Guillain-Barré syndrome is an autoimmune disorder that causes the immune system to damage nerve cells, resulting in muscle weakness and sometimes paralysis. It is usually preceded by a bacterial or viral infection. The main symptoms are rapidly progressive muscle weakness, numbness, and tingling or pain in the legs and arms. Diagnosis involves clinical evaluation, neurological tests, and examination of cerebrospinal fluid. Treatment focuses on supportive care and immunotherapy such as intravenous immunoglobulin or plasmapheresis. Most patients recover fully but some have permanent nerve damage, and 5-10% of cases are fatal due to respiratory failure or cardiac complications.

1. Post-Basic Speciality
Presentation On
Guillain–Barré Syndrome
Assigned by
Madam Fareeda faraz
Presented by
Bakht Munir

2. Outlines
In This Presentation We Will discuss / Study
Def of GBS
Causes
Pathophysiology
Diagnosis
Sign/symptoms
Management
Prognosis
NCP for GBS patients

3. Guillain–Barré Syndrome
In 1916, two French neurologist Georges Guillain &
Jean Alexandre Barré , diagnosed two soldiers with
the illness and described the abnormality—as a GBS

4. Neuron

5. Introduction
GBS is a neuro muscular and auto immune disease
causes weakness
Gullian berre syndrom is an auto immune
attack on the peripheral and some time on
cranial nerve myelin
 The result is acute ,rapid demyelination of peripheral
and some cranial nerves
 Which produces ascending weakness with dyskinesia
, hyporeflexia and paresthesia

6. Dyskinesia
Inability to voluntary movement
Hyporeflexia
When reflexes of body become weaker or lower
Paresthesia
A sensation of numbness and tingling OR pin and
needles sensation

7. Causes
Idiopathic
Mostly post infectious of
Campylobacter jejuni
Cytomegalo virus
Mycoplasma pneumonia
H-influenza
HIV

8. Epidemiology
 1-2/1 Lac per Year
 More common in male b/w 16-25 years and older
than 55 years
 Less common in female & children than male

9. Stages of GBS
Progressive phase
(from several day to weeks) majority of complication
take place in this phase
A plateau phase (maximum weakness mostly two
weeks but no longer than 4 weeks)
Recovery phase (from weeks to month or year)

10. Pathophysiology
Antibodies formed against of micro-organism (antigen)
cross react on myelin
GBS is the result of immuno attack on peripheral nerve
proteins
That causes inflammatory demyelination
Myelin sheath is a complex substance that cover nerve
It spread the conduction of impulses from cell body to
dendrites
the Schwann cell in the nerve-produce myline
Some time may be recoverable may be not

11. Clinical Manifestation
 GBS is typically begin with the muscle weakness and
diminished reflexes of lower extremities
 The nerve that innervates the diaphragm and
intercostal muscles results neuromuscular
respiratory failure
 Sensory symptoms include paresthesia,
 Weakness is usually ascending from legs to upward

12. cont
 Cranial nerve demyelination can result various
clinical manifestation
 Optic nerve=blindness
 Vagus nerve=ANS+CVS dis functioning
 HTN .arrhythmia. tachycardia

13. DIAGNOSIS
Mainly clinical
h/o infection (GIT/RTI)
h/o acute weakness
Muscles weakness and typical progression
Electro neurologic study
Most important in evidence of multi-focal
demyelination in motor and sensory neuron
It shows reduction in CMAP
EMG may be done to exclude muscular diseases

14.  CSF R/E
 CSF may be done
 RBCs less than 10
 It shows raise protein
 Mostly from 80-200mg/dl

15. Medical Management
Steroid Therapy
o Result are not so good
o May be used in any age
o Prednisolone 2mg/kg/day in children
o May be given for 2 weeks

16.  Plasmapheresis (Plasma Exchange)
It is recommended for most of the patient
It removes antibodies but costly and not risk free
Albumin or FFP (fresh frozen plasma) both are used
as replacement of volume
Its takes in four to six session

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18. Immunoglobulin Administration
 Efficacy is similar to that of plasma exchange therapy
is expensive but simple
 IVIG is lifesaving in severe cases

19. .

20.  Artificial ventilation
 It is necessary in patient with respiratory failure
 10-20% of children who haves GBS required
mechanical ventilation

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22. NURSING PROCESS
For The Patient With GBS
Assessment
o Patient presents with weakness , impaired refluxes
and upward progression of weakness
o Life threatening complication cardiac dysrrythmia ,
respiratory failure
o Infection RTI or GE

23. Nursing Diagnoses
Based on assessment
1) Ineffective breathing pattern or
2) impaired gaseous exchange
3) Impaired physical motor mobility
4) May be verbal communication impaired due
concerned nerve demyelination
5) Fear and anxiety

24. Planning and Goal
The major goal for the patient may include
1) Improve respiratory function
2) Increase mobility
3) Improve nutritional status
4) Improve effective communication
5) Decrease fear and anxiety

25. Nursing Intervention
Maintaining Respiratory Function
o Respiration may be maximized by spirometery and
chest physiotherapy
o Consent from relative for artificial ventilation and
intubation
o Proper mechanical ventilation if needed
o Proper O2 therapy
o Suction may be needed and some cases for airway
clearance
o Medication with 6 rights as prescribed by physician

26.  Enhancing Physical Mobility
o To enhance physical mobility and prevent from
complications of immobility (rigidity + pressure
ulcers)
o Proper positioning and changing 2hourly to prevent
from DVT etc
o Physiotherapy at least two time daily
o Observe for dehydration and mal nutrition
o Care of ANS changes HTN Tachycardia etc

27.  Providing Adequate Nutrition
o Due to GBS may result from insufficient
parasympathetic activity
o In this event the nurse administers IV fluid for
supplement
o Gastrostomy may be done in some cases
o The nurse should be examine for bowel sounds after
taking orally

28.  Improving Communication
o Because of paralysis pt cannot talk , lough or cry
o Establishing some forms of communication with
body postures or nonverbal communication
o Speech therapy may be needed in some case

29.  Decrease Fear And Anxiety
o In nursing intervention a nurse should decreases
his/her client fear and anxiety
o By teaching him/her religious importance and
rewards of god
o By telling that GBS is a recoverable and a disease
with better prognosis
o By sharing of informative stories and current news
updates

30.  Evaluation
o Evaluate expected outcomes
o Effective respiration
o Usual body mobility
o Demonstrate recovery of speech
o Show lessening of fear and anxiety
o Observe for complication

31. PROGNOSIS
STUDIES on recovery rates differ
But most of that 60-75% of patients recover
completely
15-20% develop permanent impairment
Deaths occurs in 3-10% of cases resulting from
respiratory failure ,autonomic dys functioning sepsis

32. Now GBS means

33. Reference
1) Medical and Surgical Nursing by Janice L.Hinkle &
Kerry H.Cheever
2) Pediatrics by Dr Pervaiz Akber
3) https://en.wikipedia.org/wiki/Guillain%E2%80%93B
arr%C3%A9_syndrome

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