Guillain-Barré Syndrome

Anatomy & Physiology

Peripheral Nervous System (PNS) – lies about outside the CNS and consists of
nerves and ganglia.

Sensory or AFFERENT Division – conducts action potentials from sensor receptors

to the CNS. Sensory Neurons.

Motor or EFFERENT Division – conducts action potentials from the CNS to effector
organs such as muscles and glands. Motor Neurons.

Somatic Motor Nervous System – transmits action potentials from CNS to skeletal
muscles.

Autonomic Nervous System (ANS) – transmits action potentials from CNS to cardiac
muscle, smooth muscle, and glands.

Axon – conducts action potentials from one part of the brain or spinal cord to another
part.

Schwann Cells (Neurolemmocytes or Neurolemma Cells) – a neuroglia that forms a

highly specialized insulating layer of cells called the Myelin Sheath.

Unmyelinated Axons – rest in indentations of the oligodendrocytes in the CNS and

the Schwann Cells in the PNS.

Oligodendrocytes – cell processes form myelin sheaths around axons, or enclose

unmyelinated axons in the CNS.

Myelinated Axons – have specialized sheaths, called myelin sheaths, wrapped around
them.

Myelin – an excellent insulator, which prevents almost all electric current flow
through the cell membrane. It also covers nerves and speeding the conduction of
impulses from the cell body to dendrites.

Reflex – an involuntary action in response to a stimulus applied to the periphery and

transmitted to the CNS. It allows person to react to stimuli more quickly.
Reflex arc – neuronal pathway by which a reflex occurs.

Five components of Reflex Arc:

1. Sensory Receptor – a structure that reacts to a physical stimulus in the

environments, whether internal or external.

2. Sensory Neuron – nerve cells within nervous system responsible for converting
external stimuli into internal electrical impulses.

3. Interneurons – relay signals between afferent and efferent neurons.

4. Motor Neuron – nerve cell which impulses pass from bain or spinal cord to muscle
or gland.

5. Effector Organ – a muscle, gland, or an organ capable of responding to stimulus.

Affected Cranial Nerves

II – Optic Nerve = Sensory: Vision.

IX – Glossopharyngeal = Sensory: taste and touch to back of tongue; Motor to

pharyngeal muscles; parasymphathetic to salivary glands.

X – Vagus = Sensory to pharynx, larynx, and viscera; motor to palate, pharynx, and
larynx; parasymphathetic to viscera of thorax and abdomen.

XI – Accessory = Motor to two neck and upper back muscles.

XII – Hypoglossal = Motor to tongue muscles.

Overview of the Disease

Guillain-Barre Syndrome

 An autoimmune attack on the peripheral nerve myelin.

 The result is acute, rapid segmental, demyelination of peripheral nerves and
some cranial nerves.
 Campylobacter Jejuni, Cytomegalovirus, Haemophilus Influenzae, and Human
Immunodeficiency Virus (HIV) are most common infectious agents that are
associated with the development of Guillain-Barre Syndrome.
  It is more frequent in males between ages 16 & 25 and 45 & 60 years of age.
 Death occurs in 5% of cases, resulting from Respiratory Failure, Autonomic
Dysfunction, Sepsis, or Pulmonary Emboli.

Clinial Manifestations

 Muscle weakness
 Hyporeflexia or areflexia
 Hyporeflexia & weakness may lead to Tetraplegia
 Neuromuscular respiratory failure
 Parethesias
 Pain
 Bulbar muscle weakness
 Blindness
 Tachycardia, Bradycardia, Hypertension, or Orthostatic Hypotension
 Ataxia

Assessment

 History of a Viral Illness (Such as Campylobacter Jejuni, Cytomegalovirus,

Haemophilus Influenzae, and Human Immunodeficiency Virus (HIV)).
 Assess speech, Cranial Nerve Function of II, IX, X, XI, & XII, sensory
function, motor function, and reflexes.
 Changes in Vital Capacity & Negative Inspiratory Force (Spirometer) – to
identify impending neuromuscular respiratory failure.

Pathophysiology

 In GBS, the Schwann Cell is spared, allowing for remyelination in the recovery
phase of the disease.
 GBS is the result of cell-mediated and humoral immune attack on peripheral
nerve myelin proteins that causes inflammatory demyelination.
 Molecular Mimicry – an infectious organism contains an amino acid that
mimics the peripheral nerve myelin protein.
 The exact location of the immune attack is the ganglioside GM1b.
  The inflammation and destruction of the myelin leaves the axon unable to
support nerve conduction.

Medical Management

 Respiratory Therapy or Mechanical Ventilation

 Elective Intubation
 Use of anticoagulant agents
 Use of thigh-high elastic compression stockings or sequential compression
boots
 Plasmapheresis & IVIG
 Continuous ECG monitoring
 If Tachycardia and Hypertension are suspected, administer short acting
medications such as alpha-adrenergic blocking agents, as ordered.
 If Hypotension is present, increase amount of IVF, as ordered.

Nursing Diagnosis

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

Nursing Management

 Maintaining respiratory function

 Enhancing physical mobility
 Providing adequate nutrition
 Improving communication
 Decreasing fear and anxiety
 Monitoring and managing potential complications