GUILLAIN-BARRE SYNDROME (POLYRADICULONEURITIS)
Gullian Barre Syndrome is an acute, rapidly progressing, inflammatory demyelinating polyneuropathy of the peripheral sensory and motor nerves and nerve roots. (GBS is a clinical syndrome of unknown cause involving the peripheral and cranial nerves).
Causes
It is an autoimmune disorder. (The syndrome is preceded by a Viral infection (Respiratory or GI) 14 weeks before the onset of neurologic deficits. It has occurred following vaccination or surgery.
Pathophysiology
Vial infection induces an autoimmune reaction that attacks the myelin of the peripheral nerves. (Myelin is a substance that surrounds or ensheaths the axons of certain nerves and plays an important role in the transmission of nerve impulses.)
Paraesthesia (tingling and numbness) and muscle weakness of face, Muscle weakness to the upper extremities truck and facial muscles. Muscles are affected quickly by complete paralysis. Cranial nerves are frequently affected, leading to paralysis of the ocular, facial and oropharyngeal muscles difficulty in talking, chewing and swallowing.
Autonomic dysfunction (frequently occurs and takes the form of over-reactivity or under reactivity of the sympathetic or parasympathetic nervous systems, as) manifested t disturbances of heart rate and rhythm BP changes (transient hypertension, orthostatic hypotension) and a variety of other vasomotor disturbances. There may be severe a 1 persistent pain in the back and calves of the legs.
Loss of position sense as well as diminished or absent tendon reflexes.
Diagnostic Evaluation
1. CSF examination - low blood cell count; increased protein.
2. Electro physiologic testing shows decreased conduction velocity of peripheral nerves.
Medical Management
1. Plasmapheresis produces temporary reduction of circulating antibodies (ma be used in the severely affected and deteriorating patient to limit th deterioration and demyelination).
2. Electrocardiography monitoring and treatment of cardiac dysrhythmias.
3. Analgesics and muscle relaxants as needed.
4. Intubation and mechanical ventilation if respiratory paralysis develops.
Complications
1. Respiratory failure
2. Cardiac dysrhythmias.
3. Complications of immobility and paralysis
4. Anxiety and depression.
Nursing Management
1. Monitor respiratory status through vital capacity measurements, rate and depth o respirations, breath sounds.
2. Monitor level of weakness as it ascends towards respiratory muscles.
3. Watch for breathlessness while talking, a sign of respiratory fatigue.
4. Maintain calm environment and position patient with head of bed elevated to provide for maximum chest excursion.
5. Avoid narcotics and sedatives, which may depress respirations.
6. Monitor and patient for signs of impending respiratory failure: HR>120 or < 70/min; RR > 30/min; prepare to intubate.
7. Position patient correctly and provide ROM exercises.
8. Encourage physical and occupational therapy exercises to regain strength during rehabilitative period.
9. Assess for complications, such as contractures, pressure sores, edema of lower extremities and constipation.
10. Auscultate for bowel sounds; (Paralytic ileus may result from insufficient parasympathetic activity). IV fluids are prescribed until bowel sounds are heard. If the patient is unable to swallow, NG tube feedings may be prescribed. When the patient can swallow normally, oral feeding is gradually resumed.
11. During rehabilitation period, encourage a well-balanced nutritious diet in small, frequent feedings with vitamin supplement if indicated.
12. Establish some form of communication, lip reading and the use of picture cards, combined with a system of blinking the eyes to indicate "yes" or "no".
13. Have frequent contact with patient and provide explanation and reassurance (remembering that the patient is fully conscious).
14. Administer analgesics are required; monitor for adverse reactions.
15. Turn the patient frequently to relieve painful pressure areas.
16. Provide explanations to relieve anxiety.
17. Get to know the patient, and build a trusting relationship.
18. Reassure patient that recovery is probable.
19. Use relaxation techniques, such as listening to soft music.
20. Advise patient and family that acute phase lasts 1-4 weeks then patient stabilizes and rehabilitation can begin; however, convalescence may be lengthy, from 3 months - 2 years.
21. Teach patient to wear good supportive and protective shoes while out of bed to prevent injuries due to weakness and paraesthesia. Check feet routinely for injuries (because trauma may go unnoticed due to sensory changes).
22. Encourage the use of scheduled rest periods to avoid over-fatigue.
