GUILLIAN-BARRE (GBS) LEWIS 1585-1587 CNs : III, V, VI, VII, X, XII

Etiology and Postinfectious polyneuropathy, ascending Drug Therapy  Plasmapheresis-used in 1st 2

Pathophysiology polyneuropathic paralysis. weeks, ↓ length of hospital
Acute, rapidly progressing, and potentially stay, length of time on a
fatal form of polyneuritis. It affects the ventilator, and time
peripheral nervous system and results in required to resume walking.
loss of myelin (a segmental  IV administration of high-
demyelination) and edema and dose immunoglobulin
inflammation of the affected nerves, (Sandoglobulin) has been
causing a loss of neurotransmission to the shown to be as effective as
periphery. plasma exchange and has
Etiology: Unknown, but it is believed to the advantage of immediate
be a cell-mediated immunologic reaction availability and greater
directed at the peripheral nerves. Often safety. Make sure pt is well
preceded by immune system stimulation hydrated and have adequate
from a viral infection, trauma, surgery, renal function. 3 weeks
viral immunizations, HIV. Campylobacter after disease onset, plasma
jejuni is most recognized organism. exchange and
Pathophysiology: These stimuli are immunoglobulin therapies
thought to cause an alteration in the have little value.
immune system, resulting in sensitization  Acute phase: Vasopressor
of T lymphocytes to the pt’s myelin and, agents and volume
ultimately, myelin damage. Demyelination expanders are used to treat
occurs, and the transmission of nerves low blood pressure.
impulses is stopped or slowed down. The
muscles innervated by the damaged
peripheral nerves undergo denervation and
atrophy. In recovery phase, remyelination
occurs slowly, and neurologic function
returns in a proximal-to-distal pattern.

Clinical Symptoms mild to severe: Surgical Therapy NA

Manifestation  Symptoms develop 1-3 weeks
after an upper respiratory or GI
infection.
 Hours to days: weakness of the
lower extremities, usually peaking
about the 14th day. Distal muscles
are more severely affected.
 Paresthesia (numbness & tingling)
 Hypotonia (reduced muscle tone)
 Areflexia (lack of reflexes)
 Objective sensory loss is variable,
with deep sensitivity more
affected than superficial
sensations.
 Autonomic nervous system
dysfunction: results from
alterations in both the sympathetic
and parasympathetic nervous
systems: Most dangerous:
orthostatic hypotension,
hypertension, and abnormal
 vagal responses (bradycardia,
heart block, asystole). Bowel and
bladder dysfunction, facial
flushing, diaphoresis.
 Syndrome of inappropriate
antidiuretic hormone secretion.
(SIADH)
 Progression of GBS include: CNs
VII, VI, III, XII, V, X. : facial
weakness, extraocular eye
movement difficulties, dysphagia,
and paresthesia of the face.
 Pain is common: paresthesias,
muscular aches, cramps, and
hyperesthesias. Pain is worse at
night. Pain also may lead to a
decrease in appetite and may
interfere with sleep.
Complications  RESPIRATORY FAILURE
(which occurs as the paralysis
progresses to the nerves that
innervate the thoracic area)
 Fever: 1st sign of infection
 Immobility: from paralysis can
cause problems such as paralytic
ileus, muscle atrophy, DVT,
pulmonary emboli, skin
breakdown, orthostatic
hypotension, nutritional
deficiencies.
Diagnostic Studies  CSF: normal or has a low protein
content initially, but after 7-10
days: shows ↑ protein level to
700mg/dl (norm 15-45mg/dl) with
normal cell count.
 EMG and nerve conduction:
(electromyogram) abnormal
reduced nerve conduction velocity
in the affected extremities.
Nursing Diagnosis  Impaired spontaneous
ventilation r/t progression of
Acute  Monitor ascending
Intervention paralysis
 Assess respiratory function
 Monitor ABGs
 Assess gag reflex
 Assess Corneal reflex
 Assess swallowing reflexes
 Monitor BP, Cardiac rate
and rhythm.
 Assess for autonomic
dysfunction: bradycardia,
dysrhythmias.
 Assess for orthostatic
hypotension secondary to
muscle atony may occur in
severe cases.
 If SIADH is present: fluid
restriction is initiated.
Nursing Nutritional Therapy:
Management  Soft mechanical diet
 Mild dysphagia is managed
by placing pt in upright
position and flexing the
head forward during
feeding.
 Severe dysphagia: tube
feeding may be required.
 Pts with paralytic ileus or
intestinal obstruction:
parenteral nutrition.
Nursing The objection of therapy is to
support body systems until the
 disease process resulting in
respiratory muscle paralysis.
 Risk for aspiration r/t dysphagia.
 Acute pain r/t paresthesias,
muscle aches and cramps, and
hyperesthesias.
 Impaired verbal communication
r/t intubation or paralysis of the
muscles of speech.
 Fear r/t uncertain outcome and
seriousness of the disease.
 Self-care deficits r/t inability to
use muscles to accomplish
activities of ADLs.
Health Promotion Goal:
Implementation patient recovers.
 Monitor vital capacity and
ABG.
 If vital capacity drops to
<800ml (15ml/kg or 2/3 of
pt’s normal vital capacity)
or ABCs deteriorate,
endotracheal intubation or
tracheostomy may be done.
 Meticulous suctioning
technique is needed to
prevent infection.
 Bronchial hygiene and
chest physiotherapy: to help
clear secretions and prevent
respiratory deterioration
 If fever exists: obtain
sputum cultures to identify
pathogen.
 Establish a communication
system: difficult if cranial
nerves are involved.
 Explain all procedures
before doing, and reassure
pt that muscle function will
return.
 Intermittent cath since
urinary retention is
common for a few days.
 If pt is receiving >2.5
L/day: indwelling
catheterization is safer.
 Physical therapy should be
indicated early to help
prevent problems r/t
immobility
 ROM exercises to prevent
contractures/ deformities.
 Meticulous eyes care
should be provided to
prevent corneal damage or
irritation
 Check for gag reflex (note
drooling)
 Assess tube feedings or
parenteral nutrition since
delayed gastric emptying
exists.
 Monitor electrolytes
 Initiate a bowel program.
 Provide support and
encouragement.
 Pt will be free from aspiration
 Maintain adequate ventilation
 Be pain free or have pain
controlled
 Maintain adequate nutritional
intake
 Maintain an acceptable method of
communication
 Return to usual physical
functioning.