What is Guillain Barre Syndrome?

Guillain-Barre syndrome is a serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness.

Guillain-Barr syndrome is an acute, usually rapidly progressive inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss. Cause is thought to be autoimmune.

Guillain-Barr syndrome is the most common acquired inflammatory neuropathy. Although the cause is not fully understood, it is thought to be autoimmune. There are several variants. In some, demyelination

predominates; others affect the axon.

Signs and Symptoms

Symptoms of Guillain-Barre can get worse very quickly. It may take only a few hours to reach the most severe symptoms, but weakness increasing over several days is also common. Typical symptoms include:
y y

Loss of reflexes in the arms and legs Muscle weakness or loss of muscle function (paralysis)
o o o o o o

In mild cases, there may be no weakness or paralysis May begin in the arms and legs at the same time May get worse over 24 to 72 hours May occur in the nerves of the head only May start in the arms and move downward May start in the feet and legs and move up to the arms and head

y y y y

Numbness, decreased sensation Sensation changes Tenderness or muscle pain (may be a cramp-like pain) Uncoordinated movement

Additional symptoms may include:

y y y y y

Blurred vision Clumsiness and falling Difficulty moving face muscles Muscle contractions Palpitations (sensation of feeling heartbeat)

Emergency symptoms (seek immediate medical help):

y y

Breathing temporarily stops Can't take a deep breath

y y y y y

Difficulty breathing Difficulty swallowing Drooling Fainting Feeling light-headed when standing

Diagnostic Procedures
Spinal tap (lumbar puncture) This procedure involves withdrawing a small amount of fluid from your spinal canal at your low back (lumbar) level. This cerebrospinal fluid is then tested for a specific type of change that commonly occurs in people who have Guillain-Barre syndrome. Nerve function tests Your doctor may want information from two types of nerve function tests electromyography and nerve conduction velocity:

 Electromyography reads electrical activity in your muscle to determine if your weakness is caused by muscle damage or nerve damage.

 Nerve conduction studies assess how your nerves and muscles respond to small electrical stimuli.

Treatments and Medications

 Plasmapheresis A method called plasmapheresis is used to remove proteins, called antibodies, from the blood. The process involves taking blood

from the body, usually from the arm, pumping it into a machine that removes the antibodies, then sending it back into the body.

 Intravenous immunoglobulin Immunoglobulin contains healthy antibodies from blood donors. High doses of immunoglobulin can block the damaging antibodies that may contribute to Guillain-Barre syndrome.

 Analgesics and muscle relaxants It is usually given to control painful sensations and fasciculation.

Other treatments are directed at preventing complications.

y y

Blood thinners may be used to prevent blood clots. If the diaphragm is week, breathing support or even a breathing tube and ventilator may be needed.

Pain is treated aggressively with anti-inflammatory medicines and narcotics, if needed.

Proper body positioning or a feeding tube may be used to prevent choking during feeding if the muscles for swallowing are weak.

Nursing Interventions
Monitor respiratory status through vital capacity measurements, rate and depth of respirations, and breath sounds. Monitor level of muscle weakness as it ascends toward respiratory muscles. Watch for breathlessness while talking which is a sign of respiratory fatigue. Monitor the patient for signs of impending respiratory failure. Monitor gag reflex and swallowing ability. Position patient with the head of bed elevated to provide for maximum

chest excursion. Avoid giving opioids and sedatives that may depress respirations. Position patient correctly and provide range-of-motion exercises. Provide good body alignment, range-of-motion exercises, and change of position to prevent complications such as contractures, pressure sores, and dependent edema. Ensure adequate nutrition without the risk of aspiration. Encourage physical and occupational therapy exercises to help the patient regain strength during rehabilitation phase. Provide assistive devices as needed (cane or wheelchair) to maximize independence and activity. If verbal communication is possible, discuss the patients fears and concerns. Provide choices in care to give the patient a sense of control. Teach patient about breathing exercises or use of an incentive spirometer to reestablish normal breathing patterns. Instruct patient to wear good supportive and protective shoes while out of bed to prevent injuries due to weakness and paresthesia. Instruct patient to check feet routinely for injuries because trauma may go unnoticed due to sensory changes. Urge the patient to maintain normal weight because additional weight will further stress monitor function. Encourage scheduled rest periods to avoid fatigue.