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Guillain Barre Syndrome Presentations

Presented by: Samantha McKee, Cari Stockard, Allison Van Riper, and Jessica Lowes
by

Samantha McKee

on 3 April 2013

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Transcript of Guillain Barre Syndrome Presentations

Patient History Guillain-Barré Syndrome Samantha McKee
Cari Stockard
Allison Van Riper
Jessica Lowes Neurons Nervous System of the Body What is Guillain-Barré Syndrome? Autoimmune disorder
Affects the nerves of the entire body
The immune system begins removing the myelin sheath from the nerve cells
This causes a "short-circuit" in the conduction of electrical signals Uncommon Types of Guillain-Barré Syndrome 3 Different Types
Miller Fisher Syndrome
Sensory Guillain-Barré Syndrome
Bulbar Guillain-Barré Syndrome Miller Fisher Syndrome Triad of symptoms
Ataxia
Loss of Balance
Areflexia
Loss of Deep Tendon Reflexes
Ophthalmoplegia
Paralysis of the eye muscles Sensory Guillain-Barré Syndrome Restricted to sensory neurons Bulbar Guillain-Barré Syndrome Symptoms begin and travel in a reverse order 2002 March (cc) image by jantik on Flickr (cc) photo by tudor on Flickr Diagnostic Studies
&
Complications Member Member Member Member Member Member Member (cc) photo by theaucitron on Flickr (cc) photo by theaucitron on Flickr copy paste branches if you need more.... Spark (cc) image by nuonsolarteam on Flickr Psychosocial Aspects of GBS Anxiety
Fear
Helplessness
Fears of Death
Trapped
Frightened
Isolated Types of Guillain-Barré Common Types
Acute Inflammatory Demyelinating Polyneuropathy
Axonal Neuropathy Axonal GBS Drug Therapy &
Treatment Immune system attacks the axon
Affects motor and sensory axons Drug Therapy Beginning Signs of GBS
Symptoms start bilaterally in the legs
"pins and needles"
weakness
Symptoms ascend up the body
Loss of bowel and bladder control
Inablity to grasp objects Clinical Manifestations Diaphragm weakens
Patient will need a ventilator to survive
Facial nerves are then weakened
Patient will no longer be able to smile, blink, or verbally communicate
Double vision is also common
Swallowing may be weak or absent
Tongue may fall back and block airway Clinical Manifestations Continued Plasmapheresis Pain Affects the entire body
Nociceptive Pain
Warns of tissue damage
Neuropathic Pain
Damaged Nerves Autonomic Manifestations Difficulty voiding
Paralytic Ileus
Palpitations
Seizures First effective treatment
Machine separates plasma from the RBC's and WBC's
Infuses RBC's and WBC's + 5% albumin solution
Process takes 2-3 hours Etiology, Pathophysiology, and Clinical Manifestations Samantha McKee Allie Van Riper Respiratory Pain Management Bronchodilators
Mini-nebulizer treatment
Postural drainage Analgesics
NSAID's
Anticonvulsants
TCA's
Corticosteroids
Proven ineffective
Non-pharmacologic
TENS
Acupuncture
Meditation Cari Stockard Psychosocial Aspects
&
Nursing Care/ Managment Where to start? Jessica
Lowes Difficult to diagnose
Usually diagnosed by excluding other neurological disorders
First step: Patient history and physical examination Supportive
Very individualized based on severity of condition Preceding viral infection Respiratory or gastric illness 2-3 weeks before presenting with GBS
Stool culture - checks for presence of Campylobacter jejuni RED FLAG!!! Other Risk Factors IV Immunoglobulin Therapy HIV infection
Recent surgery
Trauma
Bone-marrow transplant
Influenza or meningococcal vaccine Nursing Process Anatomy Review Assessment Nurse Considerations Respiratory
Neuro
Integumentary
Cardiac
Pain- Critical-Care Pain Observation Tool (CPOT) Plasma Exchange

IVIg therapy

Combination therapy is not more effective than each individually

Either one should be started within 2 weeks of onset for best results

Recovery is spontaneous and cannot be predicted Exact mechanism is unknown
Block receptors on macrophages
Modulate humoral response
Inhibit autoantibodies
Suppress autoantibodies
Dosage
0-4g/kg of body weight
5 consecutive days
IV infusion or injection Diagnoses Ineffective airway clearance
Impaired ability to communicate
Impaired skin integrity
Risk for pulmonary embolism
Risk for pneumonia (aspiration)
Risk for social isolation
Impaired physical mobility
Altered body image Cerebrospinal Fluid Examination Blood Tests White Blood Cells Electrolyte, Urea, & Creatinine Rule Out: (cc) photo by theaucitron on Flickr Lab Tests Protein Blood leaks into CSF via spinal nerve root inflammation Tumor, injury, or infection Preceding infection
Inflammatory process Hemodynamically unstable patients are at high risk for adverse effects
Not advised for elderly patients d/t narrow veins
Advise patient to eat a snack before the PE to decrease nausea
Post-PE patient is at high risk for orthostatic hypotension
Patient may experience metallic taste Cheaper & more readily available
Avoid if patient has renal insufficiency
If client is experiencing side effects decrease administration rate Planning Outcomes Interventions Decreased Na+
Increased Na+ channel blocking factor
SIADH
Decreased BUN
Malnutrition
SIADH
Decreased creatinine
Paralysis
Reduced muscle mass
Muscle cell wasting Tick paralysis
Diptheria
Toxic neuropathy
Organophosphate poisoning
Client will be able to communicate
Client will remain free of decubitus ulcers
Client will regain pulmonary function
Client's pain will be managed effectively
Client will resume ADL's
Client's feelings of fear and anxiety will be low Hallmark Signs Paresthesia
Hyperesthesia
Distal muscle weakness
Absence of reflexes
Respiratory failure
Facial weakness
Dysphagia Electrophysiologic Testing Nerve Conduction Study (NCS)
Electromyography (EMG)
MRI scans or x-ray imaging may be used, but not necessary to confirm diagnosis Auscultate breath sounds
Suction as needed
Monior cardiac status (EKG)
Take vital signs
Turn/reposition patient every two hours
Coughing and deep breathing exercises (if able)
Incorporate inventive communication techniques
Administer pain medication PRN
Provide emotional support
Passive ROM exercises Further Research Necessary to continue research in treatments
Cerebrospinal Fluid Filtration
Not much research
Not as effective as PE or IVIg The onset of the syndrome is described as being an "incomprehensible, prolonged, increasing deterioration with puzzling sensations or as a frightening, rapid onset with a sudden loss of body control" (Forsbery, Ahlstrom, & Holmqvist, p. 220, 2008). To put into perspective... Side Effects and Complications Respiratory dysfunction
Mechanical ventilation
Cardiac instability
Caused by vagal stimulation
I.e. supine positioning, suctioning, rectal stimulation, or coughing
Facial nerve dysfunction
Check mucous membranes
Keep eyes moist
Malnutrition
May require enteral feedings
Pain - major problem
Drug therapy, repositioning, massage, physical therapy, heat/ice, transcutaneous electrical nerve stimulation (TENS) Other Complications Impaired physical mobility
Joint contractures
Deep vein thrombosis
Skin breakdown
Muscle atrophy
Enteral nutrition
Aspiration pneumonia
Impaired immune system
Sepsis
ANS Effects
Sinus tachycardia or bradycardia
Hypertension
Orthostatic hypotension
Loss of bowel and bladder function
Permanent disability
Neuropathic pain syndromes
Sensory ataxia
Intrinsic hand muscle wasting
Bilateral foot drop Demonstrate understanding of communication techniques
Remain free of decubitus ulcers and contractures
Gradually wean off ventilator
Regain body functioning/ADL's
Pain will be kept under control
Feelings of fear and anxiety will be reduced References Arbour, C., & Gélinas, C. (2011). Setting goals for pain management when using a behavioral scale: Example with the critical-care pain observation tool. Critical Care Nurse, 31(6), 66-68.

Baier, S., & Schomaker, M. Z. (1995). Bed Number Ten. Boca Raton, FL: CRC Press.

Forsberg, A., Ahlstrom, G., & Holmqvist, L. W. (2008). Falling ill with Guillain-Barre syndrome: patients' experiences during the initial phase. The Authors, 220-225.

Lugg, J. (2010). Recognising and managing Guillain-Barré syndrome. Emergency Nurse, 18(3), 27-30. Retrieved from CINAHL.

Parry, G. J., & Steinberg, J. S. (2007). Guillain-Barre Syndrome: From diagnosis to recovery. New York, NY: Demos Medical Publishing, Incorporated.

Pithadia, A. B., & Kakadia, N. (2010). Guillain-Barré syndrome (GBS). Pharmacological Reports, 62, 220-232. Retrieved from CINAHL.

Pluta, R. J. (2011). Guillain-Barré Syndrome. The Journal of the American Medical Association, 305(3), 319.

Simmons, S. (2010). Guillain-Barré Syndrome: A nursing nightmare that usually ends well. Nursing 2010, 40(1), 24-29. Retrieved from CINAHL.

Smith, N., Grattan-Smith, P., Andrews, I., & Kainer, G. (2010). Acquired facial palsy with hypertension secondary to Guillain-Barre syndrome. Journal of Paediatrics and Child Health, 46(3), 125-127. Retrieved from CINAHL. doi:10.1111/j.1440-1754.2009.01650.x.

Van Doorn, P. A., Ruts, L., & Jacobs, B. C. (2008). Clinical features, pathogenesis, and treatment of Guillain-Barre syndrome. The Lancet, 7, 939-950.
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