Test 4 Ch.29 Guillain- Barré Syndrome Flashcards
An autoimmune disease that causes an acute peripheral nervous system disorder that results in flaccid paralysis of the skeletal muscles and loss of muscle reflexes
Gullian- Barré syndrome (GBS)
Another name for GBS
polyneuropathy
In severe cases, what can develop?
Paralysis of the diaphragm and ventilatory failure, Clinically it is a medical emergency
If pt is not properly managed then what can happen? (3)
- mucus accumulation
- airway obstruction
- atelectasis
Pathologic or structural changes of the lungs w/ poorly GBS are: (4)
- Mucus accumulation
- Airway obstruction
- Alveolar consolidation
- Atelectasis
GBS etiology is
idiopathic
GBS occurs w/ an overall incidence of 1 to 2 per
100,000 people
The incidence of GBS is slightly more frequent in
males than in females and greater in ppl over 50 y/o
2/3 of cases happen after
respiratory or GI infection
GBS is ___ % to ___% more common in ______ than blacks
50 - 60
whites
All forms of GBS are autoimmune disease from an
immune response to foreign that attack the nerve tissue
This is thought to be caused by an immunologic attack that results in peripheral nerve demyelination and inflammation
acute inflammatory demyelinating polyradiculopathy (AIDP)
Clinical history of pts w/ GBS is
- symmetric mule weakness in the distal extremities accompanied by paresthesia or dysesthesias
- pain (throbbing, aching in lower back, butt, and legs)
- numbness (ascending) paralysis to arms, trunk, face)
What is paresthesia?
tingling, burning, shock-like sensations
What is dysesthesias?
unpleasant, abnormal sense of touch
When does the muscle paralysis generally peek?
2 weeks
The pt often
drools and has difficulty chewing, swelling and speaking
GBS starts where?
at the feet then moves up
______________ weakness occurs in about ___% of cases
Oculomotor
15
10% to 30% of cases, what develops?
respiratory muscle paralysis, followed by ventilatory failure (hypercapnic respiratory failure)
ascending paralysis is defined as
moving from the lower portions of the legs and body upward
Between what percentage of pts have permanent residual neurologic deficits
10% to 30%
About how many pts will fully recover?
90%
The diagnosis is typically based on (3)
- the pts clinical history
- cerebrospinal fluid (CSF) findings (obtained through a lumbar spinal puncture)
- neurophysiology studies by way of electromyography (EMG) or a nerve conduction studies (NCS)
In 80% to 90% of cases, the typical CSF finding is an
elevated protein level (100 to 1000) w/ a normal WBC count
Clinical manifestations of GBS (3)
- Atelectasis
- Alveolar consolidation
- Excessive bronchial secretions
Respiratory Rate
- Varies w/ the degree of respiratory muscle paralysis
- Apnea
- Anxiety
Chest assessment findings (breath sounds)
- Diminished
- Crackles
Radiologic Findings
- Normal
- Increased opacity (when atelectasis or consolidation is present)
Autonomic nervous system dysfunction
occurs in 70% of cases
ANSD symptoms include
- Cardiac arrhythmias
- Urinary retention
- Hypertension alternating w/ hypotension
- Orthostatic hypotension
- Obstruction of intestines
- Loss of sweating
General Management of GBS w. frequent measurements of the pts’s
- vital capacity (FVC)
- maximum inspiratory pressure (MIP) (NIF)
- maximum expiratory pressure
- BP
- o2 sats
- ABG
Clinical inductors for impending acute ventilatory failure include:
- FVC <20mL/kg
- MIP <-30
- MEP <40 cmH2o
- PaCO >45 mm Hg
- pH <7.35
MIP of -15 cm H20 would confirm
severe muscle weakness and acute vent failure is likely
The primary txs modalities for GBS are (2)
- plasmapheresis (plasma exchange)
- intravenous immune globulin (IVIG)
This test has been shown to be effective in decreasing morbidity and shortening the clinical course of GBS
plasmapheresis
The removal of damaged antibodies from the pt’s blood plasma followed by the transfusion of the blood
plasmapheresis
This tx has shown to be the least as effective
high dose IVIG
Is a blood product that contains the pooled immunoglobulins IgG from thousands of donors
IVIG
Questions from the back
In GBS, which of the following pathologic changes develop?
1. Inflammation
2. Increased ability to transmit nerve impulses
3. Demyelination
4. Edema
- Inflammation
- Demyelination
- Edema
Which of the following is are associated w/ GBS
1. Alveolar consolidation
2. Mucus accumulation
3. Alveolar hyperinflation
4. Atelectasis
- Alveolar consolidation
- Mucus accumulation
- Atelectasis
GBS is more common in:
1. People older than 50 years old
2. Blacks
3. Males than females
4. Early childhood
- People older than 50 years old
- Males than females
Which of the following are possible precursors to GBS
1. Mumps
2. Swine influenza vaccine
3. Infectious mononucleosis
4. Measles
- Mumps
- Swine influenza vaccine
- Infectious mononucleosis
- Measles
Full recovery from GBS is expected in approximately what percentage
a. 30%
b. 40%
c. 50%
d. 90%
D. 90%
Which of the following are indicators for intubation and MV in pts w/ GBS?
1. pH >7.40
2. PaCO2 >45
3. FVC < 20mL/kg
4. MIP <-30 cm H2O
- PaCO2 >45
- FVC < 20mL/kg
- MIP <-30 cm H2O
