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Chapter 47 Interventions for Clients with Problems of the Peripheral Nervous System Guillain-Barr é Syndrome An acute autoimmune disorder characterized by varying degrees of motor weakness and paralysis

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chapter 47

Chapter 47

Interventions for Clients with Problems of the Peripheral Nervous System

guillain barr syndrome
Guillain-Barré Syndrome
  • An acute autoimmune disorder characterized by varying degrees of motor weakness and paralysis
  • The client’s life and ultimate potential for rehabilitation dependent upon appropriate interventions and effectiveness of nursing care
  • Chronic inflammatory demyelinating polyneuropathy

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clinical manifestations
Clinical Manifestations
  • Muscle weakness and pain have abrupt onset; cause remains obscure.
  • Cerebral function or pupillary signs are not affected.
  • The most common clinical pattern is that the immune system starts to destroy the myelin sheath surrounding the axons.

(Continued)

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clinical manifestations continued
Clinical Manifestations (Continued)
  • Weakness and paresthesia begin in the lower extremities and progress upward toward the trunk, arms, and cranial nerves in ascending GBS.

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ineffective breathing pattern interventions
Ineffective Breathing Pattern Interventions
  • Priority: maintain adequate respiratory function; implement interdisciplinary actions
  • Airway management:
    • Elevate head of bed at least 45 degrees
    • Suction

(Continued)

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ineffective breathing pattern interventions continued
Ineffective Breathing Pattern Interventions(Continued)
  • Chest physiotherapy
  • Incentive spirometer
  • Oxygen
  • Monitor arterial blood gas and vital capacity
  • Keep equipment for endotracheal intubation at the bedside

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interventions for cardiac dysfunction
Interventions for Cardiac Dysfunction
  • Can affect both the sympathetic and parasympathetic systems
  • Client placed on cardiac monitor because of the risk for arrhythmias
  • Hypertension treated with beta blocker or nitroprusside
  • IV fluids for hypotension; client placed in supine position
  • Atropine may be used for bradycardia

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drug therapy
Drug Therapy
  • Plasmapheresis or IV immunoglobulin
  • Plasma exchange
  • IV immunoglobulin
  • No corticosteroids

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plasmapheresis
Plasmapheresis
  • Plasmapheresis removes the circulating antibodies assumed to cause the disease.
  • Plasma is selectively separated from whole blood; the blood cells are returned to the client without the plasma.
  • Plasma usually replaces itself, or the client is transfused with albumin.

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acute pain interventions
Acute Pain Interventions
  • Assess pain, which is often worse at night
  • Pain usually only relieved with opiates
  • Use of analgesia pump or continuous IV drip
  • Frequent repositioning, massage, ice, heat, relaxation techniques, guided imagery, anddistraction (such as music or visitors)

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impaired physical mobility and self care deficit
Impaired Physical Mobility and Self-Care Deficit
  • Interventions include:
    • Assess muscle function every 2 to 4 hours.
    • Provide assistive devices and instructions for their use.
    • Ensure safety in ambulation, position changes.
    • Encourage independence.

(Continued)

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impaired physical mobility and self care deficit continued
Impaired Physical Mobility and Self-Care Deficit(Continued)
  • ROM exercises every 2 to 4 hours
  • Diet plan to guard against malnutrition
  • Prevention of pressure ulcers
  • Prevention of pulmonary embolic and deep vein thrombosis

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impaired verbal communication
Impaired Verbal Communication
  • Interventions include:
    • Develop a communication system that meets the needs of client.
    • Devise simple techniques—eye blinking and moving a finger to indicate yes and no responses.
    • Develop a board using letters of the alphabet.

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powerlessness
Powerlessness
  • Interventions include:
    • Encourage client to verbalize feelings about the illness and its effects.
    • Examine patterns of decision-making, roles and responsibilities, and usual coping mechanisms.
    • Refer client to other health care professionals as needed.

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myasthenia gravis
Myasthenia Gravis
  • Chronic disease characterized by weakness primarily in muscles innervated by cranial nerves, as well as in skeletal and respiratory muscles
  • Thymoma: encapsulated thymus gland tumor

(Continued)

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myasthenia gravis continued
Myasthenia Gravis (Continued)
  • Progressive paresis of affected muscle groups that is partially resolved by resting
  • Most common symptoms: involvement of eye muscles, such as ocular palsies, ptosis, diplopia, weak or incomplete eye closure

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tensilon testing
Tensilon Testing
  • Within 30 to 60 sec after injection of Tensilon, most myasthenic clients show marked improvement in muscle tone that lasts 4 to 5 minutes.
  • Prostigmin is also used.
  • Cholinergic crisis is due to overmedication.

(Continued)

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tensilon testing continued
Tensilon Testing (Continued)
  • Myasthenic crisis is due to undermedication.
  • Atropine sulfate is the antidote for Tensilon complications.

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diet therapy and interventions
Diet Therapy and Interventions
  • Cholinesterase-inhibitor drugs
  • Immunosuppressants
  • Corticosteroids for immunosuppression
  • Plasmapheresis

(Continued)

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diet therapy and interventions continued
Diet Therapy and Interventions (Continued)
  • Respiratory support
  • Nonsurgical management
  • Assistance with activities and communication

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cholinesterase inhibitor drugs
Cholinesterase Inhibitor Drugs
  • Drugs include anticholinesterase and antimyasthenics.
  • Enhance neuromuscular impulse transmission by preventing decrease of ACh by the enzyme ChE.
  • Administer with food.
  • Observe drug interactions.

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emergency crises
Emergency Crises
  • Myasthenic crisis: an exacerbation of the myasthenic symptoms caused by undermedication with anticholinesterases
  • Cholinergic crisis: an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs

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myasthenic emergency crisis
Myasthenic Emergency Crisis
  • Tensilon test is performed.
  • Priority for nursing management is to maintain adequate respiratory function.
  • Cholinesterase-inhibiting drugs are withheld because they increase respiratory secretions and are usually ineffective for the first few days after the crisis begins.

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cholinergic emergency crisis
Cholinergic Emergency Crisis
  • Anticholinergic drugs are withheld while the client is maintained on a ventilator.
  • Atropine may be given and repeated, if necessary.
  • Observe for thickened secretions due to the drugs.
  • Improvement is usually rapid after appropriate drugs have been given.

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management
Management
  • Immunosuppression
  • Plasmapheresis
  • Respiratory support
  • Promoting self-care guidelines
  • Assisting with communication
  • Nutritional support
  • Eye protection
  • Surgical management usually involving thymectomy

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health teaching
Health Teaching
  • Factors in exacerbation include infection, stress, surgery, hard physical exercise, sedatives, enemas, and strong cathartics.
  • Avoid overheating, crowds, overeating, erratic changes in sleeping habits, or emotional extremes.
  • Teach warning signs.
  • Teach importance of compliance.

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polyneuritis and polyneuropathy
Polyneuritis and Polyneuropathy
  • Syndromes whose clinical hallmarks are muscle weakness with or without atrophy; pain that is stabbing, cutting, or searing; paresthesia or loss of sensation; impaired reflexes; autonomic manifestations
  • Example: diabetic neuropathy

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peripheral nerve trauma
Peripheral Nerve Trauma
  • Vehicular or sports injury or wounds to the peripheral nerves
  • Degeneration and retraction of the nerve distal to the injury within 24 hours
  • Perioperative and postoperative care
  • Rehabilitation through physiotherapy

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restless legs syndrome
Restless Legs Syndrome
  • Leg paresthesias associated with an irresistible urge to move; commonly associated with peripheral and central nerve damage in the legs and spinal cord
  • Management: symptomatic, involving treating the underlying cause or contributing factor, if known
  • Nonmedical treatment
  • Drug therapy effective for some clients

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trigeminal neuralgia
Trigeminal Neuralgia
  • Affects trigeminal or fifth cranial nerve
  • Nonsurgical management of facial pain: drug therapy
  • Surgical management: microvascular decompression, radiofrequency thermal coagulation, percutaneous balloon microcompression
  • Postoperative care: monitoring for complications

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facial paralysis or bell s palsy
Facial Paralysis or Bell’s Palsy
  • Acute paralysis of seventh cranial nerve
  • Medical management: prednisone, analgesics
  • Protection of the eye
  • Nutrition
  • Massage; warm, moist heat; facial exercises

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