Guillain-Barre Syndrome

  1. General information
    1. Symmetrical, bilateral, peripheral polyneuritis characterized by ascending paralysis
    2. Can occur at any age; affects women and men equally
    3. Cause unknown; may be an autoimmune process
    4. Precipitating factors: antecedent viral infection, immunization
    5. Progression of disease is highly individual; 90% of clients stop progression in 4 weeks; recovery is usually from 3-6 months; may have residual deficits
  2. Medical Management
    1. Mechanical ventilation if respiratory problems present
    2. Plasmapheresis to reduce circulating antibodies
    3. Continuous ECG monitoring to detect alteration in heart rate and rhythm
    4. Propranolol to prevent tachycardia
    5. Atropine may be given to prevent episodes of bradycardia during endotracheal suctioning and physical therapy.
  3. Assessment findings
    1. Mild sensory changes; in some clients severe misinterpretation of sensory stimuli resulting in extreme discomfort
    2. Clumsiness: usually first symptom
    3. Progressive motor weakness in more than one limb (classically is ascending and symmetrical)
    4. Cranial nerve involvement (dysphagia)
    5. Ventilatory insufficiency if paralysis ascends to respiratory muscles
    6. Absence of deep tendon reflexes
    7. Autonomic dysfunction
    8. Diagnostic tests
      1. CSF studies: increased protein
      2. EMG: slowed nerve conduction
  4. Nursing interventions
    1. Maintain adequate ventilation.
      1. Monitor rate and depth of respirations; serial vital capacities.
      2. Observe for ventilatory insufficiency.
      3. Maintain mechanical ventilation as needed; keep airway free of secretions and prevent pneumonia.
    2. Check individual muscle groups every 2 hours in acute phase to check for progression of muscle weakness.
    3. Assess cranial nerve function: check gag reflex and swallowing ability; ability to handle secretions; voice.
    4. Monitor vital signs and observe for signs of autonomic dysfunction such as acute periods of hypertension fluctuating with hypotension, tachycardia, arrhythmias.
    5. Administer corticosteroids to suppress immune reaction as ordered.
    6. Administer antiarrhythmic agents as ordered.
    7. Prevent complications of immobility.
    8. Promote comfort (especially in clients with sensory changes): foot cradle, sheepskin, guided imagery, relaxation techniques.
    9. Promote optimum nutrition.
      1. Check gag reflex before feeding.
      2. Start with pureed foods.
      3. Assess need for nasogastric tube feedings if unable to swallow.
    10. Provide psychologic support and encouragement to client/significant others.
    11. Refer for rehabilitation to regain strength and to treat any residual deficits.

Tuesday, May 20, 2008 | Labels: |

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