Guillain-Barre Syndrome

Guillain- Barre Syndrome Pathophysiology: ● A rare disorder in which the body’s immune system attacks nerves and causes damage to the peripheral nerves. ● The demyelinating form of Guillain-Barre syndrome destroys the protective covering of the peripheral nerves (myelin sheath), preventing the nerves from transmitting signals to the brain. ● People of all ages can be affected, but it is more common in adults and in males. ● Usually appears days or weeks after a preceding bacterial or viral infection. Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus and Mycoplasma pneumoniae are commonly identified antecedent pathogens. ● The body's immune system begins to attack the body itself, the immune response causes a cross-reaction with the neural tissue. When myelin is destroyed, destruction is accompanied by inflammation. These acute inflammatory lesions are present within several days of the onset of symptoms. Nerve conduction is slowed and may be blocked completely. Even though the Schwann cells that produce myelin in the peripheral nervous system are destroyed, the axons are left intact in all but the most severe cases. After 2-3 weeks of demyelination, the Schwann cells begin to proliferate, inflammation subsides, and re-myelination begins. Guillain- Barre Syndrome 1st Signs and Symptoms: ● Muscle weakness and/or paresthesia starting from the lower extremities (feet) & overtime moving up the body quickly and symmetrically ● Pain (muscle aches, cramps) ● Areflexia (lack of reflexes) Autonomic nervous system dysfunction s/s: two-four weeks peak ● Orthostatic hypotension ● Paroxysmal hypertension ● Abnormal vagal dysfunctions ● Bowel and bladder dysfunction (paralytic ileus, constipation, urine retention, UTI) ● Facial flushing ● Diaphoresis ● Cranial nerves affective (facial weakness, paresthesia, eye movement difficulties, vision lost, dysphagia) ● Immobility (paralytic ileus, muscle atrophy, pressure ulcers, venous thromboembolism, DVT, nutritional deficiencies) ● Dysrhythmias ★ Risk for Respiratory Failure! (due to thoracic paralysis) ● Weak cough ● Unable to lift head or eyebrows ● Dyspnea ● Difficulty speaking or swallowing (risk for aspiration) ● Shallow respirations ● Hypoxia Guillain- Barre Syndrome Labs and Diagnostics ● Elevated protein in CSF, specifically with no elevation in additional cells. ● Electrophysiology studies that show loss of nerve conduction velocity (Hinkle et al., 2022). ● Neurological exams. ● Electromyography would show nerve conduction dysfunction in velocity and muscle conduction. ● Nerve Conduction Studies, assess electrical signals through nerves. ● CBC ● ESR ● CRP ● Serology to test for antibodies or infections which could be connected to Guillain Barre Syndrome. (Martin, 2023). ● Gadolinium Enhanced MRI (Osmosis - PNS Demyelinating Disorders Notes: Diagrams & Illustrations | Osmosis, 2023). Medications: ● Intravenous Immunoglobulin therapy (IVIG): immunoglobulin from a donor that is given to the patient to stop antibodies that are damaging the nerves. MAIN DRUG OF CHOICE May be used to directly affect the peripheral nerve myelin antibody level (Hinkle 2022) ● Plasmapheresis: plasma exchange ● Alpha-adrenergic blocking agents: to treat possible tachycardia and hypertension ● Anticoagulants: thrombosis prevention is patient needs to be intubated and in bed for long periods of time ● IV fluids for hydration and if patient becomes hypotensive and to avoid kidney stones due to immobility Guillain- Barre Syndrome Assessment: ● Obtain a health history including recent infections and illnesses. ● Conduct a thorough neuro assessment to assess the extent of motor deficits, reflexes, sensory loss, and cranial nerve involvement ● Assess respiratory function as GBS can lead to respiratory weakness including counting respirations, pulse oximetry, auscultating lung sounds, and observing for signs of respiratory fatigue such as shortness of breath and use of accessory muscles. ● Asses for swallowing difficulties. ● Assess nutritional and hydration status. ● Assess skin color, temperature, skin turgor, and capillary refill. ● Assess patients ability to close eyes, if patient is unable to close eyes completely assess for corneal abrasion. ● Assess skin integrity. ● Monitor vital signs frequently: fluctuating blood pressure, heart rate, arrhythmias, respiratory rate and effort, and pulse oximetry. ● Assess for pain (including neuropathic and other discomforts) ● Assess activity tolerance, ability to perform ADL’s, and fall risk. ● Assess IV site if applicable: redness, warmth, pain, swelling, patency. Planning: ● Patient will maintain adequate respiratory function ● Patient will achieve highest level of physical mobility ● Patient will manage pain and discomfort effectively. ● Patient will maintain adequate nutrition and hydration. ● Patient will maintain a diet low in sodium and avoid grains, dairy products, and high-sugar foods. ● Patient will not obtain any pressure ulcers and will maintain skin integrity. ● Patient will adhere to medication regimen Guillain- Barre Syndrome Interventions/Implementations: ● Administer respiratory support as needed, including intubation and mechanical ventilation. (Keep emergency Airway Equipment at bedside) ● Instruct patient how to perform coughing and deep breathing exercises. ● Assist patient in performing postural drainage and chest physiotherapy to help mobilize and clear airway secretions. ● Ensure proper suctioning and airway clearance. ● Place patient in high fowler’s when administering medication, water, and feedings. ● Assist patient with mobility exercises and repositioning to prevent muscle contractures, pressure ulcers, and maintain joint flexibility. ● Administer pain medications and provide non-pharmaceutical pain relief measures as prescribed. ● Administer intravenous immunoglobulin (IVIG) as ordered. ● Administer IV fluids if indicated. ● Administer anticoagulants and apply thromboembolism stockings to prevent DVT ● Turn patients every 2 hours and apply padding to bony prominences. ● Perform range of motion exercises as tolerated. ● Assist with ADL’s as needed while allowing patients as much independence as possible. ● Implement fall prevention strategies, such as keeping the environment free from obstacles, keeping the bed in low position, and using mobility aids. ● Educate the patient and family about GBS, its course, and the importance of adhering to treatment plans. ● Collaborate with the healthcare team including physical therapist, speech pathologist, and occupational therapists, to optimize patients rehabilitation plan. Guillain- Barre Syndrome Evaluation: ● Patient oxygen saturation >95% ● No signs of fluctuating vital signs ● Patient performing cough and deep breathing exercises ● Lung sounds clear bilaterally ● Patient tolerated medication and feedings well ● Patient tolerated range of motion exercise and turning well with no complaints of cramping or pain ● Skin intact ● Corneas intact , moist, and no complaints of vision impairment ● Patient continues to perform ADLs independently ● Client showing signs of recovery within 4 weeks ● Client understands that complete recovery may take months, thus reducing anxiety ● Negative indication of disease progression ● Patient adhering to dietary restriction ● Negative homans sign ● Evaluate for signs of kidney stones due to immobility Guillain- Barre Syndrome Case Study https://www.proquest.com/docview/2399199398?pq-origsite=gscholar&fromopenview=tr ue The article “Guillain-Barre Syndrome: Case Study and Literature Review (Wobeto et al., 2021)” is a peer-reviewed article that discusses Guillain-Barre Syndrome (GBS), which is described as an acute demyelinating inflammatory polyneuropathy which comes about as an autoimmune response resulting to overall flaccid paralysis of the body. The majority of GBS cases, according to the report, have been caused by bacterial or viral infections, which set off an aberrant immune response that leads to the production of autoantibodies and the activation of cytokines. Due to the disease's relative rarity and frequent delayed diagnosis, the clinical prognosis can worsen. The article states that intravenous human immunoglobulin is the recommended treatment for GBS patients and emphasizes the value of a multidisciplinary team for GBS patient assessment. It is addressed how vaccinations, especially the influenza A vaccine, and GBS interact. The chance of developing GBS after immunization is tiny, but it is far less than the risk of contracting influenza A virus. Reviewing the research on GBS, the report highlights the disease's complicated etiology and the potential contribution of genetic factors and gene polymorphisms to its development. There are rare occurrences of numerous family members suffering from GBS, and some research indicates that specific gene variants may enhance vulnerability to the condition. An initial misdiagnosis, growing weakness, and other common symptoms of GBS are all described in the case study included in the paper. It explains how the patient is recovering and receiving therapy, including how different drugs and treatments are prescribed to enhance her quality of life.