Download - Guillain-Barré Syndrome - Libb Cyran.pdf
Libby Cyran BSN, RN, CNRNSt. Vincent HospitalIndianapolis, IN
Paralyzed and Painfully Aware: A Discussion on
Guillain-Barré Syndrome
Objectives• Define Guillain-Barré Syndrome and its
classifications• Explain how GBS is diagnosed and treated• Consider potential complications and
nursing management• Discuss recovery and prognosis for GBS
patients• Explore a case study of a GBS survivor
Guillain-Barré Syndrome Defined
• Acute inflammatory polyneuropathy• Autoimmune• Ascending weakness and sensation changes
progressing to possible paralysis • Rare; Affecting 1-2/100,000 each year• Mortality rate = 5%
Pathophysiology• Myelin sheath on
peripheral nerves degenerates as it is attacked by the immune system
• Delays and impairs impulse along the dorsal and ventral nerve roots
• Muscles weaken and possible paralysis can result
Causes• Unknown• Post-infectious immune-mediated-Respiratory or GI
illness 1-3 weeks prior to onset
Campylobacter jejuni
• Post-surgical• Vaccination Significant elevation of GBS in1976-77 Swine Flu
vaccination season
GBS Defined3 Phases
1. Acute-rapidly progressive and potentially fatal (1-3 weeks)
2. Plateau-symptoms stabilize (several days-2 weeks)3. Recovery-remyelination of nerves (4 months-3 years),
sometimes recovery is not complete
Diagnostic EvaluationHistory• 2/3 of patients have experienced a GI or Respiratory
illness in the 3 weeks prior to onset of symptoms• Paresthesia in the legs• Stiffness or pain in legs and back• Dyspnea on exertionPhysical• Ascending weakness of the limbs (symmetrical)• Muscle weakness• Decreased/absent tendon reflexes (knee jerks)
Diagnostic Evaluation
• Lumbar Puncture Low blood cell count Elevated protein
• Nerve Conduction Velocity Decreased conduction
velocity to peripheral nerves
Treatment• No known cure• Plasmapheresis-temporarily reduces circulating
antibodies Daily exchanges for 3-5 days
• High-Dose Immune Globulin therapy-acts as a blocking receptor on the macrophages to prevent antibody attack on the myelin Daily infusions for 5 consecutive days
• Corticosteroids-thought to affect the inflammatory process, given in combination with another therapy. Some studies indicate not an effective treatment..
Complications
1. Weakness/Immobility2. Respiratory Distress3. Autonomic Dysfunction4. Nutrition5. Psychosocial6. Pain
Weakness/Immobility
Effects
• Weakness, depending on severity, leads to limited mobility to complete bedrest
• Skin breakdown, constipation, Deep Vein Thrombosis (DVT) and Pulmonary Emboli (PE)
Interventions
• Teach safety precautions• Frequently turn/reposition• Provide ROM exercises• Recommend physical
therapy referral• Assess for contractures,
edema in LE and constipation
• Provide assistive devices• Apply antiembolism
stockings
Respiratory Distress
Effects
• Decreased vital capacity and depth of respirations due to accessory muscle weakness
• Ineffective cough
Interventions
• Encourage cough/deep breathing
• Elevate HOB• Monitor breath sounds,
depth of respirations and O2 saturation
• Administer oxygen• Avoid opioids and
sedatives, if possible• Intubation
Autonomic Dysfunction
Effects
• Tachycardia and arrhythmias
• Postural hypotension• Temperature instability• Urinary retention
Interventions
• Monitor telemetry• Obtain vital signs frequently• Insert NG tube if paralytic ileus
occurs• Perform In and Out
catheterization to relieve urinary retention
• Monitor fluid and electrolytes
Nutrition
Effects
• Rapid weight loss and muscle atrophy
• Dysphagia due to cranial nerve involvement
Interventions
• Auscultate for bowel sounds; hold enteral feedings if BS are absent
• Assess chewing and swallowing ability
• During rehab, encourage small, frequent meals
• Referral to dietician for evaluation
Psychosocial
Effects
• Anxiety and depression are very common
• Inability to communicate increases anxiety
Interventions
• Build a trusting relationship• Develop a communication
system• Provide explanation and
reassurance• Provide patient call system• Recommend referral to speech
therapy• Refer to social work,
counselor, psychologist
Pain
Effects
• Described as “severe charley horse”
• Often in the extremities and low back
• Worse at night, causing sleep dysfunction
• 1/3 have pain after 2 years
Interventions
• Assess pain frequently• Administer analgesics as
required (Narcotic agents sometimes effective)
• Turn the patient frequently• Provide multiple pain relieving
techniques (massage, distraction, etc.)
Recovery• After the patient reaches
plateau, an aggressive rehab program is needed for optimal recovery
• Outcome can be predicted by age and severity of illness
• 15-25% experience residual weakness
• 1/3 of patient have pain after 2 years
Case Study-Part 1
From Guillain-Barre Syndrome to Happily Every After
• 26 year old, previously healthy female
• January 26, 2011-delivered infant by c-section
• Early February-suffered from the “flu”
• 3 weeks postpartum- tingling finger, pain in neck and weakness in lower extremities, bilaterally
• Late February-diagnosed with GBS and intubated within 24 hours of admission
Case Study-Part 2
• One IVIG dose given and patient continued to decline
• Plasmapheresis• Tracheotomy• PEG Tube
• From Guillain-Barre Syndrome to Happily Ever After
May is Guillain-Barré Awareness Month
References• Bader, Mary Kay., and Linda R. Littlejohns. "Neuromuscular Disorders
of the Nervous System." Ed. Linda Boynton Desepulveda. AANN Core Curriculum for Neuroscience Nursing. 6th ed. St. Louis, MO: Saunders, 2004. 757-60. Print.
• From Guillain-Barré Syndrome to Happily Ever After. Perf. Holly Gerlach. N.d.YouTube. 11 Nov. 2012. Web. 19 Feb. 2015.
• Gerlach, Holly. Web log post. Holly Gerlach Official Website. N.p., 30 Nov. 2012. Web. 22 Feb. 2015.
• "Guillain-Barré Syndrome." Lippincott Advisor. N.p., 2015. Web. 19 Feb. 2015.
• "Guillain-Barré Syndrome Fact Sheet.": National Institute of Neurological Disorders and Stroke (NINDS). NINDS, 1 July 2011. Web. 22 Feb. 2015.
• Hickey, Joanne V. "Guillain-Barré Syndrome." The Clinical Practice of Neurological and Neurosurgical Nursing. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2009. N.pag. Web. 19 Feb. 2015.
• McNair, N., Treatment of Guillain-Barré Syndrome. Journal of Infusion Nursing 36. 6 (2013): 397-400. Ovid Full Text. Web. 19 Feb. 2015.
• "Neuromuscular Disorders." The Lippincott Manual of Nursing Practice. 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2010. N. pag. Lippincott's Nursing Advisor. Web. 19 Feb. 2015.
• Ruts, L., J. Drenthen, J. L. M. Jongen, et al. Pain in Guillain-BarréSyndrome: A Long-term Follow-up Study. Neurology 75.16 (2010): 1439-447. Ovid Full Text. Web. 19 Feb. 2015.
• Souayah, N., A. Nasar, M. Fareed, et al. Guillain-Barré Syndrome after Vaccination in United States: Data From the Centers for Disease Control and Prevention/Food and Drug Administration Vaccine Adverse Event Reporting System (1990-2005). Journal of Neuromuscular Disease 11. 1 (2009): 1-6. Ovid Full Text. Web. 19 Feb. 2015.