Giuliani-barre syndrome (GBS) Flashcards
1
Q
Giuliani-barre syndrome (GBS) Patho
A
- Both motor and sensory nerve transmission is impaired
- An acquired acute, rapidly progressive, and potentially fatal form of polyneuritis. An autoimmune condition in which the immune system attacks the myelin sheath of *peripheral nerves in response to a virus or bacteria (some sort of initial illness).
- Rapid demyelination of *peripheral nerves produce an ascending weakness with dyskinesia (inability to execute voluntary movements), hyporeflexia, and parasthesias or a “pins and needles” sensation.
- Rapid demyelination may produce respiratory failure and autonomic nervous system dysfunction with CV instability
- Most often follows a viral infection
- Pt gets illness, immunsystem gets confused and attacks Myelin sheath of peripheral/ central nerves
- Effects both motor and sensory nerves
- Not permanent unless axon is damaged
— Peripheral nerves: located outside of brain and spinal cord (includes cranial nerves)
—- Somatic: controls voluntary functions
—- Autonomic: controls involuntary functions (if severe enough)(Respiratory failure)
— Central nerves: nerves in brain and spinal cord
2
Q
GBS cause
A
- Recent illness/ Immune response to a virus
- Triggers:
— Upper respritory infection/ Flu, common cold
— Epstein Barr Virus (EBV)
— Campylobacter Jejuni (Campylobacteriosis) (GI viral)
— Porphyria
— Infectious mononucleosis
— Viral Hepatitis
— HIV/ AIDs
— RARE: Minor surgery/Vaccine reaction(swine flu, influenza, etc.)
3
Q
Types of GBS
A
- Ascending GBS:
— Patient experiences weakness in lower extremities, which progresses upward and can lead to respiratory failure
purely motor deficit and with no altered sensation
Commonly starts in legs, arms, upper body - could cause respiratory distress
- Descending GBS:
— difficult to diagnose as it starts in jaw, tongue, larynx, head/ neck muscles - Miller-Fisher variant presents with:
— ataxia
— areflexia
— opthalmoplegia
4
Q
GBS Healing:
A
- Healing occurs in reverse
— Neurons affected last are first to recover
— Secondary damage to axon results in permanent deficits
5
Q
GBS Signs and Symptoms:
A
- S/s peak at 2 weeks recovery 1-2 years
- Parathesia/ tingling/ Numbness in feet/ legs and ascends up toward head until pt is paralyzed
- Decreased muscle tone/ constipation
- Paralysis from waist down/ entire body
- Weak ineffective cough
- Respiratory failure
- Aspiration
- Poor swallow
- Face paralysis/ blinking issues, etc.
- Poor speaking: establish communication needs
- Vision issues
- Urine retention; UTI
- Severe Pain; proper pain assessment (pts may not be able to speak)
- Muscle cramps
- DVT risk
- Weight loss
6
Q
Phases of GBS
How long do they last?
A
GBS Acute/initial phase (lasts 1-4 weeks)
GBS Plateau phase (lasts Days-2 weeks)
GBS Recovery phase ( gradually over 4-6 months)
7
Q
GBS Acute/initial phase
A
lasts 1-4 weeks
- Numbness/ tingling (paresthesia)
- Progressive weakness over next few days
- Symptoms may stay in this phase causing mild difficulty or
- Progression of illness may lead to complete paralysis
- If spread to respiratory muscles & ANS, pt. is in most danger
- Pain/aching/tingling
- **“Crawling skin”
8
Q
GBS Plateau phase
A
lasts Days-2 weeks
- No further deterioration
- No improvements
- Most discouraging phase to patients
9
Q
GBS Recovery phase
A
gradually over 4-6 months
- Improvement begins as the nerves remyelinate
- Function returns in reverse order
- May have numbness/pain as nerves remyelinate
- Residual deficits present if axon damage has occurred
10
Q
GBS Nursing assessment
A
- Ongoing assessment with emphasis on early detection of life-threatening complications of respiratory failure, cardiac dysrhythmias, and deep vein thrombosis (DVT)
- Monitor for changes in vital capacity and negative inspiratory force
- Assess VS frequently or continuously, including continuous monitoring of ECG
- Patient and family coping
11
Q
GBS Nursing Diagnosis
A
- Ineffective breathing pattern
- Impaired gas exchange
- Impaired physical mobility
- Imbalanced nutrition
- Impaired verbal communication
- Fear
- Anxiety
12
Q
GBS Nursing Planning
A
Major goals include:
- Improved respiratory function
- Increased mobility
- Improved nutritional status
- Effective communication
- Decreased fear and anxiety
- Effective patient and family coping
- Absence of complications
13
Q
GBS Diagnostics
A
- History of viral illness in last few weeks
— any recent vaccines?
— any mono? - No single lab test
- *Lumbar puncture (CSF)
— *Elevated protein/ without elevated white blood cell
— Before: empty bladder
— During: position, lateral recumbent with knees up to abdomen and bend chin to chest
— After: lie flat (decreases headache), needs to consume fluids to help replace CSF lost - Blood tests (leukocytosis increase in WBC’s)
- Electromyogram (EMG):
— assesses for deviation of nerves by determining muscles ability to respond to nerve stimulation - Nerve Conduction Velocity (NCV)
14
Q
GBS Nursing Interventions
A
- Monitor for ascending sensory loss, which precedes motor loss
- Vital signs (BP/HR/RR/Temp) and LOC
- Respiratory status; respiratory muscles are weak and patient may vital capacity
- Carefully assess swallowing and gag reflex and take measures to prevent aspiration
- Develop a plan for communication individualized to patient needs
- ABG
- Intubation if necessary
- Turn patient to prevent skin breakdown/ promote lung secretion mobility
- range of motion
— Prevent contracture: (towel)
— OT can fit them with braces to avoid foot drop - Administer IV and parenteral nutrition as prescribed
- prevent VTE/ DVT/ PE
— Support limbs in functional position
— Passive ROM at least twice daily
— Frequent position changes at least every 2 hours
— Elastic compression hose or sequential compression boots
— Adequate hydration - bowel and bladder control
- Bowel sounds for paralytic lilis/ motility
- Check tube feeding for residual (due to decreased motility)
- Trach care if necessary
— Infection control - Pressure injury wound care
- Daily weight
- Decreasing fear and anxiety
— Provide information and support
— Referral to support group
— Relaxation measures
— Maintain positive attitude and atmosphere to promote a sense of well-being
— Diversional activities
15
Q
GBS Medical Management
A
- No cure; but can regain function?
- Decrease recovery s/s
— Recovery is spontaneous and complete in about 85 % of patients within 6 to 12 months;
— mild motor or reflex deficits in the feet and legs may persist.
— The prognosis is best when symptoms clear between 15 to 20 days from onset. - Treatments need to be given within *2 weeks of onset of S/S to work
— *IV Immunoglobulin (IVIG): from a donor given to the patient to stop the antibodies that are damaging the nerves
— Plasmapheresis
—- Machine filters and removes the antibodies responsible for the disease
—- Major complication - hypovolemia
—- albumin or fresh frozen plasma (blood product; premedicate pt)
—- need dialysis catheter - Supportive care
- PT/OT/speech therapy
