Guillane Barre Syndrome (Peripheral Polyneuritis) An autoimmune atack of the peripheral nerve myelin Immune system atacks the gangliosides. Hallmark: ASCENDING WEAKNESS Predisposing events: o Respiratory or gastrointestinal infection (Campylobacter jejuni) o Cytomegalovirus o Epsteinbarr virus o HIV o Haemophilus influenza virus o Vaccination o Surgery Incidence: o 0.6 – 1.9 cases per 1000,000 o 89% of ptxs. Recoverin with residual symptoms o Death occurs 3-8% due to respiratory failure The result of a cell mediated immune attack on the peripheral nerve myelin proteins. Does not affect cognitive function. MOLECULAR MIMICRY – most accepted theory Schwann cells are not affected, causing the axons to regenerate. Clinical manisfestations: o Characteristics feature is ascending weakness. o Bilateral Paresthesia in the limbs may occur early in the course of the illness. (sock-glove distribution) o Two dangerous features: Respiratory muscle weakness + Cardiac dysrhythmias Autonomic neuropathy Phases: o Initial phase Occurs 2 weeks after the predisposing event o Plateau phase Disease no longer seem to progress but the client does not recovery functions initially last. o Recovery phase Improvement and recovery occurs with remyelination (in descending pattern) Assessment and diagnostic findings: o History of a viral illness o CSF evaluation reveals elevated protein levels without pleocytosis. o Electromyography (EMG) revelas loss of nerve conduction velocity. It test the action potentials of the skeletal muscles. Management: o There is no known cure for GBS o However, there are therapies that lessen the severity of the illness.
Medical mgt: o Problems: Immobility Incontinence (stool and urine Abdominal distention Respiratory failure - therapy or mechanical ventilation Dysrhythmias o Plasmapheresis Also known as therapeutic plasma exchange To remove plasma proteins containing antibodies Just like hemodialysis o Intravenous immunoglobulin G (IV IG) Prevention of Complications o Anitcoagulant therapy o Thigh-high elastic compression stockings of sequential compression boots o ECG monitoring o Management of tachycardia and hypertension Prognosis o Usually good 75% o Recovery may take weeks to months o DTR are last to recover Nursing interventions o Maintaining respiratory function Incentive spirometry and chest physiotherapy Suctioning as needed Mechanical ventilation may be required o Enhancing physical mobility Support paralyzed extremity in functional position Passive range of motion exercises at least twice daily Prevent DVT and pulmonary embolism • ROM exercises • Thigh high elastic compression stockings or sequential compression boots • Adequate hydration Prevention of pressure ulcers • Padding over bony prominences • Consistent position changes every 2 hours • Evaluation of laboratory test results that may indicate malnutrition or dehydration Provide adequate nutrition • IV fluids and parenteral nutrition as prescribed • Gastrostomy tube may be placed to administer nutrients • Assess the return of the gag reflex and bowel sounds before resuming oral nutrition Improving communication • Establish some form of communication with picture cards or an eyeblink system Decreasing fear and anxiety
• Diversional activities • Encourage visitors Monitoring potential complications • Assessment of respiratory function at regular intervals o Signs and symptoms of impeding respiratory failure: Breathlessness while speaking Shallow and irregular breathing Use of acceory muscles Tachycardia Changes in respiration functiono If there is relapse, GB is worsening - Aggressive treatment should be done like plasmapheresis and IV IG.o Watch for progressive muscle weakness.o Checking for increasing mobilityo IV IG contains healthy antibodies, as treatment for GBS, contain high doses of immunoglobulin Should not be used more than 5 days if so, it will result to renal failure and hepatitiso Plasmapheresis