Gullain Barre Syndrome is an autoimmune disorder where the body's immune system attacks the peripheral nervous system, causing demyelination of nerve fibers and impairing nerve conduction. It is often preceded by a viral or bacterial infection. Clinical manifestations include ascending muscle weakness, loss of reflexes, numbness, and paralysis. Diagnosis involves physical exam findings, elevated cerebrospinal fluid protein, and electrodiagnostic testing. Treatment focuses on immunotherapy to reduce antibodies, respiratory support, and prevention of complications like infections and blood clots.

2. GULLAIN BARRE SYNDROME
Definition: -
(Auto immune disorder)
It is an autoimmune attack on the peripheral nerve myelin. The result is acute,
rapid segmental demyelination and inflammation of peripheral nerves and
some cranial nerves causing loss of peripheral neurotransmission.
•GBS is characterized by dyskinesia
•Hyporeflexia and paraesthesia (numbness)

3. Aetiology: -
1. Antecedent event
2. Viral infection.(Campylobacter jejuni, Cytomegalovirus, Epstein - Barr virus
, Mycoplasma pneumonia, Haemophilus influenzae ,HIV.
3. Trauma, Surgery to the brain tissue, Peripheral nerves.
4. Viral immunization produce autoimmune antibodies.
Pathophysiology: -

4. Due to etiological factors
Cell mediated and humoral immune attack
On the peripheral nerve myelin protein inflammatory demyelination.
The immune system is unable to distinguish between the two proteins
Attacks and destroys the exact location is peripheral nerve myelin
Ganglioside GMIB destruction of myelin
The axon unable to support nerve conduction
Bulbar weakness, neuromuscular respiratory - weakness
Respiratory failure Glossopharyngeal & Vagus nerve Dysphasia.

5. Mechanism of inflammation→ molecular mimicry in which the infectious
organism contains an amino acids →that mimics the peripheral nerve myelin
protein. The immune system is unable to distinguish between the two
proteins,and an autoimmune reaction occurs.
Clinical manifestations: -
•Muscle weakness
•Hyperreflexia of lower extremities
•Tetraplegia
•Neuromuscular respiratory failure.
•Paraesthesia of the hands & feet at night
•Pain of the hands & feet at night
•Weakness of legs progressed upward.

6. If cranial nerve demyelination causes: -
1. Optic nerve demyelination causes Blindness, ophthalmoplegia
2.Glossopharyngeal & vagus nerve demyelination inability to swallow / clear
secretions.
3.Vagus nerve demyelination causes autonomic dysfunction leads to instability
of cardiovascular System and causes
•Tachycardia Bradycardia
•Hypertension

7. • Orthostatic hypotension, Heart asystole
• Areflexia
• Ascending weakness. (Variation in presentation occurs)-Sensory, Motor
• Paralysis of the ocular muscles’ ataxia
• SIADH
• Appetite & sleep
Diagnostic evaluation: -
1. Physical examination- the following symptoms will be present:-
a. Symmetric weakness
b. Hypo reflexes
c. upward progression of motor weakness
2. Past positive history of viral illness before a few weeks.
3. Changes in vital capacity and negative Inspiratory force.

8. 4. Serum laboratory Studies - increased protein levels
5. CSF evaluation → Increased protein level without an increase in other
cells(7g/l)
6. Evoked potential Studios - decreased nerve conduction velocity (EMG)
Complications: -
1. Resp. failure
2. UTI
3. Paralytic illness, Muscle atrophy, DVT, Pulmonary embolism skin break
down
4. Orthostatic hypotension
5. Nutritional deficiencies
Medical Management: -
1. Respiratory therapy/ mechanical ventilation.
2. Preventing complications of immobility (Thrombosis & pulmonary emboli)

9. •Thigh-high elastic compression stockings
•Sequential compression boots Continuous
electrocardiographic monitoring
Medical Management of GBS
Sl
no
Drug group Action/
indication
Example Contraindication
1 Plasma IVIG,
Plasma
exchange
Decrease the
circulatory
antibody level
IVIG Patient must be assessed for allergic reactions and
provide adequate hydration before infusion of IVIG
2 Short acting
alpha
adrenergic
blocking agent
Control
hypertension
and tachycardia
Doxazosin Terazosin
Prazosin
Provide adequate bed rest. Monitor vitals, cardiac
parameters closely
3 Corticosteroid Reduce
inflammation
IV
Methylprednisolon e
Combined with Immunotherapy will be effective.
4 IV fluid Prevent
Hypotension
Blood plasma Monitor the symptoms of fluid overload.

10. Nursing Management of Guillain Barre Syndrome
1.Ineffective breathing pattern and impaired gas exchange related to rapidly
progressive weakness.
2.Impaired physical mobility related to paralysis.
3.Imbalanced nutrition less than body requirements related to swallowing
disability.
4.Impaired verbal communication related to cranial nerve dysfunction.
5.Fear and anxiety related to loss of control of muscles.
6.Potential for respiratory failure.
7.Potential for Autonomic dysfunction.

11. Prof: Shanmuga Meenakshi.G.
MSN,RN QHCP