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Cadiopulmonary Medicine > Test 4 Ch.29 Guillain- Barré Syndrome > Flashcards

Test 4 Ch.29 Guillain- Barré Syndrome Flashcards

1
Q

An autoimmune disease that causes an acute peripheral nervous system disorder that results in flaccid paralysis of the skeletal muscles and loss of muscle reflexes

A

Gullian- Barré syndrome (GBS)

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2
Q

Another name for GBS

A

polyneuropathy

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3
Q

In severe cases, what can develop?

A

Paralysis of the diaphragm and ventilatory failure, Clinically it is a medical emergency

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4
Q

If pt is not properly managed then what can happen? (3)

A
  • mucus accumulation
  • airway obstruction
  • atelectasis
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5
Q

Pathologic or structural changes of the lungs w/ poorly GBS are: (4)

A
  • Mucus accumulation
  • Airway obstruction
  • Alveolar consolidation
  • Atelectasis
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6
Q

GBS etiology is

A

idiopathic

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7
Q

GBS occurs w/ an overall incidence of 1 to 2 per

A

100,000 people

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8
Q

The incidence of GBS is slightly more frequent in

A

males than in females and greater in ppl over 50 y/o

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9
Q

2/3 of cases happen after

A

respiratory or GI infection

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10
Q

GBS is ___ % to ___% more common in ______ than blacks

A

50 - 60
whites

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11
Q

All forms of GBS are autoimmune disease from an

A

immune response to foreign that attack the nerve tissue

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12
Q

This is thought to be caused by an immunologic attack that results in peripheral nerve demyelination and inflammation

A

acute inflammatory demyelinating polyradiculopathy (AIDP)

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13
Q

Clinical history of pts w/ GBS is

A
  1. symmetric mule weakness in the distal extremities accompanied by paresthesia or dysesthesias
  2. pain (throbbing, aching in lower back, butt, and legs)
  3. numbness (ascending) paralysis to arms, trunk, face)
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14
Q

What is paresthesia?

A

tingling, burning, shock-like sensations

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15
Q

What is dysesthesias?

A

unpleasant, abnormal sense of touch

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16
Q

When does the muscle paralysis generally peek?

A

2 weeks

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17
Q

The pt often

A

drools and has difficulty chewing, swelling and speaking

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18
Q

GBS starts where?

A

at the feet then moves up

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19
Q

______________ weakness occurs in about ___% of cases

A

Oculomotor
15

20
Q

10% to 30% of cases, what develops?

A

respiratory muscle paralysis, followed by ventilatory failure (hypercapnic respiratory failure)

21
Q

ascending paralysis is defined as

A

moving from the lower portions of the legs and body upward

22
Q

Between what percentage of pts have permanent residual neurologic deficits

A

10% to 30%

23
Q

About how many pts will fully recover?

A

90%

24
Q

The diagnosis is typically based on (3)

A
  1. the pts clinical history
  2. cerebrospinal fluid (CSF) findings (obtained through a lumbar spinal puncture)
  3. neurophysiology studies by way of electromyography (EMG) or a nerve conduction studies (NCS)
25
Q

In 80% to 90% of cases, the typical CSF finding is an

A

elevated protein level (100 to 1000) w/ a normal WBC count

26
Q

Clinical manifestations of GBS (3)

A
  • Atelectasis
  • Alveolar consolidation
  • Excessive bronchial secretions
27
Q

Respiratory Rate

A
  • Varies w/ the degree of respiratory muscle paralysis
  • Apnea
  • Anxiety
28
Q

Chest assessment findings (breath sounds)

A
  • Diminished
  • Crackles
29
Q

Radiologic Findings

A
  • Normal
  • Increased opacity (when atelectasis or consolidation is present)
30
Q

Autonomic nervous system dysfunction

A

occurs in 70% of cases

31
Q

ANSD symptoms include

A
  • Cardiac arrhythmias
  • Urinary retention
  • Hypertension alternating w/ hypotension
  • Orthostatic hypotension
  • Obstruction of intestines
  • Loss of sweating
32
Q

General Management of GBS w. frequent measurements of the pts’s

A
  • vital capacity (FVC)
  • maximum inspiratory pressure (MIP) (NIF)
  • maximum expiratory pressure
  • BP
  • o2 sats
  • ABG
33
Q

Clinical inductors for impending acute ventilatory failure include:

A
  • FVC <20mL/kg
  • MIP <-30
  • MEP <40 cmH2o
  • PaCO >45 mm Hg
  • pH <7.35
34
Q

MIP of -15 cm H20 would confirm

A

severe muscle weakness and acute vent failure is likely

35
Q

The primary txs modalities for GBS are (2)

A
  1. plasmapheresis (plasma exchange)
  2. intravenous immune globulin (IVIG)
36
Q

This test has been shown to be effective in decreasing morbidity and shortening the clinical course of GBS

A

plasmapheresis

37
Q

The removal of damaged antibodies from the pt’s blood plasma followed by the transfusion of the blood

A

plasmapheresis

38
Q

This tx has shown to be the least as effective

A

high dose IVIG

39
Q

Is a blood product that contains the pooled immunoglobulins IgG from thousands of donors

A

IVIG

40
Q

Questions from the back
In GBS, which of the following pathologic changes develop?
1. Inflammation
2. Increased ability to transmit nerve impulses
3. Demyelination
4. Edema

A
  1. Inflammation
  2. Demyelination
  3. Edema
41
Q

Which of the following is are associated w/ GBS
1. Alveolar consolidation
2. Mucus accumulation
3. Alveolar hyperinflation
4. Atelectasis

A
  1. Alveolar consolidation
  2. Mucus accumulation
  3. Atelectasis
42
Q

GBS is more common in:
1. People older than 50 years old
2. Blacks
3. Males than females
4. Early childhood

A
  1. People older than 50 years old
  2. Males than females
43
Q

Which of the following are possible precursors to GBS
1. Mumps
2. Swine influenza vaccine
3. Infectious mononucleosis
4. Measles

A
  1. Mumps
  2. Swine influenza vaccine
  3. Infectious mononucleosis
  4. Measles
44
Q

Full recovery from GBS is expected in approximately what percentage
a. 30%
b. 40%
c. 50%
d. 90%

A

D. 90%

45
Q

Which of the following are indicators for intubation and MV in pts w/ GBS?
1. pH >7.40
2. PaCO2 >45
3. FVC < 20mL/kg
4. MIP <-30 cm H2O

A
  1. PaCO2 >45
  2. FVC < 20mL/kg
  3. MIP <-30 cm H2O

Cadiopulmonary Medicine (24 decks)

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