guillain-barre’ syndrome 1. concept map: selected topics in neurological nursing pathophysiology...

Guillain-Barre’ Guillain-Barre’ SyndromeSyndrome

1

Concept Map: Selected Topics in Neurological Nursing

PATHOPHYSIOLOGY

Traumatic Brain InjurySpinal 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

PHARMACOLOGY

--Decrease ICP--Disease / Condition Specific Meds

ASSESSMENTPhysical Assessment Inspection Palpation Percussion Auscultation

ICP Monitoring“Neuro Checks” Lab Monitoring

Care PlanningPlan for client adl’s, Monitoring, med admin.,Patient education, more…basedOn Nursing Process: A_D_P_I_E

Nursing Interventions & EvaluationExecute the care plan, evaluate for Efficacy, revise as necessary

Biggest Issue … Biggest Issue …

Respiratory Failure Respiratory Failure from intercostal from intercostal and diapragmatic muscle paralysisand diapragmatic muscle paralysis

RAPIDRAPID progression: 25% will need ventilator within 18 days!

3

Guillain-Barre’ SyndromeGuillain-Barre’ Syndrome

Autoimmune Disorder

Inflammatory Version also

Guillain-Barre syndrome is a rare disorder

Not hereditary

Cause unknown

4

Guillain-Barre’ SyndromeGuillain-Barre’ Syndrome

Immune system attacks peripheral peripheral nervenerve cell myelinmyelin proteinsproteins (Rarely involves the brain)

Causes varying degrees of muscle weakness and paralysis

Spares the Schwann cells which produce myelin --- remyelinazation and recovery

5

Motor & Sensory NeuronsMotor & Sensory Neurons

6

Triggers?Triggers?

7

Recent History of:

• Viral illness• Vaccination• Surgery• Acute Illness

S & S’sS & S’s

SEVERESEVERE weakness and numbness in legs and arms

PAINPAIN d/t demyelinization

Ascending weakness with dyskinesia dyskinesia (inability to move voluntarily)

Loss of feeling + movement (paralysisparalysis)

Severe Bradycardia (pacemaker sometimes)

8

9

DIAGNOSTICS 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

Severe GBSSevere GBS Medical Emergency

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 complications10

TreatmentTreatment

Plasmapheresis to decrease circulating antibodies

EKG monitoring for Autonomic Dysfunction

Immunoglobulin therapy

Hormonal therapy

Physical therapy (to increase muscle flexibility and strength)

11

Nursing CareNursing Care

Maintain Patent Airway

HOB elevated

C&DB Q2H / spirometry / chest physiotherapy

Monitor Vitals vigilently

Pain management

12

Collaborative GoalsCollaborative Goals

Reducing and/or managing symptoms

Preventing complications

Provide adaptive devices to increase mobility and self-care

13

PrognosisPrognosis

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

14