GB Flashcards
definitions
acute/rapid 2-3 wks demyelinating dz of the peripheral nervous system
what happens
the immune system attacks the myelin so the nerves can’t communicate. the dendrites collect signal sends down axon passes signal down myelin to the neuromuscular junction then to muscle fibers
etiology
no clear, might be autoimmune
triggered by
infection from campylobacter, mycoplasma pna, h influ (gram -), or viral cytomegalovirus or Epstein Barr. dt they have antigens that look like myelin
affects which systems
nervous endocrine, metabolic
age and sex?
all ages and men more freq
hallmark sign
ascending paralysis/weakness
S&S
based on nerves affected, starts low extrem and ascends
nerves convey vibrations/sensation: paraesthesia
motor nerves: muscle weak, slow refelx, cant stand
cranial nerve: dbl vision/ diff speaking (7 & 12) eyes/swallowing,
resp muscles= death
autonomic nerves: constipation, B&B incont, ortho hypotension
symmetric: rapid progressive distal muscle weakness and paresthesia, deep tendon reflex
hypesthesia
bilat facial and oropharyngeal paresis
diff swallowing
*resp paralysis: poor inspiratory drive and effect, hypoxemia 2nd to resp failure
*burning toes
weakness/paralysis will stabilize in 2 wks: will gradually improve over months to years
diag
LP: increased proteins/albumin with normal wbc. normal protein 18-58 with GB protein will be in the 100’s
nerve cond/EMG: slower cond >50 normal is 20
pulmonary function test: and check abg
cbc: early leukocytosis w/ l shift
tx
02, suction, cough assist, postural drainage, trach, aimed at reducing symptoms: meds suppress the immune system IVIG or plasmapheresis: 1st line (pick 1, combo doesn't help) prevent thomboembolytic events pain: gabapentin, nsaids, opioids stress ulcer prevention encourage intake pt for rom maintain skin nutritional support
severe polyneuropathy is a
medical emergency
tx severe polyneuropathy
admit to icu
obtain abg and vital capacity
intubate if vc <12-15, Pa02 <70 diff clear secretions, concern for aspiration
anticipate vent support
monitor brady/tachy arrhythmia, ortho hypotension, systemic htn,