Navalta, John Paul V BSN 3-A

What is Guillain-Barr syndrome (GBS)? Guillain-Barr syndrome (GBS) is a rare disorder in which a persons own immune system damages their nerve cells, causing muscle weakness and sometimes paralysis. Symptoms of GBS include: Numbness or tingling in your hands and feet and sometimes around the mouth and lips. Muscle weakness in your legs and arms and the sides of your face. Trouble speaking, chewing, and swallowing. Not being able to move your eyes. Back pain. Symptoms usually start with numbness or tingling in the fingers and toes. Over several days, muscle weakness in the legs and arms develops. After about 4 weeks, most people begin to get better. Infections that may trigger GBS: GBS usually begins to affect the nerves after you've had a viral or bacterial infection. Often it is after an infection of the lungs or stomach and intestines. Infections that may trigger GBS include: Campylobacter jejuni, which can cause a type of food poisoning. Mycoplasma , which can cause pneumonia. Cytomegalovirus (CMV), which can cause fever, chills, sore throat, swollen glands, body aches, and fatigue. Epstein-Barr virus (EBV), which can cause mononucleosis (mono). Varicella-zoster virus, which can cause chickenpox and shingles. Risk factors Guillain-Barre syndrome can affect all age groups, but you're at greater risk if: You're a young adult You're an older adult

Guillain-Barre syndrome may be triggered by: Most commonly, infection with campylobacter, a type of bacteria often found in undercooked food, especially poultry Mycoplasma pneumonia Surgery Epstein-Barr virus Influenza virus Hodgkin's disease Mononucleosis HIV, the virus that causes AIDS Rarely, rabies or influenza immunizations

Navalta, John Paul V BSN 3-A

PATHOPHYSIOLOGY Acute Inammatory Demyelinating Polyradiculoneuropathy; The most common form of GBS is AIDP, which is Characterized pathologically by demyelination, lymphocytic inltration, and macrophage-mediated clearance of Myelin. Approximately two thirds of GBS cases, occur weeks after an infection such as C. jejuni, CMV, Mycoplasma pneumonia, or inuenza virus. These infectious agents have epitopes on their surface that are similar to epitopes on the surface of peripheral nerves (e.g., gangliosides, glycolipids), resulting in the peripheral nerve acting as a molecular mimic of the infectious agent. Paranodal myelin, exposed axolemma at nodes of Ranvier, and the presynaptic component of the neuromuscular junction are sites of antibody attack of varying degrees for different GBS syndromes and individuals. Macrophagemediated stripping of myelin also occurs, mediated by antibody and complement deposition on Schwann cell and myelin membranes. Demyelination may occur throughout the length of the nerve, especially and perhaps earliest at proximal nerve roots and distal intramuscular nerve twigs where the blood-nerve barriers are weak. 12,100 The nerve terminal axons are also damaged in AIDP. Nerve terminal damage follows antibody binding and complement xation. Activation of the complement pathway leads to membrane attack complex (MAC) formation with degradation of the terminal axonal cytoskeleton and mitochondrial injury.

Complications Complications of Guillain-Barre syndrome include: Breathing difficulties. A potentially deadly complication of Guillain-Barre syndrome is that the weakness or paralysis can spread to the muscles that control your breathing. You may need temporary help from a machine to breathe when you're hospitalized for treatment. Residual numbness or other sensations. Most people with Guillain-Barre syndrome recover completely or have only minor, residual weakness or abnormal sensations, such as numbness or tingling. However, full recovery may be slow, often taking a year or longer, with between 20 and 30 percent of people having an incomplete recovery. Cardiovascular problems. Blood pressure fluctuations and cardiac arrhythmias are common side effects of Guillain-Barre syndrome, often requiring pulse and blood pressure monitoring. Pain. Up to half of people with Guillain-Barre syndrome experience neuropathic pain, which may be relieved by nonprescription or prescription painkillers. Bowel and bladder function problems. Sluggish bowel function and urine retention may result from GuillainBarre syndrome.

Navalta, John Paul V BSN 3-A

Blood clots. People who are immobile due to Guillain-Barre syndrome are at risk of developing blood clots. Until you're able to walk independently, taking blood thinners and wearing support stockings may be recommended. Pressure sores. Being immobile also puts you at risk of developing pressure sores, or bedsores. Frequent repositioning may help avoid this problem. Relapse. Up to 10 percent of people with Guillain-Barre syndrome experience a relapse. Tests and diagnosis Guillain-Barre syndrome can be difficult to diagnose in its earliest stages. Its signs and symptoms are similar to those of other neurological disorders and may vary from person to person. The first step in diagnosing Guillain-Barre syndrome is for your doctor to take a careful medical history to fully understand the cluster of signs and symptoms you're experiencing. A spinal tap (lumbar puncture) and nerve function tests are commonly used to help confirm a diagnosis of Guillain-Barre syndrome. Spinal tap (lumbar puncture) This procedure involves withdrawing a small amount of fluid from your spinal canal at your low back (lumbar) level. This cerebrospinal fluid is then tested for a specific type of change that commonly occurs in people who have Guillain-Barre syndrome. Nerve function tests Your doctor may want information from two types of nerve function tests electromyography and nerve conduction velocity: Electromyography reads electrical activity in your muscles to determine if your weakness is caused by muscle damage or nerve damage. Nerve conduction studies assess how your nerves and muscles respond to small electrical stimuli.

Treatments and drugs Although some people can take months and even years to recover, most cases of Guillain-Barre syndrome follow this general timeline: Following the first symptoms, the condition tends to progressively worsen for about two weeks. Symptoms reach a plateau within four weeks. Recovery begins, usually lasting six to 12 months, though for some people it could take as long as three years. There's no cure for Guillain-Barre syndrome. But two types of treatments may speed recovery and reduce the severity of Guillain-Barre syndrome: Plasmapheresis. This treatment also known as plasma exchange is a type of "blood cleansing." Plasmapheresis consists of removing the liquid portion of your blood (plasma) and separating it from the actual blood cells. The blood cells are then put back into your body, which manufactures more plasma to make up for what was removed. It's not clear why this treatment works, but scientists believe that plasmapheresis rids plasma of certain antibodies that contribute to the immune system attack on the peripheral nerves. Intravenous immunoglobulin. Immunoglobulin contains healthy antibodies from blood donors. High doses of immunoglobulin can block the damaging antibodies that may contribute to Guillain-Barre syndrome

Navalta, John Paul V BSN 3-A

Nursing Interventions: Monitor respiratory status and provide treatments Initiate respiratory support by use of mechanical ventillation Prevent complication of immobility like use of anticoagulants and thigh-high elastic compression stockings to prevent thrombosis and pulmonary embolism Plasmapharesis and IVIg are used to affect peripheral nerve myelin antibody level by decreasing circulating antibody level and reduce amount of time patient is immobilized Cardiovascular risks require continous ECG monitoring Maintain patent airway Instruct patient to avoid crowded areas Keep tracheostomy set at bedside Administer steroids as prescribed Avoid Valium, as it may worsen respiratory depression Laboratory test: CSF exam reveals elevated total protein