Guillain-Barre Syndrome Flashcards
Guillain-Barre is the most common _____
-flaccid paralysis in developed countries
GBS
-guillain barre syndrome
GBS profile
- Men>women
- all ages and children
GBS is an
- autoimmune disease effecting peripheral nerves
- loss of limb weakness and loss of DTRs
GBS triggered by
-preceding bacterial or viral infection (60-70%)
Most common pathogen involved
- Camplyobacter (C.) Jejuni
- causing gastroenteritis
Immune Response
-infection w/ C Jejuni with ganglioside-like structure->ntibodies associated with C Jejuni attacks structures on peripheral axons–>axonal damage with influx of macrophages
axonal degeneration causes
decreased conduction speed
Temporal Pattern
- bacterial infection 1-3 weeks prior
- gradual symmetrical ascending paralysis (4 weeks with paresthesias and numbness
- Plateau (about 2 weeks)
- gradual resolution of paralysis (weeks-months)
- variable return to full function (20% left with disability)
2 preceding viral infections
- cytomegalovirus
- haemophilus influenza
diagnosis
- first ID which part of the NS involved
- EMG and Nerve conduction Velocity
- Lumbar Puncture
- Routine blood tests
- antiganglioside antibodies
4 variants of GBS
- acute inflammatory demyelinating polyneuropathy (most common in US)
- acute motor axonal neuropathy
- acute motor and sensory axonal neuropathy
- Miller Fisher Syndrome
Acure Inflammatory demyelinating Polyneuropathy
- AIDP
- most common form
- autoimmune disease with infection first
- typical demyelination-shwan cells
- EMG: Slowed NCV
Symptoms of AIDP
- LE before UE
- distal and proximal Mm (cranial nerves too)
- sensory nerves involved
- DTRs absent
- Proximal pain/ache
- variable autonomic involvement
AIDP Prognosis
- variable, depends on degree of axonal damage
- recovery may be slow and poor, or quick
- mortality rate in acute phase 3.5-12% (respiratory failure)
Indications of PT in ICU
- follows commands
- hemodynamic stability
- adequate respiratory status/O2 sat
- risk of complications that can be impacted by PT
S/Sx to terminate PT
- HR: 130bpm
- RR: 40
- SBP >200mmHg
- O2 Sats <88%
- Evidence of new arrythmia or new onset autonomic dysfunction
- pt in distress
PT Interventions in ICU
- positioning
- postural drainage
- airway clearance
- breathing retraining
- Ther ex
- inspiratory muscle training
- transfers
- gait training
- patient/family edu
- collaboration with other team members
Treatment: Pharmacology
- Immunoglobulin
- Plasmapheresis
Immunoglobulin
- preferred
- neutralize antibodies
- effect wears off after 6 weeks
Plasmapheresis
- 4 treamtnes usually
- increase rate of improvement and wean from ventilator
- shorter tiem to walk unaided
- improved strength
Supportive Treatments
- pain
- fear/anxiety edu
- communication needs
- sleep deprivation
- DVT prevention
- Skin care
- nutrition
Exercise Precautions
-concern with overuse can impede recovery and cause further weakness
Strengthening
- 3/5 or + do ex’s against gravity with resistance
- 3-/5 or less do ex’s with gravity eliminated
- PNF works well
Most patients make the most gains____
in the first 6 months
Terminate PT if HR____
-130bpm
Terminate PT if RR____
-40 breaths/min
Terminate PT if SBP___
->200mmHg
Terminate PT if O2 Sat____
-<88%
