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Guillain-Barre’ Syndrome (GBS)
Adult Health II
Neurological Diseases
Jerry Carley RN, MSN, MA, CNE
Summer 2010
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Concept Map: Selected Topics in Neurological Nursing
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
PATHOPHYSIOLOGY
PHARMACOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Huntington’s Disease
Myasthenia Gravis
Guillian-Barre’ Syndrome
Meningitis
Parkinson’s Disease
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D_O_P_I_E
--Decrease ICP
--Disease /
Condition
Specific Meds
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary
Biggest Issue …
Respiratory Failure from intercostal
and diapragmatic muscle paralysis
RAPID progression: 25% will need
ventilator within 18 days!
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Guillain-Barre’ Syndrome
 Autoimmune Disorder
 Inflammatory Version also
 Guillain-Barre syndrome is a rare disorder
 Not hereditary
 Cause unknown
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Guillain-Barre’ Syndrome
 Immune system attacks peripheral nerve cell
myelin proteins (Rarely involves the brain)
 Causes varying degrees of muscle weakness
and paralysis
 Spares the Schwann cells which produce
myelin --- remyelination and recovery
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Motor & Sensory Neurons
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Triggers?
Recent History of:
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•
•
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Viral illness
Vaccination
Surgery
Acute Illness
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S&Ss
 SEVERE weakness and numbness in legs and arms
 PAIN d/t demyelination
 Ascending weakness with dyskinesia (inability to move
voluntarily)
 Loss of feeling + movement (paralysis)
 Severe Bradycardia (pacemaker sometimes)
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DIAGNOSTICS
** Lumbar Puncture (LP) - cerebrospinal fluid with
elevated protein level
** Electromyogram (EMG) records muscle activity
which can show loss of reflexes d/t the disease's
characteristic slowing of nerve responses
**Nerve Conduction Velocity (NCV) Performed
with EMG, and together, they are often referred to
as EMG/NCV studies. NCV records the speed at
which signals travel along the nerves
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Severe GBS
Medical Emergency (AIRWAY!!!)
 Total paralysis
 Potentially dangerous fluctuations in Pulse and BP
 25% unable to breathe without respiratory assistance
 Muscles for eye movement, speaking, chewing and swallowing also
become weak or paralyzed
may
 Often need long-term rehabilitation to regain normal independence
 As many as 15% experience lasting physical impairment
 In 3% – 8% can be fatal d/t complications
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Treatment
 Plasmapheresis to decrease circulating antibodies
 EKG monitoring for Autonomic Dysfunction
 Immunoglobulin therapy
 Hormonal therapy
 Physical therapy (to increase muscle flexibility and strength)
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Nursing Care
 Maintain Patent Airway
 HOB elevated
 DBC Q2H / spirometry / chest physio
 Monitor Vitals viligently
 Pain management
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Collaborative Goals
 Reducing and/or managing symptoms
 Preventing complications
 Provide adaptive devices to increase
mobility and self-care
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Prognosis
 Most people (85%) recover from even the most severe cases of
GBS with minimal residual symptoms
 Quick diagnosis & treatment may lessen the severity of GBS and
reduce recovery time
 The signs and symptoms of GBS may last days, weeks or
months before muscle sensation begins to return. Regaining
pre-illness strength and functioning is slow, sometimes
requiring months or years. However, most people with GBS
return to normal within months
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