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1

Guillian Barre is a problem of the ---

PNS

2

Guillian Barre is caused by what?

demylenation of peripheral nerves which leads to disruption of sensory and motor pathways

3

Etiology of Guillian Barre

Immune mediated response (IgG antibodies)

Viral Infections

Bacterial Infections

Vaccines

Lymphoma

Surgery

Trauma

4

Patho of Guillian Barre

T cells migrate to peripheral nerves

Macrophages break down myelin

Inflammation can cause axonal damage (mostly temporary)

5

What are the stages of Guillian Barre?

Initial (1-4 wks)

Plateau (several days to 2 yrs)

Recovery (4-6 mths up to 2 yrs)

6

S/S of Guillian Barre

Initial muscle weakness and pain

ASCENDING paralysis

Autonomic dysfunction

Motor weakness

Cranial nerve dysfunction

Resp dysfunction

7

Guillian Barre:

What is the Ascending paralysis?

symmetric, bilateral, ascending motor loss

8

Guillian Barre:

What is the Autonomic Dysfunction caused by GB?

BP fluctuations

Dysrhythmias

9

Guilliian Barre:

Which cranial nerves are typically affected?

III: Occulomotor

VII: Facial

IX: Glossopharyngeal

X: Vagus

XI: Accessory

XII: Hypoglossal

10

Guillian Barre:

What happens to respiratory function?

changes in Tidal Volume

11

Treatment plan of Guililan Barre:

Plasmapheresis

Intravenous Immune Globulin (IVIG)

12

Guillian Barre:

What is Plasmapheresis?

removes circulating antibodies assumed to cause the disease

Plasma is selectively separated from whole blood

Plasma usually replaces itself or is transfused with albumin

13

Guillian Barre:

What is the treatment regimen if the use IVIG?

daily dose based on body weight for 5 consecutive days

14

Nursing care for Guillian Barre.

Treat the symptoms

Monitor for complications

Early Mobility

Enteral Feedings

15

Guillian Barre:

What are the cardio complications?

Acute Dysautonomia (HR, BP)

16

Guillian Barre:

What are the things we need to monitor for with respiratory care?

Atelectasis

VAP

Pneumothorax

ARDS

17

Guillian Barre:

What are the GI complications we need to monitor for?

decreased motility (paralytic ileus)

***give Reglin
***listen to bowel sounds
***keep up with BMs

18

--- --- is an autoimmune disease characterized by muscle weakness.

Myasthenia Gravia

19

What is Myasthenia Gravis caused by?

antibodies interfere with the transmission of ACh at the neuromuscular junction

20

What are the different types of Myasthenia Gravis?

Occular

Generalized

21

What is Tensilon Testing?

baseline assessment of cranial muscle strength

**tested with Myasthenia Gravis

22

What is a positive Tensilon Test?

onset of muscle tone improvement within 30-60 secs after Tensilon injection

***lasts 4-5 mins

23

Tensilon Test:

Nursing care

Observe for:

- facial fasciculations

- cardiac arrhythmias

- bradycardia

- sweating

- abdominal pain

24

Tensilon Test:

What drug do we need to have at bedside when doing the test?

Atropine

25

Myasthenia Gravis:

Why could you have a Cholinergic Crisis?

too much cholinisterase inhibitor drug (overmedication)

**remember that MG is a problem with too little ACh so cholinsterase inhibitors are used to treat

26

Myasthenia Gravis:

What are s/s of Cholinergic Crisis?

Increased weakness

Hypersalivation

Sweating

Increased Bronchial secretions

N/V/D

Hypotension

27

Myasthenia Gravis:

What is the treatment for Cholinergic Crisis?

Maintain resp function

Withhold anticholinergic drugs while on vent

Atropine

28

Myasthenia Gravis:

What is a Myasthenia Crisis?

too little cholinisterase inhibitor drug (undermedication)

29

Myasthenia Gravis:

S/S of Myasthenia Crisis?

Flare of MG symptoms

Increased weakness

HTN

Increased HR

30

Myasthenia Gravis:

Treatment for Myasthenia Crisis?

Maintain resp function

Withold cholinisterase inhibiting drugs