Guillain-Barre ’ Syndrome (GBS)

1. Guillain-Barre’ Syndrome (GBS) Adult Health II Neurological Diseases Jerry Carley RN, MSN, MA, CNE Summer 2010

2. Concept Map: Selected Topics in Neurological Nursing PATHOPHYSIOLOGY 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 ASSESSMENT Physical Assessment Inspection Palpation Percussion Auscultation ICP Monitoring “Neuro Checks” Lab Monitoring PHARMACOLOGY --Decrease ICP --Disease / Condition Specific Meds Care Planning Plan for client adl’s, Monitoring, med admin., Patient education, more…based On Nursing Process: A_D_O_P_I_E Nursing Interventions & Evaluation Execute the care plan, evaluate for Efficacy, revise as necessary

3. Biggest Issue … Respiratory Failure from intercostal and diapragmatic muscle paralysis RAPID progression: 25% will need ventilator within 18 days!

4. Guillain-Barre’ Syndrome • Autoimmune Disorder • Inflammatory Version also • Guillain-Barre syndrome is a rare disorder • Not hereditary • Cause unknown

5. Guillain-Barre’ Syndrome • Immunesystem attacks peripheral nerve cell myelinproteins (Rarely involves the brain) • Causes varying degrees of muscle weakness and paralysis • Spares the Schwann cells which produce myelin --- remyelination and recovery

6. Motor & Sensory Neurons

7. Triggers? • Recent History of: • Viral illness • Vaccination • Surgery • Acute Illness

8. S&Ss • SEVERE weakness and numbness in legs and arms • PAINd/t demyelination • Ascending weakness with dyskinesia(inability to move voluntarily) • Loss of feeling + movement(paralysis) • Severe Bradycardia(pacemaker sometimes)

9. ** 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 DIAGNOSTICS

10. Severe GBSMedical 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 may become weak or paralyzed • 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

11. Treatment • Plasmapheresis to decrease circulating antibodies • EKG monitoring for Autonomic Dysfunction • Immunoglobulin therapy • Hormonal therapy • Physical therapy(to increase muscle flexibility and strength)

12. Nursing Care • Maintain Patent Airway • HOB elevated • DBC Q2H / spirometry / chest physio • Monitor Vitals viligently • Pain management

13. Collaborative Goals • Reducing and/or managing symptoms • Preventing complications • Provide adaptive devices to increase mobility and self-care

14. 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