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Guillane Barre Syndrome (Peripheral Polyneuritis)      An autoimmune atack of the peripheral nerve myelin      Immune sy...
 Medical mgt:      o Problems:               Immobility               Incontinence (stool and urine               Abdo...
• Diversional activities              • Encourage visitors           Monitoring potential complications              • As...
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Guillane barre syndrome


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Guillane barre syndrome

  1. 1. 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.
  2. 2.  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
  3. 3. • 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