ogniti!e limitation
PlanningI
A-ter 1 hours o- rendering nursing inter)ention 2atient *ill 6e a6le to )er6alize
understanding o- condition disease 2rocess and treat%ent
Inter!ention: Rationale
+. &eter%ined in-or%ation the
client alread' $no*s and %o)e
to *hat the client does not $no*,
2rogressing -ro% si%2le to
co%2le?
To -acilitate learning and deter%ine the
client and SO0s cogniti)e li%itation
.. E?2lained the cause o- the
s'%2to%s and disease To 2ro)ide $no*ledge
/. E?2lained the goal o- treat%ent To 2ro)ide a22ro2riate in-or%ation
1. Pro)ide an en)iron%ent that is
conduci)e to learning
To -acilitate learning
3. !denti-' su22ort 2ersons or SO
re@uiring in-or%ation
To let the SO a*are o- the condition o-
the client
E)aluationI
#oal %et. A-ter 1 hours o- rendering o- nursing inter)ention the 2atient *as a6le
to 2artici2ate in learning 2rocess and *as a6le to )er6alize understanding o- condition
o- treat%ent.
59
N7RSIN& C.RE P#.N F2
Se2te%6er .9, .>>;
Su67ecti)e CueI
S&ili $o $ala$a* %a0a% $a' *ala ga7ud $usog a$o tiilT. As )er6alized 6' the 2atient
O67ecti)e cuesI
Li%ited range o- %otion, li%ited a6ilit' to 2er-or% grossL-ine %otor s$ills, di--icult'
turning, slo*ed %o)e%ent uncoordinated %o)e%ent, %o)e%ent induced, 2ostural
insta6ilit', ina6ilit' to %aintain acti)it'.
,LS ta$en as -ollo*I
Te%2I /4.3 WC RRI +9 c2% PRI 94 62% BP I ++>L5> %%(g
"ursing &iagnosisI
!%2aired 2h'sical %o6ilit' related to ina6ilit' to %aintain acti)it' as e)idenced 6'
li%ited range o- %otion.
PlanningI
Bithin 9 hours o- gi)ing a22ro2riate nursing inter)ention, 2atient *ill 6e a6le to
2artici2ate in Acti)ities o- &ail' Li)ing and desired acti)ities.
!nter)entionsI
+. Monitor )ital signs
Baseline data during %edication o- 2rocedures.
.. O6ser)e %o)e%ent *hen client is una*are o- o6ser)ation.
To note an' incongruence *ith re2orts o- a6ilities.
/. "ote e%otionalL 6eha)ioral res2onses to 2ro6le%s o- i%%o6ilit'.
8eelings o- -rustrationL2o*erless %a' i%2ulse attain%ent o- goals.
1. Encourage 2artici2ation in sel- care, di)ersional acti)ities.
Enhances sel- conce2t and sense o- inde2endence.
3. !denti-' energ': conser)ing techni@ues -or A&L0s.
Li%its -atigue, %a?i%izing 2artici2ation.
4. Encourage ade@uate inta$e o- -luidsL nutritious -oods
Pro%otes *ell 6eing and %a?i%izes energ' 2roduction.
5. Encourage clientsLSO0s in)ol)e%ent in decision %a$ing as %uch as 2ossi6le.
Pro%otes *ell 6eing and %a?i%izes energ' 2roduction.
E)aluationI
#oal *as not %et. Patient *as not a6le to 2artici2ate in Acti)ities o- &ail' li)ings
and desired acti)ities.
?<
60
N7RSIN& C.RE P#.N F=
Se2te%6er .9, .>>;
Su67ecti)e cueI
SBa'a 2a a$o $aligo 2ila na $aadla*T as )er6alized 6' the 2atient.
O67ecti)e cuesI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
&irt' nails noted
Bad 6od' odor noted
&andru-- noted
(alitosis noted
Patient is not 2ro2erl' groo%ed
&r' s$in noted
&iagnosisI
Self4are defiit related to im+aired +%ysial mobility
PlanningI
A-ter . hours o- rendering nursing inter)ention 2atient *ill 6e a6le to 2er-or% sel-:
care acti)ities *ithin 2h'sical li%itations.
Inter!ention: Rationale
+. &eter%ined indi)idual strengths
and s$ills Lo- the client
To $no* the strengths and *ea$nesses
o- the client as 6asis in gi)ing
a22ro2riate inter)entions
.. Pro)ide -or co%%unication
a%ong those *ho are in)ol)ed
in caring
To gain trust and coo2eration -ro% the
client and SO
/. Pro)ide health teaching to
2atient a6out the i%2ortance o-
good h'giene
To 2ro%ote good h'giene to the 2atient
1. &e)elo2 2lan o- care a22ro2riate
to indi)idual situation,
scheduling acti)ities to con-or%
to clients nor%al schedule
To encourage 2er-or%ance o- A&L
*ithin 2h'sical li%itation
3. Plan ti%e -or listening to the
client and SO
To disco)er 6arriers to 2artici2ation in
regi%en
63 &e%onstrated to the client and
SO the 6asic *a's in sel- care
such as hand *ashing, co%6ing
the hair, tri%%ing nails, tooth
6rushing and 6athing
To 2ro)ide a*areness that sel- care
acti)ities are still 2ossi6le e)en *ith
2h'sical li%itations
61
5. Encouraged 2atient and SO to
use 2roducts to enhance sel-
i%age such as deodorant
To 2ro%ote sel- care
E)aluationI
#oal %et. A-ter 1 hours o- rendering nursing inter)ention 2atient *as a6le to
2er-or% sel-:care acti)ities such as co%6ing, tooth 6rushing and tri%%ing o- nails.
62
N7RSIN& C.RE P#.N F>
Se2te%6er .9, .>>;
Su67ecti)e cuesI
S "anhina %an a$o %aa%, %urag na*al an $o ug $usogT , as )er6alized 6' the
2atient.
O67ecti)e CuesI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
&ecreased 2h'sical strength
&ecreased %o6ilit'
Bea$ness
"ursing &iagnosisI
Po*erlessness related to decreased 2h'sical strength.
PlanningI
A-ter 9 hours o- rendering nursing care the 2atient *ill 6e a6le to e?2ress sense
o- control o)er the 2resent situation and ho2e-ulness a6out -uture outco%es.
!nter)entionsI
+. Encourage client to 6e acti)e in o*n health care %anage%ent
and to ta$e res2onsi6ilit' -or choosing o*n actions and reactions.
Can enhance -eelings o- 2o*er and sense o- 2ositi)e sel- \estee%.
.. E?2ress ho2e -or client and encourage re)ie* o- 2ast
e?2eriences *ith success-ul strategies.
Sho* concerns to client as a 2erson.
/. Acce2t e?2ressions o- -eelings, including anger and reluctance,
to tr' to *or$ things out.
Being a6le to e?2ress -eelings -reel' ena6les client to sort out
*hat is ha22ening and co%e to a 2ositi)e conclusion.
1. Ma$e ti%e to listen to client0s 2erce2tions o- the situation.
Sho*s concern -or client as a 2erson.
3. Listen to state%ents client %a$es *hich %ight indicate -eelings o-
2o*erlessness.
Suggest concerns regarding on 2o*erL a6ilit' to control
situation.
4. Monitor )ital signs.
To ha)e 6aseline data.
E)aluationI
63
#oal %et. Patient *as a6le to e?2ress sense o- control and ho2e-ulness a6out
-uture outco%es.
N7RSIN& C.RE P#.N F?
Se2te%6er .9, .>>;
Su67ecti)e cueI
S"a6iro $o nga di na $o %a$ala$a*T as )er6alized 6' the 2atient
O67ecti)e cueI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
Poor e'e contact
Tear-ulness during con)ersation
,er6alization o- concerns (refer to subjective cue)
Anal'sisI
.n:iety related to t%reat on role funtion seondary to +%ysial illness
PlanningI
A-ter 9 hours o- dut' 2atient *ill 6e a6le to identi-' health' *a's to deal *ith and
relie)e an?iet'
!nter)ention Rationale
+. Pro)ided o22ortunities -or @uestion
and ans*er session
Enhance sense o- trust and nurse client
relationshi2
.. Co%2ared )er6al and non:)er6al
res2onses
/. Encouraged )er6alization o- -eelings
To note %is2erce2tion o- situations
To 2ro)ide a22ro2riate e%otional
su22orti)e care
1. &iscussed the disease o- #uillain:
Barre S'ndro%e
3. Enu%erated *a's the 2atient %a'
use to relie)e an?iet' such as acce2ting
the realit' o- his condition, o2ti%istic
*a' o- seeing things and ha)ing -aith in
#od0s lo)e
To 2ro)ide in-or%ation that could hel2
2atient understand conditions
To 2ro)ide in-or%ation and to 6oost
2atient0s ho2e
E)aluationI
64
#oal 2artiall' %et. A-ter 9 hours o- inter)ening, the 2atient *as a6le to enu%erate
*a's to relie)e an?iet' 6ut )er6all' said, S Bisan na$asa6ot na $o..&ili ga7ud na$u
%ali$a'an na %ag:isi2 ng a$o $ahi%tang $aron.T
N7RSIN& C.RE P#.N F@
Se2te%6er .9, .>>;
Su67ecti)e cuesI
] Mahadlo$ lage a$o %otindog $a' 6asin %atu%6a a$oT as )er6alized 6' the 2atient.
O67ecti)e cuesI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
&i%inished 2roducti)it'
A)oidance 6eha)ior
!ncreased 2ers2iration
Pallor
&iagnosisI
8ear related to loss o- 2h'sical su22ort as e)idenced 6' di%inished 2roducti)it'.
PlanningI
A-ter t*o da's o- rendering a22ro2riate nursing care 2atient *ill dis2la'
a22ro2riate range o- -eelings lessened -ear.
!nter)entionsI
+ .Co%2are )er6alL non:)er6al res2onses.
To note congruencies as o- situation.
.. Sta' *ith the client or %a$e arrange%ents to ha)e so%eone else 6e there.
Sense o- a6andon%ent can e?acer6ate -ear.
/. Pro)ide in-or%ation in )er6al and *ritten -or%. S2ea$ in si%2le sentences and
concrete ter%s.
8acilitate understanding and retention o- in-or%ation.
1. Pro)ide o22ortunit' -or @uestions and ans*er honestl'.
Enhances sense o- trust to nurse:client relationshi2
3.Present o67ecti)es in-or%ation *hen a)aila6le an d allo* client to use it -reel'. A)oid
arguing a6out client 2erce2tions o- the situations.
Li%its con-licts *hen -ear res2onse %a' i%2air rational thin$ing.
4.Pro%ote client control *here 2ossi6le and health client identi-' and acce2t those
things o)er *hich control is not 2ossi6le.
strengthen internal locus o- control
5.E?2lain 2rocedures *ithin le)el o- clients a6ilit' to understand and handle.
To 2re)ent con-usion or o)erload
9.Encourage assist client to de)elo2 e?ercise 2rogra%.
65
Pro)ides a health' outlet -or energ' generated 6' -ear-ul -eelings and 2ro%otes
rela?ation.
E)aluationI
#oal is %et. A-ter . da's o- rendering a22ro2riate nursing care, 2atient is a6le to
dis2la' a22ro2riate range o- -eelings and lessened -ear.
N7RSIN& C.RE P#.N FA
Se2te%6er .;, .>>;
Su67ecti)e cueI
SMa0a% dili na%an $o $ali6ang ta2os tag duga'T as )er6alized 6' he 2atient.
O67ecti)e cueI
irrita6le, restlessness, *ea$ness, una6le to %o)e, hard stool.
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
"ursing &iagnosisI
Altered Bo*el Mo)e%entI Consti2ation related to !nsu--icient Ph'sical Acti)it'.
PlanningI
A-ter 9 hours o- dut', 2atient *ill 6e a6le to )er6alize understanding o- the
i%2ortance o- %o6ilit' and diet to nor%al 6o*el %o)e%ent
!nter)entionsI
INTER6ENTIONS R.TION.#E
!nde2endentI
+. Ad)ised 2atient to drin$ ade@uate
-luid and include -oods that are high in
-i6er li$e 2a2a'a, oat%eal and
2inea22le
:to 2ro%ote %oist and so-t stool
.. Encouraged acti)it'Le?ercises *ithin
2ersonal li%itation.
:to sti%ulate a6do%inal %uscle
contraction.
/.Pro)ided *ith 2ri)ac' and routinel'
scheduled ti%e de-ecation
:to 2ro%ote de-ecation
1.Educated 2atient a6out the
i%2ortance o- %o6ilit' and diet to
nor%al 6o*el %o)e%ent
3."ote energ'. Acti)it' le)el and
e?ercise 2attern.
4. Auscultate a6do%en -or the
characteristics o- 6o*el sounds
:to 2ro)ide in-or%ation
: sedi%entar' li-est'le %a' a--ect
eli%ination 2atterns
: re-lecting 6o*el acti)it'
&e2endentI
+.Ad%inistered Bisacod'l <2edia=
su22ositor' as 2rescri6ed
To increase 2eristalsis 2ro%oting eas'
de-ecation
66
E)aluationI
#oal %et. A-ter 9 hours o- dut', 2atient a6le to de-ecate and )er6alized S
na$ali6ang na ga7ud $o %aa%,i%2ortante dia' ga7ud ang e?ercise ug diet la6a* na
adtong ta%6al na tagsu$su$ sa a$o lu6ot.T
N7RSIN& C.RE P#.N FB
Se2te%6er .;, .>>;
Su67ecti)eI
S&ili $o $ara7a* %a$atulogT as )er6alized 6' the 2atient.
O67ecti)esI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
E'e6ags noted
8re@uent 'a*ning noted
Restlessness noted
Sun$en e'es noted
8atigue
An?iet'
&ecreased a6ilit' to -unction
"ursing &iagnosisI
Slee2 Pattern &istur6ance related to en)iron%ental -actors such as e?ternal
noise and lac$ o- slee2 2ri)ac'.
PlanningI
A-ter 9 hours o- dut', 2atient *ill 6e a6le to re2ort i%2ro)e%ent in slee2 2attern.
INTER6ENTIONS R.TION.#E
!nde2endent
+. Pro)ided *ith @uiet and cal%
en)iron%ent during 6edti%e
To 2ro%ote rest and slee2
.. Ad)ised to li%it -luid inta$e in
e)ening
:to reduce need -or nightti%e
%icturation
/. Encouraged 2artici2ation in regular
e?ercise 2rogra% during da'
:to aid stress controlLrelease o- energ'
1. !denti-ied the -actors that a--ect the
slee2ing 2attern
:to reduce slee2 distur6ance
3..Reco%%ended to li%it inta$e o-
chocolates and ca--einated 6e)erages
Such 6e)erages are sti%ulants that
inhi6its slee2
&e2endent
67
+. Ad%inistered sedati)e L other slee2
%edication *hen indicated
:to enhance clients a6ilit' to -all aslee2
E)aluationI
#oal %et. A-ter 9 hours o- dut', 2atient a6le to slee2 co%-orta6l' and re2ort
i%2ro)e%ent o- slee2 2attern.
N7RSIN& C.RE P#.N FC
Se2te%6er .;, .>>;
Su67ecti)e cueI
SMaula* na$o sa a$o $ahi%tang $aron,T as )er6alized 6' the 2atient.
O67ecti)e cueI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
Loss o- 6od' -unction noted
Restlessness noted
(iding 6od' 2arts *ith 6lan$et <lo*er e?tre%ities=
Less e'e contact
Bea$ness and nu%6ness <lo*er e?tre%ities=
Anal'sisI
0isturbed body image related to +%ysial illness as e!idened by inability
to "al*
PlanningI
A-ter 9 hours gi)ing a22ro2riate nursing inter)ention, 2atient *ill ac$no*ledge
sel- as an indi)idual *ho has res2onsi6ilit' -or sel-.
Inter!ention Rationale
+.Encouraged -a%il' %e%6er to treat
client nor%all' and not as in)alid.
To a)oid -eeling o- isolation or re7ection
..Encouraged e?2ression o- -eeling
regarding his condition.
To 2ro)ide a22ro2riate e%otional su22ort
/.Encouraged client to loo$ and touch
a--ected 6od' 2arts.
To 6egin to incor2orate changes into 6od'
i%age
1.&iscussed %eaning o- loss change to
client.
A change o- -unction such as i%%o6ilit'
%a' 6e %ore di--erent -or so%e to deal
*ith than a change in a22earance
3.,isited client -re@uentl' and
ac$no*ledged the indi)idual as so%eone
*ho is *orth*hile
Pro)ides o22ortunities -or listening o-
2atient0s concerns and @uestions.
68
E)aluationI
#oal %et. A-ter 9 hours gi)ing a22ro2riate nursing inter)ention, 2atient
)er6alized -eeling o- acce2tance and res2onsi6ilit' o- his a--ected 6od' 2arts as
e)idenced 6' -re@uent chec$ing and touching o- his lo*er e?tre%ities.
N7RSIN& C.RE P#.N F<D
Se2te%6er .;, .>>;
Su67ecti)e cueI
STaglaa' na %an $o diri sa hos2italT, as )er6alized 6' the client.
O67ecti)e cuesI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
Restlessness noted
8re@uent 'a*ning noted
,er6al e?2ression o- 6oredo%
ee2 on l'ing in 6ed
"ursing &iagnosisI
0efiient di!ersional ati!ity related to +%ysial limitations and la* of
soures.
PlanningI
A-ter 9 hours o- gi)ing a22ro2riate nursing inter)ention, 2atient *ill 6e a6le to
engage in satis-'ing acti)ities *ithin 2ersonal li%itations.
Inter!ention: Rationale
+.Ac$no*ledged realit' o- situation and
-eelings o- the client.
To esta6lish thera2eutic relationshi2
..Pro)ided *ith di)ersional acti)ities
such as reading %aterials and tal$ing
to the client.
To re-ocus the attention o- the client .
To relie)e 6oredo%.
/.Pro)ided change o- scener' . To direct attention.
1.Encouraged e?2ression o- -eelings To deter%ine concerns that needs
inter)ention.
3.Pro)ided re@uire%ents -or %o6ilit'
such as *heelchair.
8or %o6ilit'.
4.&e)elo2ed 2lan o- care a22ro2riate
to indi)idual situation, scheduling
acti)ities to con-or% to clients nor%al
To encourage 2er-or%ance o- A&L
*ithin 2h'sical li%itation.
69
schedule.
E)aluationI
#oal %et. A-ter 9 hours o- gi)ing a22ro2riate nursing inter)ention, 2atient
)er6alized -eelings o- satis-action in acti)ities engaged *ith in 2ersonal li%itations.
N7RSIN& C.RE P#.N F<<
Se2te%6er .;, .>>;
Su67ecti)e CuesI
Sadaghan sad diri ta*o, gusto na a$o ra isa,T as )er6alized 6' the 2atient.
O67ecti)e CuesI
)Ls ta$en as -ollo*I
Te%2I /4.3 c RRI +9c2% PRI 9462% BPI++>L5>%%(g
8atigue
O6ser)ed disco%-ort
O6ser)ed use o- unsuccess-ul social in reactions 6eha)ior
!nsecurit' in 2u6lic
&'s-unctional interaction *ith others
&iagnosisI
!%2aired social interactions related to li%ited 2h'sical %o6ilit'.
PlanningI
A-ter 9 hours o- gi)ing a22ro2riate nursing inter)ention 2atient *ill e?2ress
desireL6e in)ol)ed in achie)ing 2ositi)e changes in social 6eha)iors and inter2ersonal
relationshi2s.
!nter)entionsI
+. !nter)ie* -a%il', SO, and -riends.
To o6tain o6ser)ation o- clients 6eha)ior changes.
.. &eter%ine client use o- co2ing s$ills and de-ense %echanis%.
A--ects a6ilit' to 6e in)ol)ed in social situation
/. (a)e client list 6eha)iors that cause disco%-ort.
Once recognized, client can choose to change.
1. Bor$ *ith the client to alle)iate underl'ing negati)e sel- conce2ts
Because the' a-ter i%2ede social interactions
3. Encourage client to )er6alized 2ro6le%s and 2erce2tions o- reasons -or 2ro6le%s
70
Acti)e listen to note indications o- ho2elessness, 2o*erlessness, -ear, an?iet',
grie-, anger, -eeling unlo)ed or unlo)a6leE 2ro6le%s *ith se?ual identit'.
E)aluationI
#oal %et. A-ter 9 hours o- gi)ing a22ro2riate nursing inter)ention, 2atient
e?2ress desireL6e in)ol)ed in achie)ing 2ositi)e changes in social 6eha)iors and
inter2ersonal relationshi2s.
N7RSIN& C.RE P#.N F<2
Potential "ursing Care Plan
Subjective cue:
Objective cues:
Ascending 2aral'sis noted <-ro% -eet to the 2el)ic 2art=
Li%ited ROM
Slo*ed 6od' %o)e%ents noted
Bea$ness
"ursing &iagnosisI
,ig% ris* for im+aired s*in integrity related to immobility as e!idened by
asending +aralysis
PlanningI
A-ter 9 hours o- rendering a22ro2riate nursing inter)entions, 2atient *ill 6e -ree
-ro% an' ris$ o- i%2aired s$in integrit'.
INTER6ENTIONS R.TION.#E
+. Changed 2atient 2osition e)er' .
hours.
:to 2ro%ote circulation and 2re)ent 6ed
sore and consti2ation
.. Re%o)ed *etL*rin$led linens
2ro%2tl'.
:%oisture 2otentiates s$in 6rea$do*n
/. &e)elo2ed re2ositioning schedule
-or client, in)ol)ing client in reasons -or
and decisions a6out ti%es and
2ositions in con7unction *L other
acti)ities.
:to enhance understanding and
coo2eration.
1. Pro)ided *L *ell )entilated :To 2ro%ote co%-ort
71
en)iron%ent.
3. Ele)ated 6oth legs *ith a 2illo* To 2ro%ote 6lood )enous return
4. Encouraged 2atient to touch his
lo*er e?tre%ities e)er' no* and
then
:To re%ind the 2atient that his lo*er
e?tre%ities are 2resent and still needs
care
5. !ncreased -luid and high -i6er in diet. :to 2re)ent consti2ation.
E)aluationI
N7RSIN& C.RE P#.N F<=
Potential "ursing Care Plan
Su67ecti)e cueI
O67ecti)e cuesI
Ph'sical i%%o6ilit'
Motor d's-unction
Bea$ness and nu%6ness <lo*er e?tre%ities=
"ursing &iagnosisI
Ris$ -or !n7ur' related to Ph'sical !%%o6ilit'.
PlanningI
Patient *ill 6e a6le to understand o- indi)idual -actors that contri6ute to 2ossi6ilit'
o- in7ur'.
"ursing !nter)entionI
+. Per-or% thorough assess%ent regarding sa-et' issues *hen 2lanning
-or client care andLor 2re2aring -or discharge -ro% care.
8ailure to accuratel' assess and inter)ene or re-er these
issues can 2lace the client at needless ris$ and creates
negligence issues -or the health care 2ractitioner.
.. Ascertain $no*ledge o- sa-et' needsLin7ur' 2re)ention and
%oti)ation.
To 2re)ent in7ur' in ho%e and co%%unit'.
/. "ote clients0 de)elo2%ental stage, decision: %a$ing a6ilit', le)el o-
cognitionLco%2etence.
A--ects clients a6ilit' to 2rotect sel- and in-luence choice o-
inter)ention.
1. Assess %ood, co2ing a6ilities, 2ersonalit' st'les.
72
That %a' result in carelessnessLincreased ris$:ta$ing *ithout
consideration o- conse@uences.
3. Assess clients0 %uscle strength, gross and -ine %otor coordination.
To identi-' ris$ -or -alls.
4. !denti-' inter)entionsLsa-et' de)ices.
To 2ro%ote sa-e 2h'sical en)iron%ent and indi)idual sa-et'.
5. &iscuss i%2ortance o- sel- %onitoring o- conditionLe%otions.
That can contri6ute to occurrence o- in7ur'.
E)aluationI
0ISC,.R&E P#.N
"a%eI Patient R
8inal &iagnosisI #uillain Barre0 S'ndro%e
Condition u2on &ischargeI !%2ro)ed
&ate o- &ischargeI Octo6er >4, .>>;
MedicationsI
!nstructed 2atient and SO to ta$e the %edication on ti%e.
Co%2leted duration o- those o- %edications ta$e ho%e.
!nstructed SO to gi)e 2atient *ith Multi)ita%ins.
En)iron%ental ConcernsI
!nstructed SO to 2ro)ide clean en)iron%ent to 2re)ent lodging o- in-ectious
%icroorganis%s.
!nstructed SO to 2ro)ide 2ro2er dis2osal o- *astes.
!nstructed SO to re%o)e or lessen an' en)iron%ental hazards.
Changes in 'our ho%e en)iron%ent can aid in 'our reco)er' 6' %a$ing it easier
-or 'ou to 6athe, dress and 2re2are %eals *hile 'our %uscles return to nor%al
le)els o- strength.
Treat%entsI
Encouraged 2atient doing light e?ercise such as *al$ing.
Encouraged 2atient to ha)e an ade@uate rest 2eriods.
Encouraged SO to 2ro)ide co%-ort %easures to the 2atients.
73
!nstructed SO to change the 2osition o- the 2atient *hen l'ing in 6ed -or long
2eriods o- ti%e to 2re)ent 6ed sores.
8ind a good 2h'sical thera2' 2rogra% -ro% *hich 'ou can learn s2eci-ic
iso%etric, isotonic and resistance e?ercises to re6uild *ea$ened %uscles. Jou
%a' do these e?ercises on an out2atient 6asis and continue the% at ho%e.
Re%e%6er to 2ace 'oursel- and get ade@uate rest, as -atigue is to 6e e?2ected
*ith #uillain:Barre S'ndro%e.
(ealth TeachingsI
Pro)ided 2atient health teaching a6outI
0 Pro2er hand *ashing
0 Pro2er 2ersonal h'giene
0 Tell 2atient to -re@uentl' change 2ositions *hen l'ing in 6ed -or long
2eriods o- ti%e to 2re)ent 6ed sores.
Tell 2atient0s %other a6out %onitoring signs ^ s'%2to%s or recurring #uillain:
Barre S'ndro%e, eg. Tingling sensation, di--icult' o- s*allo*ing, restlessness,
-e)er.
!nstructed 2atient to a)oid so%e hea)' *or$s.
!nstructed SO to *ell coo$ the -ood.
Bear co%-orta6le shoes and soc$s to hel2 soothe 2ain and 6urning -ro%
neuro2ath' in the -eet. !ns2ect 'our -eet o-ten to 6e sure there are no cuts or
6listers that 'ou %a' not ha)e noticed.
Out Patient <-ollo* u2 chec$:u2=I
Encouraged 2atient to ha)e -ollo* u2 chec$:u2 a-ter / *ee$s.
!nstructed 2atient to noti-' 2h'sician i- there is an' undesired -eeling a6out the
disease.
&iet
Encouraged 2atient to eat nutritious -ood li$e )egeta6les.
Encourage 2atient to eat -ruits rich in )ita%in C -or strong i%%unit'.
Ad)ised 2atient to ta$e lo*:sodiu% diet.
!nstructed 2atient to a)oid 7un$ -oods.
8ollo* a health' eating 2lan *ith -resh, seasonal -ruits and )egeta6les, lean
%eat and -ish, *hole grains and 2lent' o- color-ul salads. Eating *ell %a' hel2
'ou to sustain 'our energ' and can 6oost 'our %ood.
S2iritual
74
Encouraged 2atient to attend %ass as -re@uent as he can, or e)en once a *ee$
together *ith his -a%il'.
Encouraged 2atient to al*a's 2ra' to #od to hel2 hi% to reco)er i%%ediatel'.
Encouraged 2atient than$ #od -or the gi-t o- li-e.
Encouraged SO to 2ra' -or the health o- the 2atient.
E%otional
See$ e%otional su22ort to co2e *ith -eelings o- de2ression and an?iet' that are 2art o-
li)ing *ith #uillain:Barre S'ndro%e. &iscuss antide2ressant %edication *ith 'our doctor
i- 'ou are ha)ing trou6le *ith acti)ities necessar' -or dail' li)ing.
75
S7--.R5 O8 INTR.6ENO7S 8#7I0S
&ateLTi%e Started !ntra)enous 8luids and
,olu%e
&ro2 Rate "u%6er o- hours to 6e
!n-used
>;L.3L>;
>;L.4L>;
&3!MB +L
&3!MB +L
+3gttsL%in.
+3gttsL%in.
+4 hours and /> %inutes
+4 hours and /> %inutes
>;L.5L>;
&3!MB 3>>%l +3gttsL%in. 9 hours and +3 %inutes
+>L>+L>;
&3LR +L +3gttsL%in +4 hours and /> %inutes
+>L>.L>; &3LR +L +3gttsL%in +4 hours and /> %inutes
+>L>/L>; &3LR +L +3gttsL%in +4 hours and /> %inutes
+>L>1L>; &3LR +L +3gttsL%in +4 hours and /> %inutes
+>L>3L>; &3LR +L +3gttsL%in +4 hours and /> %inutes
76
'. &ENO&R.-
LegendI 4; 'ear old 43 'ear old
Mother died at the age o- 5+ 'ear +;;9 died at the age o- 49 'ear .>>3
8ather
#rand-ather 34 'ears old 1/ 'ears old
#rand%other
Si6lings
Patient
#BS
Cough
Arthritis
#eneralized S*elling
&eceased
77
0efinition of Terms
.utoimmune: Pertaining to autoi%%unit', a %isdirected i%%une res2onse that occurs
*hen the i%%une s'ste% goes a*r' and attac$s the 6od' itsel-.
.utoimmune disease: An illness that occurs *hen the 6od' tissues are attac$ed 6' its
o*n i%%une s'ste% . The i%%une s'ste% is a co%2le? organization *ithin the 6od'
that is designed nor%all' to Nsee$ and destro'N in)aders o- the 6od', including in-ectious
agents. Patients *ith autoi%%une diseases -re@uentl' ha)e unusual anti6odies
circulating in their 6lood that target their o*n 6od' tissues.
.:on: A long -i6er o- a ner)e cell <a neuron= that acts so%e*hat li$e a -i6er:o2tic ca6le
carr'ing outgoing <e--erent= %essages.
'ateria: Single:celled %icroorganis%s *hich can e?ist either as inde2endent <-ree:
li)ing= organis%s or as 2arasites <de2endent u2on another organis% -or li-e=.
'aterial: O- or 2ertaining to 6acteria. 8or e?a%2le, a 6acterial lung in-ection.
'lood +ressure: The 6lood 2ressure is the 2ressure o- the 6lood *ithin the arteries. !t
is 2roduced 2ri%aril' 6' the contraction o- the heart %uscle. !tCs %easure%ent is
recorded 6' t*o nu%6ers. The -irst <s'stolic 2ressure= is %easured a-ter the heart
contracts and is highest. The second <diastolic 2ressure= is %easured 6e-ore the heart
contracts and lo*est. A 6lood 2ressure cu-- is used to %easure the 2ressure. Ele)ation
o- 6lood 2ressure is called Nh'2ertensionN.
'rain: That 2art o- the central ner)ous s'ste% that is located *ithin the craniu%
< s$ull =. The 6rain -unctions as the 2ri%ar' recei)er, organizer and distri6utor o-
in-or%ation -or the 6od'. !t has t*o <right and le-t= hal)es called Nhe%is2heres.N
'reat%ing: The 2rocess o- res2iration, during *hich air is inhaled into the lungs through
the %outh or nose due to %uscle contraction, and then e?haled due to %uscle
rela?ation.
Cam+ylobater ;e;uni: a s2ecies o- cur)ed, rod:sha2ed, non:s2ore -or%ing, #ra%:
negati)e %icroaero2hilic, 6acteria co%%onl' -ound in ani%al -eces._+` !t is one o- the
%ost co%%on causes o- hu%an gastroenteritis in the *orld. 8ood 2oisoning caused 6'
Ca%2'lo6acter s2ecies can 6e se)erel' de6ilitating 6ut is rarel' li-e:threatening. !t has
6een lin$ed *ith su6se@uent de)elo2%ent o- #uillain:BarrD s'ndro%e <#BS=, *hich
usuall' de)elo2s t*o to three *ee$s a-ter the initial illness.
Cerebros+inal fluid: A *ater' -luid, continuousl' 2roduced and a6sor6ed, *hich -lo*s
in the )entricles <ca)ities= *ithin the 6rain and around the sur-ace o- the 6rain and s2inal
cord.

78
Clinial trials: Trials to e)aluate the e--ecti)eness and sa-et' o- %edications or %edical
de)ices 6' %onitoring their e--ects on large grou2s o- 2eo2le.
Cure: <. To heal, to %a$e *ell, to restore to good health. Cures are eas' to clai% and,
all too o-ten, di--icult to con-ir%.
2. A ti%e *ithout recurrence o- a disease so that the ris$ o- recurrence is s%all, as in the
3:'ear cure rate -or %alignant %elano%a .
=. Particularl' in the 2ast, a course o- treat%ent. 8or e?a%2le, ta$e a cure at a s2a.
0iagnosis: < The nature o- a disease E the identi-ication o- an illness. 2 A conclusion or
decision reached 6' diagnosis. The diagnosis is ra6ies . = The identi-ication o- an'
2ro6le%. The diagnosis *as a 2lugged !,.
&astrointestinal: Ad7ecti)e re-erring collecti)el' to the sto%ach and s%all and large
intestines.
,eart: The %uscle that 2u%2s 6lood recei)ed -ro% )eins into arteries throughout the
6od'. !t is 2ositioned in the chest 6ehind the sternu% <6reast6oneE in -ront o- the
trachea, eso2hagus, and aortaE and a6o)e the dia2hrag% %uscle that se2arates the
chest and a6do%inal ca)ities. The nor%al heart is a6out the size o- a closed -ist, and
*eighs a6out +>.3 ounces. !t is cone:sha2ed, *ith the 2oint o- the cone 2ointing do*n
to the le-t. T*o:thirds o- the heart lies in the le-t side o- the chest *ith the 6alance in the
right chest.
See the entire de-inition o- (eart
,eart rate: The nu%6er o- heart 6eats 2er unit ti%e, usuall' 2er %inute. The heart rate
is 6ased on the nu%6er o- contractions o- the )entricles <the lo*er cha%6ers o- the
heart=. The heart rate %a' 6e too -ast < tach'cardia = or too slo* < 6rad'cardia =. The
2ulse is 6ulge o- an arter' -ro% the *a)e o- 6lood coursing through the 6lood )essel as
a result o- the heart 6eat. The 2ulse is o-ten ta$en at the *rist to esti%ate the heart rate.
See the entire de-inition o- (eart rate
Immune: Protected against in-ection. The Latin i%%unis %eans -ree, e?e%2t.
Immune system: A co%2le? s'ste% that is res2onsi6le -or distinguishing us -ro%
e)er'thing -oreign to us, and -or 2rotecting us against in-ections and -oreign su6stances.
The i%%une s'ste% *or$s to see$ and $ill in)aders.
Infetion: The gro*th o- a 2arasitic organis% *ithin the 6od'. <A 2arasitic organis% is
one that li)es on or in another organis% and dra*s its nourish%ent there-ro%.= A 2erson
*ith an in-ection has another organis% <a Nger%N= gro*ing *ithin hi%, dra*ing its
nourish%ent -ro% the 2erson.
79
Knee: The $nee is a 7oint *hich has three 2arts. The thigh 6one <the -e%ur= %eets the
large shin 6one <the ti6ia= to -or% the %ain $nee 7oint. This 7oint has an inner <%edial=
and an outer <lateral= co%2art%ent. The $neeca2 <the 2atella= 7oins the -e%ur to -or% a
third 7oint, called the 2atello-e%oral 7oint. The 2atella 2rotects the -ront o- the $nee 7oint.
#imb: The ar% or leg.
#o" blood +ressure : An' 6lood 2ressure that is 6elo* the nor%al e?2ected -or an
indi)idual in a gi)en en)iron%ent. Lo* 6lood 2ressure is also re-erred to as
h'2otension.
-usle: Muscle is the tissue o- the 6od' *hich 2ri%aril' -unctions as a source o- 2o*er.
There are three t'2es o- %uscle in the 6od'. Muscle *hich is res2onsi6le -or %o)ing
e?tre%ities and e?ternal areas o- the 6od' is called Ns$eletal %uscle.N (eart %uscle is
called Ncardiac %uscle.N Muscle that is in the *alls o- arteries and 6o*el is called
Ns%ooth %uscle.N
-yelin: The -att' su6stance that co)ers and 2rotects ner)es. M'elin is a la'ered tissue
that sheathes the a?ons <ner)e -i6ers=. This sheath around the a?on acts li$e a conduit
in an electrical s'ste%, ensuring that %essages sent 6' a?ons are not lost en route. !t
allo*s e--icient conduction o- action 2otentials do*n the a?on. M'elin consists o- 5>H
li2ids <cholesterol and 2hos2holi2id= and />H 2roteins. !t is 2roduced 6'
oligodendroc'tes in the central ner)ous s'ste%.
Ner!e: A 6undle o- -i6ers that uses che%ical and electrical signals to trans%it sensor'
and %otor in-or%ation -ro% one 6od' 2art to another..
Neurologial: (a)ing to do *ith the ner)es or the ner)ous s'ste%.
Onset: !n %edicine, the -irst a22earance o- the signs or s'%2to%s o- an illness as, -or
e?a%2le, the onset o- rheu%atoid arthritis . There is al*a's an onset to a disease 6ut
ne)er to the return to good health. The de-ault setting is good health.
Pain: An un2leasant sensation that can range -ro% %ild, localized disco%-ort to agon'.
Pain has 6oth 2h'sical and e%otional co%2onents. The 2h'sical 2art o- 2ain results
-ro% ner)e sti%ulation. Pain %a' 6e contained to a discrete area, as in an in7ur', or it
can 6e %ore di--use, as in disorders li$e -i6ro%'algia . Pain is %ediated 6' s2eci-ic
ner)e -i6ers that carr' the 2ain i%2ulses to the 6rain *here their conscious a22reciation
%a' 6e %odi-ied 6' %an' -actors.
Paralysis: Loss o- )oluntar' %o)e%ent <%otor -unction=. Paral'sis that a--ects onl' one
%uscle or li%6 is 2artial 2aral'sis, also $no*n as 2als'E 2aral'sis o- all %uscles is total
2aral'sis, as %a' occur in cases o- 6otulis%.
80
Parest%esia: An a6nor%al sensation o- the s$in, such as nu%6ness, tingling, 2ric$ing,
6urning, or cree2ing on the s$in that has no o67ecti)e cause. Paresthesia is the usual
A%erican s2elling and 2araesthesia the 2re-erred English s2elling.
Peri+%eral: Situated a*a' -ro% the center, as o22osed to centrall' located.
Peri+%eral ner!ous system 1PNS2: That 2ortion o- the ner)ous s'ste% that is outside
the 6rain and s2inal cord.
P%ysial t%era+y: A 6ranch o- reha6ilitati)e health that uses s2eciall' designed
e?ercises and e@ui2%ent to hel2 2atients regain or i%2ro)e their 2h'sical a6ilities.
Ph'sical thera2ists *or$ *ith %an' t'2es o- 2atients, -ro% in-ants 6orn *ith
%usculos$eletal 6irth de-ects, to adults su--ering -ro% sciatica or the a-ter: e--ects o-
in7ur', to elderl' 2ost:stro$e 2atients.
Plasma: The li@uid 2art o- the 6lood and l'%2hatic -luid, *hich %a$es u2 a6out hal- o-
its )olu%e. Plas%a is de)oid o- cells and, unli$e seru%, has not clotted. Blood 2las%a
contains anti6odies and other 2roteins. !t is ta$en -ro% donors and %ade into
%edications -or a )ariet' o- 6lood:related conditions. So%e 6lood 2las%a is also used in
non:%edical 2roducts.
Plasma+%eresis: A 2rocedure designed to de2lete the 6od' o- 6lood 2las%a <the li@uid
2art o- the 6lood= *ithout de2leting the 6od' o- its 6lood cells. Bhole 6lood is re%o)ed
-ro% the 6od', the 2las%a is se2arated -ro% the cells, the cells are sus2ended in saline,
a 2las%a su6stitute or donor 2las%a=, and the reconstituted solution %a' 6e returned to
the 2atient. The 2rocedure is used to re%o)e e?cess anti6odies -ro% the 6lood in lu2us,
%ulti2le sclerosis, %ulti2le %'elo%a, etc. Plas%a2heresis carries *ith it the sa%e ris$s
as an' intra)enous 2rocedure. The ris$ o- in-ection increases *ith the use o- donor
2las%a, *hich %a' carr' )iral 2articles des2ite screening 2rocedures. The 2rocedure is
done in a clinic or hos2ital.
Protein: A large %olecule co%2osed o- one or %ore chains o- a%ino acids in a s2eci-ic
order deter%ined 6' the 6ase se@uence o- nucleotides in the &"A coding -or the
2rotein.
Proteins: Large %olecules co%2osed o- one or %ore chains o- a%ino acids in a
s2eci-ic order deter%ined 6' the 6ase se@uence o- nucleotides in the &"A coding -or
the 2rotein.
Rela+se: The return o- signs and s'%2to%s o- a disease a-ter a 2atient has en7o'ed a
re%ission . 8or e?a%2le, a-ter treat%ent a 2atient *ith cancer o- the colon *ent into
re%ission *ith no sign or s'%2to% o- the tu%or, re%ained in re%ission -or 1 'ears, 6ut
then su--ered a rela2se and had to 6e treated once again -or colon cancer.
Residual: So%ething le-t 6ehind. Bith residual disease, the disease has not 6een
eradicated.
81
Res+iratory: (a)ing to do *ith res2iration, the e?change o- o?'gen and car6on dio?ide.
8ro% the Latin re: <again= R s2irare <to 6reathe= U to 6reathe again.
Sensory: Relating to sensation , to the 2erce2tion o- a sti%ulus and the )o'age %ade
6' inco%ing < a--erent = ner)e i%2ulses -ro% the sense organs to the ner)e centers.
S+inal ord: The %a7or colu%n o- ner)e tissue that is connected to the 6rain and lies
*ithin the )erte6ral canal and -ro% *hich the s2inal ner)es e%erge. Thirt':one 2airs o-
s2inal ner)es originate in the s2inal cordI 9 cer)ical , +. thoracic , 3 lu%6ar, 3 sacral,
and + cocc'geal. The s2inal cord and the 6rain constitute the central ner)ous s'ste%
< C"S =. The s2inal cord consists o- ner)e -i6ers that trans%it i%2ulses to and -ro% the
6rain. Li$e the 6rain, the s2inal cord is co)ered 6' three connecti)e:tissue en)elo2es
called the %eninges . The s2ace 6et*een the outer and %iddle en)elo2es is -illed *ith
cere6ros2inal -luid < CS8 =, a clear colorless -luid that cushions the s2inal cord against
7arring shoc$. Also $no*n si%2l' as the cord.
S+inal ta+: Also $no*n as a lu%6ar 2uncture or NLPN, a s2inal ta2 is a 2rocedure
*here6' s2inal -luid is re%o)ed -ro% the s2inal canal -or the 2ur2ose o- diagnostic
testing. !t is 2articularl' hel2-ul in the diagnosis o- in-la%%ator' diseases o- the central
ner)ous s'ste%, es2eciall' in-ections, such as %eningitis. !t can also 2ro)ide clues to
the diagnosis o- stro$e , s2inal cord tu%or and cancer in the central ner)ous s'ste%.
Stage: As regards cancer , the e?tent o- a cancer, es2eciall' *hether the disease has
s2read -ro% the original site to other 2arts o- the 6od'..
Steroid: A general class o- che%ical su6stances that are structurall' related to one
another and share the sa%e che%ical s$eleton <a tetrac'clic c'clo2enta_a`2henanthrene
s$eleton=.
Stro*e : The sudden death o- so%e 6rain cells due to a lac$ o- o?'gen *hen the 6lood
-lo* to the 6rain is i%2aired 6' 6loc$age or ru2ture o- an arter' to the 6rain. A stro$e is
also called a cere6ro)ascular accident or, -or short, a C,A.
Surgery: The *ord Nsurger'N has %ulti2le %eanings. !t is the 6ranch o- %edicine
concerned *ith diseases and conditions *hich re@uire or are a%ena6le to o2erati)e
2rocedures. Surger' is the *or$ done 6' a surgeon. B' analog', the *or$ o- an editor
*ielding his 2en as a scal2el is s -or% o- surger'. A surger' in England <and so%e other
countries= is a 2h'sicianCs or dentistCs o--ice.
Syndrome: A set o- signs and s'%2to%s that tend to occur together and *hich re-lect
the 2resence o- a 2articular disease or an increased chance o- de)elo2ing a 2articular
disease.
Trigger: So%ething that either sets o-- a disease in 2eo2le *ho are geneticall'
2redis2osed to de)elo2ing the disease, or that causes a certain s'%2to% to occur in a
82
2erson *ho has a disease. 8or e?a%2le, sunlight can trigger rashes in 2eo2le *ith
lu2us.
6iral: O- or 2ertaining to a )irus. 8or e?a%2le, NM' daughter has a )iral rash .N
6iral infetion: !n-ection caused 6' the 2resence o- a )irus in the 6od'. &e2ending on
the )irus and the 2ersonCs state o- health, )arious )iruses can in-ect al%ost an' t'2e o-
6od' tissue, -ro% the 6rain to the s$in. ,iral in-ections cannot 6e treated *ith anti6ioticsE
in -act, in so%e cases the use o- anti6iotics %a$es the in-ection *orse. The )ast
%a7orit' o- hu%an )iral in-ections can 6e e--ecti)el' -ought 6' the 6od'Cs o*n i%%une
s'ste% , *ith a little hel2 in the -or% o- 2ro2er diet, h'dration, and rest. As -or the rest,
treat%ent de2ends on the t'2e and location o- the )irus, and %a' include anti:)iral or
other drugs.
6irus: A %icroorganis% s%aller than a 6acteria, *hich cannot gro* or re2roduce a2art
-ro% a li)ing cell. A )irus in)ades li)ing cells and uses their che%ical %achiner' to $ee2
itsel- ali)e and to re2licate itsel-. !t %a' re2roduce *ith -idelit' or *ith errors <%utations=:
this a6ilit' to %utate is res2onsi6le -or the a6ilit' o- so%e )iruses to change slightl' in
each in-ected 2erson, %a$ing treat%ent %ore di--icult.
6iruses: S%all li)ing 2articles that can in-ect cells and change ho* the cells -unction.
!n-ection *ith a )irus can cause a 2erson to de)elo2 s'%2to%s. The disease and
s'%2to%s that are caused de2end on the t'2e o- )irus and the t'2e o- cells that are
in-ected.
83
RE8ERENCES
Brunner and Suddarth0s Medical and Surgical "ursing ele)enth edition
Patho2h'siolog' /
rd
edition 6' Tho%as J. "o*a$
Assess%ent 6' Li22incott Billia%s and Bil$ins
htt2ILLen.*i$i2edia.orgL*i$iLCa%2'lo6acterX7e7uni
htt2ILL***.a6out:guillain:6arre.co%L
htt2ILL***.cehs.siu.eduL-i?L%ed%icroLc%ir.ht%
htt2ILL***.a6out:ca%2'lo6acter.co%Lca%2'lo6acterXs'%2to%sXris$s
htt2ILL***.%edicinenet.co%Lguillain:6arreXs'ndro%eLarticle.ht%
htt2ILL***.direct:%s.orgL2d-LMolecularMi%icr'OtherL#illianBarrMolMi%icr'.2d-
htt2ILL***.%icro6iolog'6'tes.co%L6logL.>>9L>+L/>Lho*:ca%2'lo6acter:7e7uni:sur)i)es:
*ithin:cellsL
htt2ILL***.%icro6iolog'6'tes.co%L6logL.>>9L>+L/>Lho*:ca%2'lo6acter:7e7uni:sur)i)es:
*ithin:cellsL
htt2ILLen.*i$i2edia.orgL*i$iLM'elinXsheath
htt2ILL***.dr$aslo*.co%Lht%lL6loodXcellXcounts.ht%l
htt2ILL***.scri6d.co%
htt2ILL***.nursingcri6.co%
84