Chapter 46 Problems of PNS Flashcards
Factors Associated with Development of Guillain-Barre Syndrome
acute illness gastrointestinal illness campylobacter jejuni bacteria human immune deficiency virus infection mycoplasma pneumoniae surgery upper respiratory infection virus (cytomegalovirus, epstein barr virus, varicella zoster virus) vaccination (flu, group A streptococcus, rabies) drugs (captopril, danazol, penicillamine) SLE Hodgkin's disease
Key Features: Gullain-Barre Syndrome: Motor
ascending symmetric muscle weakness-flaccid paralysis without muscle atrophy
decreased or absent DTRs
respiratory compromise (dypnea, diminished breath sounds, decreased tidal volume, vital capacity) and respiratory failure
loss of bowel and bladder control (less common)
ataxia
GB Syndrome: Sensory/Cranial Nerve/Autonomic
paresthesias,pain (cramping)
facial weakness, dysphagia, diplopia, difficulty speaking
labile blood pressure, cardiac dysrhythmias, tachycardia
Ascending GBS
most common
weakness, paresthesias, leg pain beginning in lower extremities to include trunk and arms or affect the cranial nerves
symptoms of ascending flaccidity or weakness that evolves over hours to several days (1-10days)
mild paresis to total quadriplegia
some degree of respiratory compromise
DTRs are absent in limbs that become paralyzed
Pure Motor GBS
identical to ascending except sensory manifestations are absent and pt is generally in much less pain
Descending GBS
initially experiences weakness of face or bulbar muscles of jaw, sternocleidomastoid muscles (head rotators), and muscles of tongue, pharynx, and larynx
weakness progresses downward to involve limbs
may quickly affect respiratory function (breathlessness during speech, shallow respirations, dyspnea, decreased tidal volume)
often includes ophthalmoplegia (paralysis or weakness of eye muscles) causing diplopia
if papillary response to light is affected, functional blindness may result
numbness is more common in hands than in feet
DTRs are decreased or absent
Miller Fischer Variant (GBS)
a rare polyneuropathy
trial of ophthalmoplegia, areflexia (absence of reflexes) and severe ataxia (defective muscle coordination
motor strength and sensory function are normal
pupillary response to light is occasionally affected by the ophthalmoplegia, which results in functional blindness
Preventing and Managing Complications of Plasmapheresis
trauma or infection as vascular access site (keep site clean and dry. monitor site for redness, swelling, drainage, or other signs of infection)
hypovolemia with resultant hypotension, tachycardia, dizziness and diaphoresis (monitor fluid and electrolyte status and v/s, administer fluids as prescribed. provide and explanation of SEs and reassure the pt.)
hypokalemia and hypocalcemia (monitor fluid and electrolyte balance. administer replacement electrolytes as prescribed. observe for cardiac dysrhythmias)
temporary circumoral and distal extremity paresthesias, muscle twitching, nausea, and vomiting r/t administration of citrated plasma (add calcium gluconate or calcium chloride to exchange fluids as prescribed. provide explanations comfort measures and reassurance)
Intervention Activities for Pt with Gullain-Barre Syndrome: Respiratory
monitor rate rhythm depth effort of resps
monitor breathing patterns
auscultate breath sounds
monitor PFT values, vital capacity, maximal inspiratory force, forced expiratory volume in 1 second and FEV/FVC
monitor mech ventilator readings, noting increases in inspiratory pressures and decreases in tidal volume
monitor for increased restlessness, anxiety and air hunger
note changes in SaO2, Svo2, and end tidal CO2 and changes in ABGs
monitor ability to cough
monitor for dyspnea and events that decrease and worsen it
monitor chest x ray reports
place pt on side to prevent aspiration, log roll if cervical aspiration suspected
institute respiratory therapy treatments prn
Intervention Activities for Pts with Gullain-Barre Syndrome: Airway
position pt to maxamize ventilatino potential
identify pt requiring actual/potential airway insertion
perform chest physical therapy
remove secretions by coughing or suctioning
instruct how to cough
auscultate breath sounds noting areas of decreased or absent ventilation and presence of adventitious sounds
perform endotracheal or nasotracheal suctioning prn
administer humidified oxygen as appropriate
administer aerosol treatments
administer ultrasonic nebulizer treatments
position to alleviate dyspnea
monitor respiratory and oxygen status prn
Myasthenia Gravis: Motor Manifestations
progressive muscle weakness (proximal) that usually improves with rest poor posture ocular palsies ptosis weak or incomplete eye closure diplopia respiratory compromise loss of bowel and bladder control fatigue
Myasthenia Gravis: Sensory Manifestations
muscle achiness
paresthesias
decreased smell and taste
Myasthenic Crisis
increased pulse and respirations rise in BP anoxia cyanosis bowel and bladder incontinence decreased urine output absence of cough and swallow reflex
Cholinergic Crisis
nausea vomiting diarrhea abdominal cramps blurred vision pallor facial muscle twitching pupillary miosis hypotension
Mixed Crisis
apprehension restlessness dyspnea dysphagia (difficulty swallowing) dysarthria (painful joints) increased lacrimation increased salivation diaphoresis generalized weakness
