NRSG 3200 Unit 10 Guillain-Barre Syndrome(answered and graded A+)

GBS is an autoimmune attack on the ____ peripheral nerve myelin An antecedent event (most often a viral infection) precipitates clinical presentation. Common agents that are associated with the development of GBS are: Campylobacter Cytomegalovirus Epstein-Barr virus Mycoplasma pneumoniae Influenza virus HIV Zika virus Hepatitis Surgery Hodgkin's lymphoma Vaccinations 00:36 01:14 Types of GBS 1. Ascending weakness, potential for respiratory failure. 2. Motor impairment with no altered sensation. 3. Descending GBS, mostly affects the head and neck muscles. 4. Miller Fisher Syndrome. Rare. Presents with ataxia, areflexia, and opthalmoplegia. GBS is more frequent in ____ between ____ and ____ years of age and those older than ____. males; 16-25; 55 Death occurs in 5-10% of cases, resulting from... respiratory failure, autonomic dysfunction, sepsis, or pulmonary embolism The cell that produces myelin in the peripheral nervous system is the ______ Schwann cell In GBS, the Schwann cell can be spared, allowing for... remyelination and recovery If damage has occurred to the axons, then regrowth is required and takes ____ to ____ and is often _____ months-years; incomplete GBS is the result of a _____ and ____ immune attack on peripheral nerve myelin proteins that causes inflammatory demyelination. cell-mediated; humoral S/S of GBS Prickling, pins and needles sensations in your fingers, toes, ankles or wrists. Weakness in your legs that spreads to your upper body. Unsteady walking or inability to walk or climb stairs. Difficulty with eye or facial movements, including speaking, chewing or swallowing. Severe pain that may feel achy or cramp-like and may be worse at nigh.t Difficulty with bladder control or bowel function. Rapid heart rate. Low or high blood pressure. Difficulty breathing. Complications of GBS Breathing difficulties/ respiratory failure. Residual numbness or other sensations. Blood pressure fluctuations. Cardiac dysrhythmias. Pain. Sluggish bowel function. Urinary retention. Blood clots Pressure sores. Relapse. The antecedent event usually occurs _____ before symptoms begin. 1-3 weeks Weakness usually begins in the legs and progresses ____ upward GBS progresses to peak severity typically within _____. 2-4 weeks. If the progression is longer than 4 weeks, then the patient is classified as having... chronic inflammatory demyelinating polyneuropathy. Any residual symptoms are permanent and reflect axonal damage from demyelination. Optic nerve demyelination may result in _____ blindness Bulbar muscle weakness related to demyelination of the glossopharyngeal and vagus nerves results in the... inability to swallow or clear secretion Vagus nerve demyelination results in autonomic dysfunction, manifested by instability of the cardiovascular system. The presentation is variable and may include.... tachycardia, bradycardia, hypertension, or orthostatic hypotension The symptoms of autonomic dysfunction occur and resolve ___ rapidly GBS does not affect ____ or ____ cognitive function; LOC Assessment and Diagnostic Findings Symmetric weakness. Diminished reflexes. Upward progression of motor weakness. History of a viral illness in the previous few weeks. Changes in vital capacity and negative inspiratory force (indicate impending neuromuscular respiratory failure). Elevated protein levels in CSF. Medical Management of GBS No cure. Respiratory therapy, mechanical ventilation, or intubation may be necessary. DVT prophylaxis (anticoagulants, SCDs) EKG monitoring IV fluids and short acting BP meds to manage hypotension. Plasmapheresis helps get rid of antibodies that contribute to the attack on the PNS. Immunoglobulin therapy blocks the damaging antibodies. Physical therapy Occupational therapy Speech therapy Pain relievers Because of rapid progression and neuromuscular respiratory failure, GBS is a.... medical emergency that may require management in the ICU. Some clinicians recommend elective intubation before the onset of _______. extreme respiratory muscle fatigue. Emergent intubation may result in _____, and mechanical ventilation may be required for an extended period. autonomic dysfunction Plasmapheresis Therapy that involves the removal of plasma and its components and the infusion of plasma substitute. This helps by ridding the plasma of certain antibodies that contributes to the immune system's attack on the peripheral nerves. Immunoglobulin Therapy High doses of IVIG can block the damaging antibodies that may contribute to GBS. Ongoing assessment for disease progression is critical. The patient is monitored for life-threatening complications such as: respiratory failure cardiac dysrhythmias VTE/PE/DVT Nursing Diagnoses for GBS Ineffective breathing pattern Impaired gas exchange Impaired bed and physical mobility Imbalanced nutrition: less than body requirements Impaired verbal communication Fear Anxiety Patient Goals/Outcomes Improved respiratory function Increased mobility Improved nutritional status Effective communication Decreased fear and anxiety Absence of complications Nursing Interventions to Maintain Respiratory Function Incentive spirometry. Chest physiotherapy. Monitor for changes in vital capacity and negative inspiratory force. Discuss the potential need for mechanical ventilation with the patient and family upon admission to provide time for psychological preparation and decision making. Suction as needed to maintain clear airway. Assess the BP and heart rate frequently to identify autonomic dysfunction. Meds or temporary pacemaker may be used to treat significant bradycardia. Nursing Interventions to Enhance Physical Mobility Perform range of motion at least twice a day. Ensure paralyzed extremities are placed in comfortable positions. Assist in frequent position changes. Administer anticoagulants as ordered. Use antiembolism stockings and SCDs. Provide adequate hydration. Place padding over bony prominences. Evaluate lab results that may indicate malnutrition or dehydration, which increase the risk of pressure ulcers and decreased mobility. Nursing Interventions to Provide Adequate Nutrition Collaborate with doctor and dietitian to develop a plan to meet the patient's nutritional and hydration needs. Administer IV fluids. Provide parenteral or enteral feedings when needed. Carefully assess for the return of gag reflex and bowel sounds before allowing oral nutrition. Nursing Interventions to Improve Communication Establish some form of communication with picture cards or an eye blink system. Collaborate with the speech therapist. Nursing Interventions to Decrease Fear and Anxiety Refer patient and family to support group. Allow and encourage family to participate in patient care. Provide information about the condition. Emphasize a positive appraisal of coping resources. Provide instruction about relaxation exercises and distraction techniques. Create an atmosphere of positivity. Encourage diversional activities to decrease loneliness and isolation. Encourage visitors. Encourage visitors to read to the patient, listen to music, or watch television with the patient. Nursing Interventions to Monitor and Manage Potential Complications Perform thorough assessment of respiratory function at regular and frequent intervals. Monitor respiratory rate and quality of respirations. Monitor EKG. Adhere to DVT prophylaxis. Understand what complications may occur and monitor and assess appropriately. Educating Patient and Family Educate about the disorder and its generally favorable prognosis. Educate about strategies that can be implemented to minimize the effects of immobility and other complications. Educate about care of the patient and the rehabilitation process. Include all members of the healthcare team (nurses, physician, OT, PT, ST, RT) in discharge teaching. Recovery and Rehabilitation Most patients experience a complete recovery. Patients who have experienced total or prolonged paralysis require intensive rehabilitation. Extent of rehab depends on the patient's needs. Comprehensive inpatient program should be considered if deficits are significant. Outpatient program can be used if the patient can travel by car. Home program may include physical and occupational therapy. The recovery phase may be long and requires patience and involvement of the patient and family. Evaluation of Patient Outcomes- Improved Respiratory Function Maintains effective respirations and airway clearance Has clear breath sounds on auscultation. Demonstrates gradual improvement in respiratory function. Breathes spontaneously. Has vital capacity within normal range. Exhibits arterial blood gases and pulse oximetry within normal limits Evaluation of Patient Outcomes- Increased Mobility Regains use of extremities Participates in rehabilitation program Demonstrates no contractures and minimal muscle atrophy. Evaluation of Patient Outcomes- Improved Nutritional Status Consumes diet adequate to meet nutritional needs. Swallows without aspiration. Evaluation of Patient Outcomes- Effective Communication Communicates needs through alternative strategies. Practices exercises recommended by the speech therapist Evaluation of Patient Outcomes- Absence of Complications Maintains intact skin integrity. Does not develop VTE. Voids without difficulty. Recovery typically lasts _____, though some take as long as 3 years. 6-12 months