2.9 Neurological and Sensory GUILLAIN BARRE

Question 1

Guillain-Barre

Pathophysiology

Answer 1

Pathophysiology

Segmental demyelination with edema & inflammation of affected nerves

• Acute & rapidly progressing motor paralysis, paresthesia, numbness
• Impacts muscles, nerves, cranial nerves, LOC not affected
• Autoimmune
• Affects all ages, ethnicities, & genders (men & elderly most at risk)
• Triggers: infections, immunizations, surgery

Question 2

Guillain-Barre
Manifestations
S/S

Answer 2

Manifestations

Acute onset – progresses over days to 4 weeks

Most report precipitating event within 28 days before onset

Signs & Symptoms:

• Bilateral and symmetrical loss of sensation and weakness
• Begins in feet and spreads upward = ascending
• Pain
• Reflexes are lost
• Autonomic features at times: ↑↓ BP, arrhythmia, paralytic ileus
• May lead to difficulty in breathing – ventilator needed for 25%

Question 3

Guillain-Barre

Diagnosis

Answer 3

Diagnosis:

No specific test – diagnosis by presentation and correlating history & tests

Lumbar puncture: often protein in the CSF

Nerve conduction studies show a neuropathy

Question 4

Guillain-Barre

Treatment

Answer 4

Treatment:
Plasma exchange (plasmapheresis)

IV immunoglobulin infusions to suppress antibodies

Supportive care- multisystem impacts

Rehabilitation: recovery weeks to years

Approximately 5% of GBS patients die and up to 20% have persistent disability, despite immunotherapy

Question 5

Guillain-Barre

Nursing Care:

Answer 5

Nursing Care:
Manage anxiety
Pain Management
Prevent complications of immobility (skin, DVT, muscle wasting)
Respiratory support – ventilated pt. 
Autonomic complications – ICU 
Nutrition & fluid support
Communication – can impact speech and vision
Therapy