GUILLAIN - BARRE

SYNDROME
 DEFINITION
• Guillain Barre syndrome is a rare disorder in
which body's immune system attacks nerves and
causes damage to the peripheral nerves.

• The nerve injury often causes muscle weakness,

cause paralysis and sensitivity problems, including
pain, tingling or numbness.
The demyelinating form
of Guillain-Barre
syndrome destroys the
protective covering of
the peripheral nerves
(myelin sheath),
preventing the nerves
from transmitting signals
to the brain.
 Types
Once thought to be a single disorder, Guillain-Barre
syndrome is now known to occur in several forms. The
main types are:
– Acute Inflammatory Demyelinating
Polyradiculoneuropathy (AIDP) The most common sign
of AIDP is muscle weakness that starts in the lower part of
your body and spreads upward.
– Miller Fisher Syndrome (MFS), in which paralysis starts in
the eyes. MFS is also associated with unsteady gait.
– Acute Motor Axonal Neuropathy (AMAN) and Acute
Motor-sensory Axonal Neuropathy (AMSAN)
 ETIOLOGY
• Bacterial infection
• Viral infection
• Protozoan infection
• Surgeries
• Blood Transfusion
• Transplantation
• Anesthesia
• Preceding heat stroke
• Preceding vaccination – Swine flu
 PATHOPHYSIOLOGY
Infection with organism contain amino acid that mimic peripheral
nerve myelin

Edema and inflammation of affected nerves.

Immune system fails to distinguish between foreign proteins and

nerve protein

Demyelination of peripheral nerves

Transmission of nerve impulses is stopped or slowed.

Flaccid paralysis with muscle denervation and atrophy.

 Clinical Manifestations
• Hyporeflexia and weakness progress and may result in
quadriplegia.
• Neuromuscular respiratory failure - demyelination of the
nerves that innervate the diaphragm and inter costal
muscles results.
• Cranial Nerve deficit in (III- VII, IX- XII) with facial palsy.
• Ptosis, diplopia, facial weakness, dysarthria, dysphagia with
pooling of secretions.
• Sensory dysfunction with abnormal proprioception, sensory
ataxia can also occur.
• Gloves and stocking paraesthesias with slight disturbances
of sensibility.
• Weakness spreads to the arms and upper body.
• The weakness may increase until muscles cannot
be used at all and may result in paralysis.
• Inability to walk due to muscle weakness and
paralysis.
• Difficult to speaking, chewing and swallowing,
various muscles required to form speech are
weakened.
 DIAGNOSIS
• Spinal tap (lumbar puncture). The fluid is tested for
a type of change that commonly occurs in people who
have Guillain-Barre syndrome.
• Electromyography. The electrodes measure nerve
activity in the muscles.
• Nerve conduction studies. Electrodes are taped to
the peripheral nerves. A small shock is passed through
the nerve to measure the speed of nerve signals.
• CSF analysis – elevated protein content upto 700
mg/dl. Normal- 15-45 mg/dl
 MANAGEMENT
• Supportive care
• Ventiltory support
• Plasmapheresis (plasma exchange)– to remove
abnormal antibodies
• IV Immunoglobulin's – stop antibody damaging
cells.
• Immunomodulatory intravenous immunoglobulin
– Muscle weakness
– Respiratory depression
 NURSING MANAGEMENT
• Autonomic dysfunction with orthostatic
hypotension and tachycardia.
• Check for previous history of viral illness or
surgical procedure Urinary incontinence
• Check for facial nerve paralysis.
• Inspect the patient’s face at rest and during
conversation.
• Assess for any problems during talking,
swallowing and chewing.
• Assess for any change in the vital signs.
• Maintaining respiratory function incentive
spirometry and chest physiotherapy .
• Mechanical ventilation
• Close monitoring and suctioning
• Enhancing physical mobility passive range-of-
motion exercises are performed at least twice daily.
• providing adequate nutrition IV fluids and
parenteral nutrition .
• monitors for the return of bowel sounds
gastrostomy tube assesses the return of the gag
reflex
• Monitoring and managing potential complications
Thorough assessment of respiratory function at
regular intervals cardiac dysrhythmias, which
necessitate ECG monitoring
 COMPLICATIONS
• Complications can also include:
– Lingering weakness, numbness, or other odd
sensations even after recovery
– Heart or blood pressure problems
– Pain
– Slow bowel or bladder function
– Blood clots and bedsores due to paralysis