Guillain-Barre Syndrome to Spinal Cord Injury Ilah Enriquez BSN3L

Guillain-Barre Syndrome  Check individual muscle groups every 2 hours

GBS, Landry’s Paralysis, Acute Idiopathic  Assess pain
Polyneuropathy  Maintain respiratory function
o Chest physiotherapy
 Is an acute syndrome characterized by
widespread inflammation or demyelination of o Incentive spirometry
ascending nerves in the peripheral nervous  Enhance physical mobility
system o Support the paralyzed extremities
 Motor and sensory losses occur simultaneously o Passive exercises
and potentially fatal o Padding the bony prominences
 GB: Ground (lower extremities) to the brain
Medical management
 cause:
o autoimmune  Mechanical ventilation: O2 and endotracheal
o bacterial infection intubation
o viral infection  IV immunoglobulin G (A and M): Risk for infection
 Corticosteroid—for inflammation
Polyradiculoneuritis Demyelination of several nerves
 Immunosuppressive agents
 Anticoagulant to prevent thromboembolic
complications (DVT and Pulmonary embolism)—
Paralysis in ocular, Oropharyngeal, facial muscles prolonged immobilization
 Plasmapheresis (Plasma exchange)
o The liquid portion of blood is removed and
Ptosis, Diplopia, Difficulty of swallowing and chewing separated from the blood cells. The blood
cell is then put back into the body
 Recovery: 3-6 months; may have residual deficits
o Paralysis is temporary
Peripheral Neuritis Because of Demyelination of
Peripheral nerves Amyotrophic Lateral Sclerosis (ALS)
 Synonyms: Lou Gehrig’s Disease or Charcot’s
Disease
Ascending Paralysis  Progressive, incapacitating, and fatal disease in
which there is a degeneration of the motor
Autonomic Dysfunction Over excitation/under neurons
excitation of the sympathetic nerve and parasympathetic  Cause: unknown
nerve fibers  Common among males
Assessment:  As motor neurons die the muscle cells undergo
atrophic changes leading to paralysis: death in
 mild sensory changes: tingling sensations in 2-6 years
upper and lower extremities  No known cure or treatment
o prickling, pins and needles sensation in
the fingers, toes, ankles, or wrists Pathophysiology
 clumsiness—initial sign; prone to accident Increase (Excess) Glutamate (brain functioning)
 progressive motor weakness leads to paralysis
o ascending, symmetrical, bilateral Excitotoxicity—pathological process wherein the
o leg affected first neurons are killed due to increased Glutamate
o upper extremities Destruction of the motor neurons:
o total paralysis
 Diminished Deep Tendon Reflex of the lower Fasciculations: muscle twitching; involuntary muscle
extremities contractions; muscle relaxation
 Dysphagia Hyperreflexia—over responsiveness of reflexes
 Pain
Loss of functions can lead to Quadreplegia or
If paralysis ascends to respiratory muscles: paralysis to the four quadrants of the body—tongue
 Ventilatory insufficiency then ventilation support is atrophy—dysphagia (small tongue)—can lead to Death
needed due to respiratory depression (lifespan: 2-6 years)

Diagnostic tests: Pre-disposing factors:

1. CSF: elevated protein  Male (50-60 years old)

2. EMG: slowed nerve conduction  Viral infection
 Possible familial or genetic component
Management:
Signs and Symptoms:
 Adequate nutrition: pureed food, NGT
o Assess gag and swallowing reflexes  Progressive weakness, atrophy muscles: arms,
 Prevent immobility complications: repositioning, legs, trunks
massage  Spasticity of the flexor muscles/stiffness
 Improve communication: Picture board
Guillain-Barre Syndrome to Spinal Cord Injury Ilah Enriquez BSN3L
 Progressive respiratory difficulties—  Extreme temperature
diaphragmatic paralysis  Toothbrushing
 Fasciculations  Chewing hard food
 Dysarthria—difficulty in speaking  Touching face/face manipulation
 Dysphagia

Eventually respiratory muscles become affected leading Diagnostic test: No tests to diagnose—will depend on
to respiratory compromise, pneumonia, and death the type and location of the pain and factors that trigger
pain
Cardinal signs:
- Medical history and physical exam
 Progressive muscle weakness - Neurological exam to determine which part of the
 Atrophy trigeminal nerve is being affected.
 Fasciculation - Will touch various parts of the face to determine
the location of the pain
Management: Medications:
 Promote respiratory  Spasticity: Nursing Interventions: the goal is to stop the pain
functions Baclofen
 Prevent complications of  Diluted/Riluzole  Meds:
immobility o Carbamazepine (Tegretol)
 Diversional activities o Phenytoin (Dilantin)
 Physical therapy o Baclofen
 Client and family with  Even room temperature
support
 Avoid hot/cold food
 Soft diet
 Avoid facial massage
Diagnostic tests: Intact functions:
 EMG  GIT  Soft/warmed food
(electromyography)—  GUT  Chew unaffected side; mouth care
to evaluate  Memory Surgical management:
denervation and  Sensory and
muscle atrophy Autonomic  Nerve block: Alcohol or phenol on one or more
 Pulmonary function systems branches of Trigeminal nerve
test—to evaluate
 Glycerol injections: the glycerol may block the
respiratory function
 Muscle biopsy— nerve’s ability to transmit signals related to pain
confirms changes in o A needle is inserted through the cheek
muscle atrophy and and into the base of the skull
loss of muscle fiber o The needle is guided by X-ray to a small
sac of spinal fluid that surrounds the
root of the trigeminal nerve
Trigeminal Neuralgia/Tic Doulourex o Once the needle is in place, a small
 Chronic disease of trigeminal nerve (Cranial
amount of sterile glycerol is released
Nerve 5) causing severe facial pain
 Facial rhizotomy
 The trigeminal nerves are pairs of cranial nerve
o The damage trigeminal nerve by
for sensations in the face
severing or cutting the sensory root
 Occurs more often in middle and older adults,
females more than males Bell’s Palsy
 Most painful condition known to humans  Due to unilateral inflammation of the cranial
 Cause: unknown nerve 7 which results in weakness and paralysis
 Each trigeminal nerve splits into 3 branches, of the facial muscles on the affected side
controlling the feeling for different part of the  Occur when the nerve that controls the facial
face: muscles becomes inflamed, swollen, or
o Ophthalmic—it controls the eye, upper compressed
eyelid, and forehead  occurs between age of 20-60 equally in males
o Maxillary—this affects lower eyelid, cheek, and females
nostril, upper lip, and upper gum  cause: unknown but thought to be related to
o Mandibular—it runs jaw, lower gum, and herpes virus
some muscles for chewing
Signs and symptoms:
Assessment:
 numbness, stiffness noticed first
 Brief severe one side of face pain: 100 a day  later on, face appears asymmetric: side of face
 Sensory droops’ unable to close the eye, wrinkle
 Excruciating facial pain forehead or pucker lips on one side
 Motor: twitching and grimace  Sensory: 20% minor pain: ear and eye
 Excruciating, stabbing pain (seconds to 2  Motor (unilateral): risk corneal abrasion and
minutes droop eyelid

Triggers: Diagnostic test: No specific test

 Cold breeze
Guillain-Barre Syndrome to Spinal Cord Injury Ilah Enriquez BSN3L
 EMG—presence of nerve damage and o Complete cord transection—loss of
determine severity movements and sensation below the level
 MRI/CT scan—to rule out possible sources of of injury
pressure on the facial nerve o Incomplete Cord Transection—Varying
degree of motor or sensory loss below the
level of the lesion
Collaborative Care:

 Corticosteroids—inflammation
 Antiviral drugs Take note:
 Facial massage
 Paralysis below the level of injury
 Approach client at the unaffected side
 The higher the injury, the greater the loss of
 Artificial teats
function
 Patch or taping eye at night to avoid eye injury
 Symptoms depend on the level and extent of injury
 Eye shield (wear sunglass)
 Treatment is supportive Nursing Intervention (Emergency care less than 1
hour)
Nursing care:
 Assess Airway, Breathing, Circulation
 Teaching client self-care  Do not move the client during the assessment
 Prevent injury  Do not hyperextend the neck to open the airway
 Maintain nutrition —use jaw thrust maneuver
 Soft diet that can be chewed easily, small  Avoid flexion of the spinal column
frequent meals o Immobilize the head and neck with a
Spinal Cord Injury (SCI) cervical collar
 Partial or complete disruption of nerve tracts and o Placed the client on a spinal board
neurons resulting in  Have suction available to clear the airway and
o Paralysis prevent aspiration
o Sensory loss  Perform quick head-t-toe assessment
o Altered reflex activity  Check for LOC
o Autonomic nervous system dysfunction  Signs of trauma to the head and neck
 Most common causes:  Signs of motor and sensory impairment
o Traumatic:
Treatment:
 MVA (Motor Vehicular accident)
 Falls  Methylprednisolone (Medrol)—administered
 Contact sports within 8 hours after the injury, help reduce
 Industrial accidents swelling
 Gunshot  Skeletal traction to prevent movement
 Stab wound  Surgery—remove bone fragments, disk
fragments, or foreign objects; fuse broken spinal
Pathophysiology:
bones; or place spinal braces
o Decompression fluid or tissue that
presses on the spinal cord

Medical Management

 Horizontal turning frames (Stryker frame)—

can prevent bed sore
 Skeletal traction
o Gardner-wells tong
o Halo tractions
o Surgery: Laminectomy and Spinal fusion
 Laminectomy—is the excision of portion of
vertebral bone called the lamina
Symptoms depend on the: o Purpose: to reduce pressure on spinal
cord or spinal nerves
 Location: the higher the injury, the greater the o To provide access for removing the disc
paralysis o Management:
C1-C8: Quadriplegia/Tetraplegia  Turn patient every 2 hours: log-
rolling technique (turning sheet)
- Lesion above C6 causes respiratory paralysis due and pillow between legs
to lack of innervation to the diaphragm  Monitor sensory and motor
- Phrenic nerve is located at the C4-C5 level status every 2 hours
T1-L4: Paraplegia—half of the body is paralyzed  Check dressings: hemorrhage,
CSF leak, infection
 Extent of the damage of the spinal cord
Guillain-Barre Syndrome to Spinal Cord Injury Ilah Enriquez BSN3L
 Spinal Fusion or Spondylodesis—surgical  Spinal Shock
technique used to join two or more vertebrae in o Spasticity—involuntary movement
the spine (jerking) of muscles
o Patient (Autograft); Donor (allograft) o Return of reflex activity may occur after
o To fuse the vertebrae together spinal shock resolves
permanently, the surgeon places the o Medications: Baclofen (Lioresal);
bone graft material between the Dantrolene (Dantrium), Diazepam
vertebrae. (Valium)
o Metal plates, screws or rods may be o Physical therapy: exercises, whirlpool,
used to help hold the vertebrae together tub baths
while the bone graft heals

Complications

1. Spinal shock/neural shock—period of flaccid

paralysis and a complete loss of reflexes
o Treated in ICU as many complications
should be expected due to the injury

Signs and symptoms:

- Absence of sweating BELOW the level of injury

- Bowel and bladder retention
- Hypotension
- Bradycardia
- Lasts for 4-6 weeks

Management:

- Bring the blood pressure at the 90-100mmHg

systolic
- Oxygenation
- Norepinephrine drip
- Atropine for bradycardia
- Methylprednisone
- Foley catheter; I/O monitored
- Low dose dopamine

2. Autonomic Hyperreflexia/Dysreflexia—causes
hyperstimulation of Sympathetic nervous system
 Occur clients with SCI above T6

Signs and symptoms:

 Severe headache
 Blurred vision
 Hypertension
 Bradycardia
 Sweating above the injury
 Pilomotor spasms (gooseflesh) below the
injury

Management:

 Autonomic hyperreflexia
o Place in a sitting position or elevate
HOB to 90 degrees and place the
extremities in dependent position
o Loosen constricting clothing
o Check for distended bladder and bowel
impaction—indwelling catheter, check
for patency and kinks
o If removing the triggering event does not
reduce the client’s BP, IV
antihypertensives should be
administered
o A fan SHOULD NOT be used because
drafts of cold may trigger autonomic
dysreflexia
o Remember: most dangerous effect:
Severe Hypertension