Guillain-Barre syndrome is an inflammatory disorder of the peripheral nervous system that causes muscle weakness. It is usually triggered by a bacterial or viral infection. The main symptoms include numbness and tingling in the lower body that spreads upwards, causing muscle weakness, paralysis, and difficulty with bodily functions like breathing and swallowing. Diagnosis involves lumbar puncture, electromyography, and nerve conduction tests. Treatment focuses on plasma exchange or immunoglobulin therapy to speed recovery. Nursing care centers around managing symptoms like pain and impaired mobility, as well as risks of complications like respiratory issues.

1. Guillain-Barre syndrome
Helen Mary Moni

2. contents
• Definition
• Types
• Causes
• Risk factors
• Symptoms
• Diagnosis
• Treatment
• Complications
• Support and Rehabilitation
• Nursing Management

3. Definition
• Guillain-Barré (Ghee-yan Bah-ray) Syndrome is an inflammatory
disorder of the peripheral nerves outside the brain and spinal cord.

4. Types
Guillain-Barre syndrome is now known to occur in several forms. The main types are:
• Acute inflammatory demyelinating
polyradiculoneuropathy (AIDP), the most common form in
North America and Europe. The most common sign of AIDP
is muscle weakness that starts in the lower part of your
body and spreads upward.
• Miller Fisher syndrome (MFS), in which paralysis starts in
the eyes. MFS is also associated with unsteady gait. MFS is
less common in the U.S. but more common in Asia.
• Acute motor axonal neuropathy (AMAN) and acute
motor-sensory axonal neuropathy (AMSAN) are less
common in the U.S. But AMAN and AMSAN are more
frequent in China, Japan and Mexico

5. Causes
The exact cause of Guillain-Barre syndrome isn't known.
The disorder usually appears days or weeks after a respiratory or digestive
tract infection.
Rarely, recent surgery or vaccination can trigger Guillain-Barre syndrome.
Recently, there have been cases reported following infection with the Zika
virus.
Guillain-Barre syndrome may also occur after COVID-19 infection.

6. Risk Factors
Guillain-Barre syndrome can affect all age groups. It's also more common in
males than females.
Guillain-Barre syndrome may be triggered by:
Most commonly, infection with campylobacter, a type of bacteria often found in
undercooked poultry
Influenza virus
Cytomegalovirus
Epstein-Barr virus
Zika virus
Hepatitis A, B, C and E
HIV, the virus that causes AIDS
Mycoplasma pneumonia
Surgery
Trauma
Hodgkin's lymphoma
Rarely, influenza vaccinations or childhood vaccinations
COVID-19 infection

7. Symptoms
Early Symptoms:
• Symptoms of Guillain-Barré syndrome usually develop over hours or days
and tend to start in feet and hands before spreading to the arms and
legs.
At first people may have:
• numbness
• pins and needles
• muscle weakness
• pain
• problems with balance and co-ordination
• These symptoms usually affect both sides of the body at the same time.

8. Symptoms
Later Symptoms
The symptoms may continue to get worse over the next few days or weeks.
• Some people are only mildly affected, but others may have:
• difficulty walking without assistance
• an inability to move the legs, arms and/or face (paralysis)
• difficulty breathing
• blurred or double vision
• difficulty speaking
• problems swallowing or chewing
• Difficulty with bladder control or bowel function
• persistent and/or severe pain
• Guillain-Barré syndrome usually reaches its most severe point within 4 weeks. It
may then remain stable for a few weeks or months before gradually improving.

9. Diagnosis
• Guillain-Barre syndrome can be difficult to diagnose in its earliest stages.
Its signs and symptoms are similar to those of other neurological
disorders and may vary from person to person
• Lumbar Puncture
• Electromyography
• Nerve conduction studies

10. Treatment
There's no cure for Guillain-Barre syndrome. But two types of treatments
can speed recovery and reduce the severity of the illness
Plasma exchange (plasmapheresis).
Immunoglobulin therapy
Symptomatic management

11. Complications
• Breathing difficulties
• Residual numbness or other sensations.
• Blood pressure fluctuations and irregular heart rhythms (cardiac
arrhythmias).
• Sluggish bowel function and urine retention
• Pain
• Blood clots
• Pressure sores
• Relapse

12. Support and rehabilitation
Physiotherapy
Occupational therapy
Speech and language therapy
Counseling therapy

13. Nursing Management

14. Nursing Diagnosis
• Ineffective Breathing Pattern
• Acute Pain
• Impaired Physical Mobility
• Impaired Urinary Elimination
• Anxiety
• Risk for Altered Parenting

15. 1.Ineffective Breathing Pattern
• Assess frequency, symmetry, and depth of breathing. Observed for increased
work of breathing and evaluate skin color, temperature, capillary refill
• Observe for signs of respiratory fatigue such as shortness of breath,
decreased attention span, and impaired cough.
• Auscultate lung sounds for any changes and notifies the physician
immediately
• Auscultate lung sounds for any changes and notifies the physician
immediately.
• Assess oxygen saturation and review client’s arterial blood gases results
• Keep the head of bed elevated at around 35-45°
• Perform chest physiotherapy which includes postural drainage, chest
percussion, chest vibration, turning, deep breathing and coughing exercises.
• Anticipate the need for mechanical ventilation as ordered.
• Suction secretions as appropriate, especially if the client is intubated or
undergone a tracheostomy.

16. 2.Acute Pain
• Assess level of pain and ability to engage in activities.
• Identify the child’s perception of the word “pain” and inquire family
members what word the child uses at home; Utilize pain scale
appropriate for the child’s age and developmental level.
• Administer analgesics based on pain assessment and respiratory status;
Monitor side effect after administration.
• Provide support to extremities and maintain clean, comfortable bed
using egg-crate mattress and padding to bony prominences as needed;
Reposition client every 2 hours, use good postural alignment, assist with
passive ROM
• Apply a moist warm compress to painful areas as needed.
• Reassure parents and child that pain diminishes as motor function
slowly improve or resolved.
• Identify pain preventive measures around the clock; observe for
behavioral and physiological signs of pain.

17. 3.Impaired Physical Mobility
• Assess motor strength or functional level of mobility.
• Monitor nutritional needs as they associate with immobility
• Place the client in a position of comfort. Provide frequent position changes as
tolerated.
• Administer heparin as ordered.
• Provide padding to bony prominences such as elbow and heels.
• Perform active, passive and isotonic range of motion exercises as appropriate.
• Evaluate the need for assistive devices and provide a safe environment e.g., bed
in low position and side rails up.
• Provide rest periods in between activities. Consider energy-saving techniques.
• Assist client and their families to establish goals in participation with activities,
exercise and position changes.
• Consider the need for home assistance (e.g., physical therapy and occupational
therapy).

18. 4.Impaired Urinary Elimination
• Assess progressive degree of paralysis and effect on urinary elimination.
• Monitor intake and output every 4 to 8 hours and palpate bladder every
2 hours; assess for cloudy, foul-smelling urine.
• If needed, insert an indwelling urinary catheter to maintain elimination
• Assist client in urinary elimination rehabilitation program; perform
Crede’s maneuver in a gentle manner if indicated.
• Educate parents in the program to restore urinary function.
• Instruct parents to maintain fluid intake and monitor output in
connection to intake.
• Instruct to report any reduction or absence of urinary elimination

19. 5. Anxiety
• Assess source and level of anxiety,how anxiety is manifested and need for
information that will relieve it.
• Facilitate expression of concerns and an opportunity to ask inquiries regarding
the condition and rehabilitation of the ailing child.
• Encourage parents to stay with the child and in the care of the child.
• Therapeutically communicate with parents and child and answer questions in a
calm and honest manner.
• Assist parents and child to recognize improvements resulting from treatments.
• Allow the child to participate in own care depending on ability and degree of
paralysis; allow to make informed choices about ADL as soon as possible.
• Teach parents and child about disease condition and manifestation.
• Discuss each procedure or type of therapy, effects of any diagnostic tests to
parents and child as appropriate to age.
• Teach parents and child that degree of severity varies but motor weakness and
paralysis start with extremities and move upward with the peak reached in 3
weeks and improvement seen by 4 to 8 weeks
• Clarify any information and answer questions in lay terms and utilize visual aids
for reinforcement if helpful.

20. 6.Risk for Altered Parenting
• Assess for presence of permanent disability or possibility of long-term
recovery and effect on parents.
• Encourage parents to express feelings and unmet needs and ability to
meet and develop self-expectations.
• Encourage and praise positive parental behaviors; support any
participation in care or decision-making on behalf of the child.
• Encourage touching and play activities between parents and child.
• Teach about physical therapy program including ROM, exercises, gait
training, bracing.
• Continue to inform and support parents during the recovery period .

21. References
• https://www.mayoclinic.org/diseases-conditions/guillain-barre-
syndrome/diagnosis-treatment/drc-20363006
• https://www.gbs-cidp.org/gbs/
• https://www.nhs.uk/conditions/guillain-barre-syndrome/recovery/
• https://nurseslabs.com/guillain-barre-syndrome-nursing-care-
plans/6/
• https://www.webmd.com/brain/what-is-guillain-barre#1
• https://www.nursingcenter.com/wkhlrp/Handlers/articleContent.pdf
?key=pdf_00003465-200511000-
00005#:~:text=The%20nursing%20care%20for%20a,such%20as%20re
spiratory%20muscle%20dysfunction.