1. Guillain-Barre’ Syndrome

2. Concept Map: Selected Topics in Neurological Nursing
PATHOPHYSIOLOGY
Traumatic Brain Injury
Spinal Cord Injury
Specific Disease Entities:
Amyotropic Lateral Sclerosis
Multiple Sclerosis
Huntington’s Disease
Alzheimer’s Disease
Myasthenia Gravis
Guillian-Barre’ Syndrome
Meningitis
Parkinson’s Disease
ASSESSMENT
Physical Assessment
Inspection
Palpation
Percussion
Auscultation
ICP Monitoring
“Neuro Checks”
Lab Monitoring
PHARMACOLOGY
--Decrease ICP
--Disease / Condition Specific Meds
Care Planning
Plan for client adl’s,
Monitoring, med admin.,
Patient education, more…based
On Nursing Process:
A_D_P_I_E
Nursing Interventions & Evaluation
Execute the care plan, evaluate for
Efficacy, revise as necessary

3. Biggest Issue …
Respiratory Failure from intercostal and diapragmatic muscle paralysis
RAPID progression: 25% will need ventilator within 18 days!

4. Guillain-Barre’ Syndrome
Autoimmune Disorder
Inflammatory Version also
Guillain-Barre syndrome is a rare disorder
Not hereditary
Cause unknown

5. Guillain-Barre’ Syndrome
Immune system attacks peripheral nerve cell myelin proteins (Rarely involves the brain)
Causes varying degrees of muscle weakness and paralysis
Spares the Schwann cells which produce myelin -- - remyelinazation and recovery

6. Motor & Sensory Neurons

7. Triggers?
Recent History of:
Viral illness
Vaccination
Surgery
Acute Illness

8. S & S’s SEVERE weakness and numbness in legs and arms
PAIN d/t demyelinization
Ascending weakness with dyskinesia (inability to move voluntarily)
Loss of feeling + movement (paralysis)
Severe Bradycardia (pacemaker sometimes)

9. DIAGNOSTICS
Lumbar Puncture (LP) - cerebrospinal fluid with elevated protein level
Electromyogram (EMG) records muscle activity which can show loss of reflexes d/t the disease's characteristic slowing of nerve responses
Nerve Conduction Velocity (NCV) Performed with EMG, and together, they are often referred to as EMG/NCV studies. NCV records the speed at which signals travel along the nerves

10. Severe GBS Medical Emergency
Total paralysis
Potentially dangerous fluctuations in Pulse and BP
25% unable to breathe without respiratory assistance
Muscles for eye movement, speaking, chewing and swallowing also may become weak or paralyzed
Often need long-term rehabilitation to regain normal independence
As many as 15% experience lasting physical impairment
In 3% – 8% can be fatal d/t complications

11. Treatment Plasmapheresis to decrease circulating antibodies
EKG monitoring for Autonomic Dysfunction
Immunoglobulin therapy
Hormonal therapy
Physical therapy (to increase muscle flexibility and strength)

12. Nursing Care Maintain Patent Airway HOB elevated
C&DB Q2H / spirometry / chest physiotherapy
Monitor Vitals vigilently
Pain management

13. Collaborative Goals Reducing and/or managing symptoms
Preventing complications
Provide adaptive devices to increase mobility and self-care

14. Prognosis
Most people (85%) recover from even the most severe cases of GBS with minimal residual symptoms
Quick diagnosis & treatment may lessen the severity of GBS and reduce recovery time
The signs and symptoms of GBS may last days, weeks or months before muscle sensation begins to return. Regaining pre-illness strength and functioning is slow, sometimes requiring months or years. However, most people with GBS return to normal within months