Guillain-Barr Syndrome (GBS)

Team
carlotta carrie john nathaniel ryan yvonne

GO

by: n8dgr8

Etiology and Pathophysiology

Cause of this disorder is unknown. Believe to be a cell-mediated immunologic reaction directed at peripheral nerves. Can be see in immune system stimulation from a viral infection, trauma, surgery, viral immunizations, or human immunodeficiency virus (HIV). Campylobacter jejuni is the most recognized organism associated with Guillain-Barr syndrome. Its a rare syndrome that can affect 1 in 100,000 Its an acute, rapidly progressing and potential fatal form of polyneuritis. By affecting peripheral nervous system damaging myelin sheath, (a segmental demyelination). Also edema and inflammation of the affected nerves, causing a loss of neurotransmission to the periphery. More common in males than females and typically seen in adults

Genetic Factors
GBS has not been genetically linked but campylobactor jejuni is the most common organism known. 30% of pts w/ campylocator jejuni gastroenteritis will be diagnosed w/ GBS. Other pathogens include mycoplasma pneumoniae, CMV and Epstein Barr.

Incidence and Prognosis

Can be a rapid unexpected onset. Pts have the most weakness in the first 2 weeks after s/sx first appear. At the third week of the illness, 90% of pts will have a further decline in weakness. The recovery ranges from 3 wks to 3 yrs. After 3 yrs, 30% of the pts will have residual weakness. The mortality rate is 3% from GBS.

How is GBS diagnosed?

Based on pt hx and clinical manifestations. Lumbar puncture for CSF is normal or low protein. After 7 days protein is high. Electromyogram (EMG) test shows that nerve conduction is slower. Electrocardiogram (ECG) test shows heart irregularities. Nerve biopsy can be done examining the damaged nerve or axon.

Signs and Symptoms

Weakness in lower extremities progresses over hours to weeks and peaks in 14 days. Muscles of the distal extremities are severely affected. Paresthesia (numbness and tingling) and paralysis follows in the extremities. Common sx include: hypotonia (reduced muscle tone) and areflexia (lack of reflexes). Autonomic disturbances include: orthostatic hypotension, HTN, abnormal vagal responses (bradycardia, heart block and asystole), bowel and bladder dysfunction, facial flushing and diaphoresis.

Signs and Symptoms cont.

If the disease progresses to the lower brainstem, the following cranial nerves may be affected. CNs VII, VI, III, XII, V and X. Facial weakness, difficulties w/ extraocular eye movement, dysphagia and facial paresthesia. Pain is common. There are 3 classes of pain: paresthesias, hypersthesias and muscle aches and cramps.

Diet and effect on bowel/bladder

GBS often causes dysphagia. Mild dysphagia, elevate HOB during feeding and ensure to flex the head forward. If severe dysphagia, tube feedings may be required. Pt who experiences paralytic ileus or intestinal obstruction, may require parenteral nutrition. Urinary retention may occur, especially in the first few days. Indwelling catheter may be required. Bowel care to prevent constipation.

Respiratory Implications
Respiratory failure is a serious complication. Pts may be intubated or may need tracheostomy and placed on mechanical ventilation. Monitor ABGs, respiratory rate and depth, forced vital capacity, and negative inspiratory force.

Medications
Analgesics/narcotics Muscle relaxants Antidepressants Anti-anxiety (i.e. Xanax, Ativan) Stool softeners (i.e. Docusate) Anti-convulsants (i.e. Tegretol, Dilantin) Anti-dysrhythmia agents Eye ointment or artificial tears

Treatments
No cure for GBS, but two types of treatment speed recovery and reduce severity. Plasmapheresis used in the first 2 weeks of the syndrome. IV immunoglobulin (Sandobulin) contains healthy antibodies from blood donors. High doses of immunoglobulin can block the damaging antibodies.

Nursing Interventions
Monitor airway, respiratory function, and ABGs Monitor for cardiac dysrhythmias and BP. Seizure precautions, ascending paralysis Assess gag, corneal and swallow reflexes Elevate HOB at least 30 degrees Intermittent cath or foley, bowel care

Nursing Interventions cont.

Maintain adequate nutrition and hydration Assess pain Eye care F/E therapy. Physical therapy (ROM exercises to prevent contractures & foot drop)

Teaching
Educate pt and family Explain all procedures Reassure that motor function will return Use sensor call light Refer patient and family to GuillainBarr Syndrome Foundation International. http://gbs-cidp.org/

Guillain-Barr Syndrome video

Click on the icons