LESSON PLAN ON

GUILLAIN BARRE
SYNDROME

Presented by, Submitted to,

Mr Vivek Kurane, Mrs Meena Sonawane.

1st year Msc Nursing HOD Child Health Nursing

INE - Mumbai -08 INE- Mumbai -08

Name of the student teacher : Vivek Kurane

Subject : Nursing Education

Unit :

Topic : Nursing Management Of

Guillain barre syndrome

Previous knowledge about the topic : Students have some

knowledge about topic.

A.V AIDS : LCD Black board ,

Methods of teaching : Lecture cum discussion

Class : First year M.Sc. Nursing

Number of students :

Date :

Time :

Duration : 45 min

Venue :
 GENERAL OBJECTIVES:-

After completion of this class the students will be able to understand about
nursing management of Guillain Barre syndrome

SPECIFIC OBJECTIVES:-

At the end of the class students will be able to:

 Define Guillain Barre syndrome

 Explain etiology of Guillain Barre syndrome

 Explain various clinical manifestation

 Discuss the surgical management

 Explain nursing management of Guillain Barre syndrome

Tim Specific CONTENT Teachin Learnin AV. Evaluati
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2 Introduction Lecture Listenin LCD
Min g
Guillain-Barré syndrome is an autoimmune attack of the
peripheral nerve myelin. The result is acute, rapid segmental
demyelination of peripheral nerves and some cranial nerves,
producing ascending weakness with dyskinesia (inability to
execute voluntary movements), hyporeflexia (subnormal or
Absent reflexes), and paresthesias (numbness). Myelin is a
complex substance that covers nerves, providing
insulation and speeding the conduction of impulses from the cell
body to the dendrites. It is produced by Schwann cells that are
spared, allowing for remyelination in the recovery phase of the
disease

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2 To Antecedent Events Lecture Listenin LCD
Min explain g
• A respiratory or gastrointestinal infection, although vaccination,
antecede
nt pregnancy, and surgery were identifed as antecedents. Infection
Events
with Campylobacter jejuni (a relatively common gastrointestinal
bacterial pathogen) precedes Guillain-Barreé syndrome in a few
cases.
• The antecedent event usually occurs 2 weeks before symptoms
begin. Weakness usually begins in the legs and progresses
upward for about 1 month.

3 Explain
Min Pathophy
To siology
PATHOPHISIOLOGY
explain of
Pathophy • Guillain-Barré is the result of a cell-mediated immune attack on Guillain-
siology Barré
peripheral nerve myelin proteins. The best-accepted theory is
of syndrom
Guillain- that an infectious organism contains an amino acid that mimics e
Barré the peripheral nerve myelin protein. The immune system cannot
syndrom
e distinguish between the two proteins and attacks nerve myelin
causing inflammation and destruction and the axon is left unable
to support nerve conduction.
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5 Identify CLINICAL MANIFESTATION Lecture Listenin LCD
Min the g
clinical • Initially muscle weakness and diminished reflexes of the lower
manifest extremities.
ation of
GBS • Neuromuscular respiratory failure.

• Sensory symptoms include paresthesias of the hands and feet

and pain related to the demyelination of sensory fibres.

• Optic nerve demyelination may result in blindness.

• Bulbar muscle weakness related to de-myelination of the glosso-

pharyngeal and vagus nerves results in an inability to swallow or
clear secretions. Vagus nerve de-myelination results in
autonomic dysfunction, manifested by instability of the
cardiovascular system. Patients may have tachycardia,
bradycardia, hypertension, or orthostatic hypotension. These
problems occur and resolve rapidly.

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3 Recogniz Assessment and Diagnostic Findings lecture Listenin LCD What are
Min e the g the
• Symmetric weakness, hyporeflexia, and upward progression of
diagnosti diagnosti
c motor weakness. c
findings findings
• A history of a viral illness is suggestive of the diagnosis.
in GBS in GBS
• Changes in 2 respiratory function tests, which are the vital
capacity and negative inspiratory force (< 25 cm H2O) are
assessed to identify impending neuromuscular respiratory
failure. Vital capacity is the maximum amount of air a person
can expel from the lungs after a maximum inspiration.
• Serum laboratory tests are not useful in the diagnosis.
• Elevated protein levels are detected in CSF evaluation.

7
Min Explain MEDICAL MANAGEMENT
the
medical
manage • This syndrome presents a medical emergency in view of rapid
ment of
GBS progression and neuromuscular respiratory failure, requiring
ICU admission.
• Mechanical ventilation may be necessary to support pulmonary
function and adequate oxygenation, and may be required for an
extended period.
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• Weaning from mechanical ventilation occurs when the Lecture listening LCD
respiratory muscles can again support spontaneous respiration
and maintain adequate tissue oxygenation.
• Anticoagulant agents and thigh-high elastic compression
stockings or sequential compression are used to prevent
complications.
• Plasmapheresis and intravenous immunoglobulin (IVIG) are
used to directly affect the peripheral nerve myelin antibody
level. Both therapies decrease circulating antibody levels and
reduce the amount of time the patient is immobilized and
dependent on mechanical ventilation.
The cardiovascular risks of tachycardia and hypertension are treated Explain
10 Discuss with alpha-adrenergic blocking agents (Doxazosin, Prazosin, Terazosin, nurses
Min in detail Tamsulosin, Alfuzosin). Hypotension is managed by increasing the role in
about amount of IV fluid administered caring
nursing for a
manage Nursing Management of Patient With child
ment of Guillain-Barre Syndrome with
GBS GBS
• Assessment
– Ongoing assessment for disease progression is critical.
The patient is monitored for life-threatening
complications (respiratory failure, cardiac
dysrrhythmias, DVTs) so that appropriate interventions
can be initiated.
 • Nursing diagnoses
– Ineffective breathing pattern and impaired gas exchange
related to rapidly progressive weakness and impending
respiratory failure.
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• Impaired physical mobility related to paralysis.

Planning and goals

– Improved respiratory function
– Increased mobility
 Nursing interventions (maintaining respiratory function)
 Use of incentive spirometry and chest physiotherapy.
 Monitoring for changes in vital capacity and negative
inspiratory force are key to early intervention for respiratory
failure.
 Mechanical ventilation is required if the vital capacity falls,
making spontaneous breathing impossible and tissue
oxygenation inadequate
• Indications for initiating mechanical ventilation include a vital
capacity of 12 to 15 mL/kg, downward vital capacity trend over
4 to 6 hours, and an inability to clear secretions.

• Discussion of the potential need for mechanical ventilation

should be carried out with the patient and family on admission.

• Intubation and mechanical ventilation will result in less anxiety

if it is initiated on a nonemergent basis to a well-informed
patient.
• Suctioning may be needed to maintain a clear airway.
• The nurse assesses the blood pressure and heart rate frequently.
 • Medications are administered or a temporary pacemaker is
placed for clinically significant bradycardia.

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• Nursing interventions (Enhancing physical mobility and
preventing complications)
Supporting paralysed extremities in functional positions (The splint
held the hand in the functional resting position: wrist positioned
between 10° and 30° extension, thumb in.
Nursing interventions (Enhancing physical mobility and
preventing complications) (Continued….)
– Performing range-of-motion exercises, altering
positioning, anticoagulation, thigh-high elastic
compression stockings or sequential compression boots,
and adequate hydration.
– Padding may be placed over bony prominences such as
the elbows and heels.
– Evaluating laboratory test results that may indicate
malnutrition or dehydration.

– Collaboration with the physician and dietitian to meet

the patient’s nutritional and hydration needs.

• Evaluation (Expected patient outcomes). The patient:

– Maintains effective respirations and airway clearance
• Has normal breath sounds on auscultation
• Demonstrates gradual improvement in
respiratory function
– Shows increasing mobility
 • Regains use of extremities
• Participates in rehabilitation program
Demonstrates no contractures and minimal muscle atrophy
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SUMMARY :-
Today we have seen about the guillain barre syndrome definition ,
clinical manifestation , etiology , pathophysiology, medical
management ,& nursing management

CONCLUSION :-
Full recovery is mostly achieved with restoration of full functions
but it may need 6 months to 2 years time. Fatal outcome may occur in
case of respiratory paralysis GB syndrome which may have some
residual disability & handicaps

BIBLIOGRAPHY :-

• 1.PARUL DATTA Pediatric nursing II nd edition, 2009, jaypee

Newdelhi. Page no. 359-360

• LIPIN COTT manual of essential pediatric nursing 8 th edition

page no. 1643-1645

• Wong & willy taxt book of pediatric nursing page no.

Search
www.google.com
wwa.encyclopedia.com

ASSIGNMENT :-
 Define the GB syndrome
Enlist the etiology & clinical manifestation of GB syndrome