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GUILLAIN BARR SYNDROME

NEFELY JOY GO BSN 3-F

GUILLAIN BARR SYNDROME


It is an inflammatory disease of unknown origin that involves degeneration of the myelin sheath of peripheral nerves. An acute inflammatory demyelinating polyneuropathy (AIDP), a disorder affecting the peripheral nervous system.

PATHOPHYSIOLOGY

Infectious organism
Epstein-Barr virus (EBV) Cytomegalovirus Campylobacter jejuni

Infectious organism contains amino acid that mimics the peripheral nerve myelin protein

Immune system cannot distinguish between the 2 proteins

Peripheral nerve myelin is attacked and destroyed

Inflammation and destruction of myelin

Schwann cell deposit myelin around axons with interruption at intervals by the nodes of Ranvier

Axon is unable to support nerve conduction/ slow conduction of impulses

Clinical Manifestations
1. Initial Phase
Ascending weakness from the lower extremities and spreading to the upper trunk, upper extremities and face evolves over hours to days with maximal deficit by 4 weeks Deep tendon reflex are lost Paresthesias in the limbs

2. Plateau phase
Disease does not progress Deep, aching muscle in the shoulder and thigh Respiratory muscle weakness Autonomic neuropathy w/c involves sympathetic and parasympathetic systems

3. Recovery Phase
Improvement and recovery occur with remyelination Remyelination occurs in a descending pattern. The last function that was lost are the first to be regained Usually maximal at 6 mos. up to 2 years

The principle Ones neurons die, they don t regenerate is not applicable because the neurons here did not die. Only the myelin sheath is demyelinated. And so, once remyelination begins functions will be back.

Nursing Management

Ineffective breathing pattern related to neuromascular weakness or paralysis of the facial, throat and respiratory
Monitor patients ability to take fluids orally. Assess for cough reflex, gag reflex, and difficulty in swallowing Monitor RR, rhythm and depth Observe changes in mental status, LOC and orientation coughing and deep breathing

Impaired physical mobility related to decrease muscle strength


assistive devices as needed such as cane or wheelchair. physical and occupational therapy exercises Turn dependent client every 2 hours and reposition in good body alignment. safety measures.

Impaired swallowing related to neuromuscular impairment


Assess strength and excursion of muscle involved in mastication and swallowing. Elevate head 30-45
Watch for signs and symptoms of aspiration and pneumonia.