GUILLAIN-BARRE’ SYNDROME

• Also known as infectious polyneuritis, is an uncommon acute

demyelinating polyneuropathy with a progressive, usually ascending
flaccid paralysis.
• Children are less often affected than adults, with children however
between 4 and 10 years of age having higher susceptibility. Both
sexes are affected with equal frequency.
GUILLAIN-BARRE’ SYNDROME
• The cause of the condition is unknown, but it is suspected that the
reaction is immune mediated, occurring after upper respiratory
tract or gastrointestinal illness or, rarely, immunizations.
• Both motor and sensory portions of peripheral nerves are affected.
• Inflammation of the nerve fibers apparently causes temporary
demyelination of the nerve sheath.
Gastrointestinal infection:
Campylobacter jejuni

Respiratory infection:
Cytomegalovirus
Epstein-Barr virus
Mycoplasma pneumoniae
DIAGNOSTIC EVALUATION:
• Diagnosis of GBS is based on
the paralytic manifestation
and/or EMG findings.
DIAGNOSTIC EVALUATION
Spinal tap
(Lumbar puncture)
gold standard test for
Guillain Barre

During the acute phase of

GBS, characteristic findings
on CSF analysis include
albuminocytologic
dissociation, which is an
elevation in CSF protein
(>0.55 g/L) without an
elevation in white blood cells.
 DIAGNOSTIC EVALUATION
• The symmetric nature of the
paralysis helps differentiate
this disorder from spinal
paralytic poliomyelitis, which
usually affects sporadic
muscles.
• Electroencephalogram (EEG)
may show denervation and
decreased nerve conduction
velocity.
THERAPEUTIC MANAGEMENT:
• Treatment of GBS is symptomatic.
• In some reports, corticosteroid
therapy has been of benefit in the
early stages.
• Respiratory and pharyngeal
involvement requires assisted
ventilation, commonly with
tracheostomy.
• If pneumonia develops, antibiotic
therapy is given.
THERAPEUTIC MANAGEMENT:
• Plasma exchange
(plasmapheresis) may be
beneficial both in shortening the
length of illness and in lessening
the long-term disability.
THERAPEUTIC MANAGEMENT:
• Intravenous
immunoglobulin is also
advocated in the acute
stage.
• The most commonly used
treatment for Guillain-Barré
syndrome is intravenous
immunoglobulin (IVIG).
THERAPEUTIC MANAGEMENT
• Cardiac and respiratory function must be closely monitored
• All patients should be given heparin and support stockings until they
are able to walk independently to prevent deep vein thrombosis.
• An indwelling urinary catheter is usually inserted to monitor urine
output. – ANS is affected which results to urinary retention
• Enteral or total parenteral nutrition may be used to support protein
and carbohydrates needs.
• If the child has discomfort from neuritis, adequate analgesia is
necessary.
 • Turning and repositioning every 2 hours is
important in addition to passive range-of-
THERAPEUTIC motion exercises about every 4 hours
MANAGEMENT o To prevent muscle contractures and effects of
immobility.
 • Better outcomes are associated with younger age,
no requirement for respiratory assistance, slower
progression of disease, normal peripheral nerve
function on EMG, and treatment by
plasmapheresis.
• Almost all deaths are caused by respiratory failure;
therefore early diagnosis and access to respiratory
support are especially important.
COURSE AND • Muscle function begins to return 2 days to 2
PROGNOSIS weeks after the onset of symptoms, and recovery
is complete in most patients. The rate of recovery
is usually related to the degree of involvement,
which may extend from a few weeks to months.
The greater the degree of paralysis, the longer the
recovery phase.
 • The outcome for most children is complete
recovery although it may extend over a 2-
year period.
• Some children may have residual
COURSE AND weakness, contractures and areflexia
• A few patients may die during the acute
PROGNOSIS phase of this disease from respiratory and
cardiac complications.
 Initial symptoms
1. Muscle tenderness
Clinical 2. Paresthesia and cramps (sometimes)
manifestation 3. Proximal symmetric muscle weakness
of GBS
 • Paralysis
1. Ascends from lower extremities
2. Frequently involves muscles of trunk, upper
Clinical extremities, and those supplied by cranial
nerves (especially facial)
manifestation
3. Flaccid paralysis with loss of reflexes
of GBS
 • Paralysis
1. May involve facial, extraocular, labial,
lingual, pharyngeal, and laryngeal muscles
Clinical 2. Intercostal and phrenic nerves:
manifestation breathlessness in vocalization. Shallow,
irregular respirations
of GBS
 Tendon reflexes depressed or absent

Other Variable degrees of sensory impairment

manifestation
Muscle tenderness or sensitivity to slight pressure

Urinary incontinence or retention and constipation

(frequently) – due to ANS dysfunction
Analysis/nursing diagnoses
1. Inability to sustain spontaneous ventilation related to muscle
weakness
2. Altered role performance related to lengthy recovery period
3. Impaired physical mobility related to impaired neuromuscular
function
4. Ineffective breathing pattern r/t ascending paralysis
5. Risk for impaired skin integrity r/t paralysis
6. Impaired bowel elimination r/t neuromuscular impairment/paralysis
 Nursing care is essentially supportive and is
the same as that required for quadriplegia
from any cause.

The emphasis of care is on close observation

Nursing care to assess the extent of paralysis and on
management prevention of complications.

During the acute phase of GBS the child’s

condition should be carefully observed for
possible difficulty in swallowing and
respiratory involvement.
 1. Monitor vital signs, breath sounds, and arterial blood
gases. Elevation of temperature is not typical in this
syndrome; a fever may indicate infection, a disturbance in
temperature regulation, or dehydration.
2. Maintain airway and keep tracheostomy set at bedside.
Planning/implementation Monitor functioning of the respirator and suction, as
necessary.
3. Provide emotional support for the client and family
because of the severity of adaptations and lengthy
convalescent period.
 4. Prevent complications of immobility: skin care;
range-of-motion exercises; position changes;
Planning/implementation coughing and deep breathing; antiembolism
stockings.
5. Support of the child and parents.
 1. Maintains effective respiratory function
2. Remains free from complications of
immobility
Evaluation/outcomes 3. Discusses feeling with family and other
health-team members.