MEDICAL-SURGICAL NURSING: GUILLAIN-BARRE-SYNDROME

Guillain-Barre Syndrome (GBS)

Structure affected: Myelin Sheath

 Acts as insulator so that impulses can send to muscles and tissues in a fast rate and vice
versa (stimulus to the brain) for the brain to interpret it
 Myelin sheath in brain- oligodendrocytes cells
 Myelin sheath that insulates the axons is being made by the Schwann cells

Pathophysiology
*autoimmune disorder: the antigen that entered and the
protein of that antigen is so similar to the protein that is
being prod by the myelin sheath so the entrance of antigen
which can be protozoa fungi, virus is triggered the wbc,
antibodies to immediately migrate to that area because
whenever bacteria or viruses will enter the body that is
going to attract wbc and antibodies to that area—
chemotaxis so when the wbc specifically, the neutrophils
and antibodies like IgA, M, E reached that injured area, it
cannot distinguish the antigen and its own cells so our wbc
and antibodies destroys both so it damaged the myelin
exposing now the axon
• GBS initially affects the peripheral nervous system
• Exact cause of GBS: UNKNOWN
• AGE: 30-50 years old
• Men and women are equally affected

GBS (periphery) Multiple sclerosis

(brain)
Myelin sheath that insulates the axon in the periphery Affects the myelin
sheath in the brain
30-50 20-40 y/o
Acute form of paralysis that the weakness tarts at the lower Will paralyze you at the
extremities and progresses upward including the face and later peak of your career and
you’ll lose your reflexes until complete paralysis. no cure
Men and women are affected Women
 Multiple sclerosis: no cure
 GBS-reversible however, it will take 1-2 year for myelin sheath in the periphery to
recover

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Manifestations
• GBS - muscle weakness starts from
the feet that will progress up the body
and once it affects lungs that is
dangerous as it paralyzes the muscle
and patient will die and difficulty
breathing will occur.
• numbness and weakness
• Progress within 2 weeks for the lungs
• It will start lower extremities then
ascends bilaterally: weakness, ataxia,
bilateral paresthesia progressing to paralysis

*What is paresthesia? Patient cannot feel any sensation. tingling sensation will be an
early manifestation

4 variants of GBS
• respiratory compromise is rapid!!! Oh no! Because Lungs is for exchange of carbon
dioxide and oxygen and for breathing
• Dysphagia and difficulty in speaking, slurred speech
• Reflexes are diminished/ absent; (cannot swallow anymore such as gag reflex), knee jerk,
ankle reflex, etc.
• recovery phase: will take maximum of 6 months - 2 years to recover
• Symptoms slowly improve
• A few patients experience chronic disability
*Can it affect the brain? Yes, because it can progress in an upward motion
• 12 Cranial nerves: 10 cranial nerves in the brain stem and CN 1 & 2 are seen in the
cerebrum
*Cranial Nerves 7, 9, 10, 11, 12
1. IF BRAIN STEM AFFECTED : CN7- FACIAL NERVE IS FOR FACIAL EXPRESSION , TO STIMULATE , THE SECRETION
OF TEAR GLANDS BELOW OUR EYEBROW AND RESP FOR PRODUCTION OF SALIVA FROM SALIVARY GLAND .
• unable to smile
• Eyes can be dry
• Less saliva. (Saliva acts as lubricant so bolus of food can enter the pharynx down to
esophagus to stomach, contains antibodies such as Ig A/G, contains lysosomes to it
cleanses the mouth so if you have less saliva— you have halitosis)

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2. CN 9 - GLOSSOPHARYNGEAL IS FOR SWALLOWING . IT CONTROLS THE MUSCLES OF THE PHARYNX .

• dysphagia
• Inability to talk
• Nursing diagnosis: impaired swallowing related to
• Inability to communicate related to
3. CN 10 - VAGUS NERVE FOR SPEECH AND SWALLOWING
4. CN11- SPINAL ACCESSORY THAT CONTROLS THE STERNOCLEIDO MUSCLES AND TRAPEZIUS MUSCLE : THESE
ARE USED TO MOVE HEAD LEFT , RIGHT, UP , DOWN, BACK, HYPEREXTENSION , AND FLEXION
• Less movement of the head
5. CN12 - HYPOGLOSSAL NERVE - TONGUE FOR MOVEMENT OF THE FOOD / MASTICATION,
SWALLOWING , AND SPEAKING

DIAGNOSTIC CRITERIA (“*” - common)

1. *Progressive weakness of 2 or more limbs
• caused by neuropathy
2. *Areflexia (PE)
• absent deep tendon reflexes
• How will you know if there’s areflexia? Brachio radialis, triceps, bicep, ankle, knee jerk,
patellar reflex, corneal reflex
3. *History of recent viral infection (Health history)
• “Did your mother had an infection 2 or 3 weeks ago?” Then it will progress so the mother
will feel a pain on the feet
• Elevated protein levels in CSF (cerebral spinal fluid)
• Abnormal electromyography EMG

GBS doesn’t affect the patients: (assessments)

• cognitive function
• Level of consciousness
• Pupillary signs

Medical treatment: supportive managements and relieve client of discomfort

1. no cure
2. IV Ig G (gamaSTAN, Bivigam)
• An antibody
• Immunoglobulin coming from another person, and it is replacing the antibody in the
patient’s bloodstream because antibodies are destroying the myelin sheath, 6and this is
less destructive
• Expensive cos it’s coming from another person
3. Plasma Exchange (plasmapheresis)

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• machine is needed to clean the plasma which is part of the blood.

• plasma contains fluid, albumin, electrolytes, antibodies
*Plasmapheresis - if the patient could hardly ambulate for 4 weeks or bedridden and doctor
will talk to the family to perform plasmapheresis. Plasma is being cleansed with antibodies
that is destroying the myelin sheath in the periphery and once cleanse, it goes back to
arteries
4. Anticoagulants
• Why is the patient is receiving anticoagulant? What is anticoagulant? There is weakness
starting from the feet going up, it is possible to paralyze so patient will be bedridden so
patient is in bed more than 3 days, there is no muscular contractions of the lower
extremities therefore, more blood will stay in the lower extremities there will be stagnant
blood in lower extremities because you’re paralyze and weakness and immobile then
there’s venous stasis and plenty of blood will stay in the veins in the lower extremities
that makes blood viscous and give opportunity for the blood to clot that can be an emboli
that will travel to lungs resulting to pulmonary embolism — to prevent this complication
then an anticoagulant will be given to this patient such as heparin or warfarin— they will
prevent the platelets in aggregating so that it will not form into a blood clot

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• If ever that clotted blood is too small to obstruct that pulmonary bed? The clotted blood
can go to the pulmonary vein going to left side of heart via left ventricle to aortic valve
going to
ascending aorta to the brain resulting too CVA
*Passive leg exercises: like flexion, extension, abduction, and adduction —- you are
stimulating muscular contraction squeezing the vein ad valve will be closing pushing that
blood towards the right side of the heart reducing the venous stasis therefore preventing
thrombus formation
5. Morphine to control muscle pain
6. Tramadol

NURSING CARE

Impaired verbal communication

• teach family to talk to patient even though patient is unconscious
• Explain what you’re doing as you perform his care
• Put a clock and calendar within view
• Acknowledge him when you enter the room

• Ex. “Elevate right leg: if it causes discomfort: please blink twice. If it’s okay with you,
please blink once” the last sense that leave the body: hearing. First sense “once you wake
up: hearing
• Ex. “Mr. Cruz, do you feel hot? If you tap your finger once, the answer is yes. If you top
your finger twice, the answer is no”
• Picture board
• Letter and number board

Risk for respiratory dysfunction

• Closely monitor the patient for:
• RR
• ABG
• Respiratory depth
• Breath sounds
• *If pulse oximetry is 78%, what will be the
anticipated treatment? Patient will be intubated
or the use of mechanical ventilator.
Immediately call the doctor because the
normal is 95-100%.

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• Vigorous pulmonary toileting after extubating

• If respiratory did not improve with intubation within 2 weeks: Tracheostomy if
respiratory parameters haven’t improved in 2 weeks

Impaired physical mobility

• turn patient every 2 hours
• no wrinkled bed sheets to avoid bed sores
• do passive exercises because patient can’t participate in active exercise.
• bathing to keep the patient contact to prevent wound
*Risk for bed sore related to immobility
*Risk for deep vein thrombosis

Facial Nerve Dysfunction

• keep the patient’s eyes moist with eye lubricants. Artificial tears- to prevent corneal
abrasion
• Wear eye mask to gently close the eyelids during sleep of the patient

Less than body requirements related to dysphagia secondary to cranial

nerve impairment
• osterize feeding as ordered
• High: calories (due to increased metabolism caused by sickness, protein for tissue
regeneration of myelin sheath & essential fatty acids with Vit B, C, & Zinc (strawberries,
oyster, meat, eggs, squash, red kidney beans) is good for wound healing

Impaired swallowing
• no liquid diet, semi solid food
• Put straw away
• Amount of food that should be given
• How to position the patient

 Ascending Guillain-Barre Syndrome is another type of GBS.

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