Care of Patients with Problems of the Peripheral Nervous System Case Study The Patient with Guillain–Barré Syndrome The patient is a 45-year-old construction worker who is admitted for diagnostic testing for possible Guillain–Barré syndrome (GBS). The patient reports an abrupt weakness in the legs with a crawling sensation, pain, and tingling in the legs. He also reports a burning sensation that started in the lower trunk area. He states, “I feel a little nervous and scared. Am I having a stroke? Sometimes I feel like I am having trouble taking in a deep breath. Is that just my nerves?” There is history of a recent episode of gastroenteritis, but otherwise he reports good general health. 1. List several of the diagnostic tests that this patient is likely to have. Lumbar puncture to check for CSF, blood tests to show leukocytosis, EPS to demonstrate demyelinating neuropathy, EMG which reflect peripheral never function, NCV performed with EMG, MRI and CT to rule out other causes of motor weakness and ABG's may be abnormal. 2. Identify at least four priority problems for this patient. The patient has an ineffective airway, potential for inadequate oxygen, fluid shift in different areas of the body and pain/ anxiety. 3. Discuss the assessment and monitoring associated for adequate respiratory function for a patient with GBS. Monitor for respiration, distress, such as dyspnea, air hunger adventitious breathing sounds, decreased Oxygen and cyanosis. Assess the respiration rate, rhythm and depth q1 -2 hours. Check the vital capacity every 2 hours and check the lung sounds every 4 hours . Monitor the ability to cough or swallow.Also check mental status which indicate hypoxia. 4. The health care provider orders a plasmapheresis treatment for this patient. Explain the purpose and the procedure to the patient. The purpose of plasmapheresis is to remove the circulating antibodies thought to be responsible for the disease by separating plasma from whole blood and then returning the whole blood. Plasma can replace itself, this may be done a few time over a couple days. 5. In the chart below, fill in the nursing interventions to prevent complications associated with plasmapheresis. Complication Nursing Interventions Treatment-Related Complications Nurse must assess for signs of neuromuscular excitably Citrate-induced hypocalcemia including tetany and chvosteks and trousseau signs Urticarial (skin) reactions from proteins in replacement fluids Depletion coagulopathy Risk for infection from immunoglobulin depletion Fluid shift or depletion Sensitivity reaction (including potential anaphylaxis with incorrect crossmatch or administration) when fresh frozen plasma is used in replacement fluid Site-Related Complications Trauma to skin and blood vessels from largebore needles for access or catheter-related trauma Non sedating antihistamines taken regularly for several week. Prevent dehydration with nursing intervention Prevent the patient from living or sharing space with large crowd. Serve beverages at activities. All staff should encourage 60 ml of fluid of the resident choice upon entering each residents room. Strategies to manage reactions have included patient desensitization, alteration of infusion rates, skin testing and the use of premedication. Baseline comprehensive assessments, including allergy test. Bleeding, phlebitis, or infection at access site Monitor the patients vital signs and the site The D diner test is sometimes done in primary care by the Clotting at access site assessing nurse but can be done in hospitals. 6. The preceptor is reviewing the nursing notes documented by Donna Jones, a nursing student. What changes, if any, will the preceptor recommend to the student about her documentation: 0800—Pt is nervous and scared. C/O a burning sensation that started in the lower trunk area. The preceptor should instruct her to include exactly what patient said in the note, enclosed in quotation marks. The note also needs to be signed according to the facility policy, which is the initial step.