Guillain Barre Syndrome Flashcards
what is GBS? structures involved?
-acute inflam demyelinating polyradiculone neuropathy
-peripheral nerves and nerve roots
what causes GBS
infection; bacteria or viral
what are the three types of GBS
-acute motor axonal neuropathy
-acute motor-sensory axonal neuropathy
-Miller-Fischer syndrome
what is acute motor axonal neuropathy
-axons damaged rather than myelin
-arms and legs involved
what is acute motor-sensory axonal neuropathy
combo axon and myelin damage
what is Miller-Fischer syndrome
-rare
-wk or paralysis of eye mus
4 clinical presentations
-acute or slowly over 3-4 wks
-symmetrical ascending weakness from distal LE
-varies from mild-paralysis
-severe fatigue
Describe the pathogenesis of GBS
-origin
-cells involved in
-mild vs severe
-2/3 bacterial or viral infection, 2 wk prior via respiratory or GI
-macrophages and T cells into spinal roots and PN —> macrophages attack myelin
-mild: axons in tact
-severe: axons destroyed
What is saltatory conduction? How is it affected in GBS?
Rapid process of nerve impulse transmissions along myelinated axons
Decreased
What is the most common pathogen to cause GBS
Campylobacter jejuni —> bacterial gastroenteritis
What 3 other viruses cause GBS
Cytomegalovirus
Epstein-Barr
HIV
What are 4 varying triggers for GBS
-surgery
-IMMUNIZATIONS
-trauma
-bone marrow transplant
What are 2 main factors that make chronic inflam demyelinating polyneuropathy (CIDP)
-persists for years
-relapses more frequent
What are 5 additional characteristics that chronic inflam demyelinating polyneuropathy differs from GBS
-slow progression (up to 8 wks)
-no resp involvement
-rarely precluded by infect
-longer recovery
-corticosteroids help
What is progression rate of GBS
Over 2-4 weeks
What are 3 main clinical presentations that dx GBS
-progressive wk
-symmetrical
-CN involvement
What CNs are involved with GBS
V, VII, IX, X, XI, XII
What are 3 additional clinical presentations that can dx GBS
Dysphagia, no/decreased DTR, no fever
What is the gold standard test to dx GBS? What is another test to confirm?
Nerve conduction velocity
CSF spinal tap between L3 and 4; decreased leukocytes and increased CSF protein
What are the 3 phases of GBS? Explain
-initial: symps 1-3 wks
-plateau: days to 2 wks
-recover: 4-6 m’s to 2 years
What is the first tx option for GBS? How does it work?
Plasmapheresis
Plasma exchange, initiated within 2 weeks
What is a second tx method for GBS? How does it work?
-IV immunoglobulins
-inhibits autoantibodies
-decrease or block secondary immune attack
-implemented immediately
8 negative prognostic indicators
- > 40 yo
-rapid progression (< 7 days)
-length til nadir
-severe mus wk
-CN involve w/ loss eye mvmnt and swallowing
-vent support
-avg distal motor response
-preceding diarrheal illness or cytomegalovirus
What are the 5 long term outcome categories and the %
-independent amb at 6 m’s: >80%
-full recovery 1 year: 60%
-prolonged course: 5-10%
-relapse: 10%
-develop CIDP: 2%
What are 2 first symptoms in GBS
Symmetrical
-numb/tingle
-ascending mus wk
Autonomic symps (5)
-tachycardia
-decreased CO
-arrhythmias
-HTN
-urinary retention
What senses can be lost
Vib and prop
4 main special considerations (s/s or complications) for GBS
-DVT
-skin integrity
-autonomic dysfxn (hypoTN, dysautonomia)
-aspiration: dysphagia
What position must be avoided? How can you prevent this?
-prolonged hip and knee flex
-change every 2 hours; SLying, supine, SLying with floating heels
What should be avoided during acute phase ex
Avoid fatigue or over exertion
-stop at signs of fatigue
What are 3 interventions for ICU care
-supported upright pos w/ close heart and resp monitoring (initial 10-20 min, BP/HR every 3 min)
-prevent contracture
-prevent skin break down
What are two main goals of ICU and acute
-prevent contractures
-promote mobility: as soon as nadir reached
What are some precautions (s/s to watch out for) during assessment
Autonomic changes
-sweat, BP and HR, dizzy
-DVT, Holman’s sign
-aspiration
What are 4 major things to assess
CN, pain, sensation (prop, deep touch), and sitting tolerance
Describe how to assess vitals during sitting tolerance assessment
-BP/HR/O2 initial
-every 3-5 mins
-recheck after in bed
4 ways to promote mobility in ICU and acute
-mg OH
-abdominal binder
-w/c tilt w/ LE elevated
-stocking and leg wraps
