Unit 7 Chapter 38 Guillian Barre Syndrome , and Myasthenia Gravis Flashcards
What is Gullian Barre Syndrome?
Guillain-Barré syndrome (GBS) is a rare acute inflammatory disorder that affects the axons and/or myelin of the PNS resulting in ascending muscle weakness or paralysis
Autoimmune disorder with acute attack of peripheral nerves, spinal nerve roots
and cranial nerves
* Immune system starts to destroy the myelin sheath that surrounds the axons
* Characterized by varying degrees of motor weakness and pathology
Where does Gullian Barre start?
A. feet
B. head
A. feet
Weakness starts at the legs and moves upwards
Are clients with Gullian Barre Fall risk?
A. Yes
B. No
A. Yes
What can cause Gullian Barre Syndrome?
RECENT VIRAL ILLNESS
A client has presented to the emergency department with sudden symmetrical weakness in both legs. On assessment, the client said they had the flu 2 weeks ago. What medical diagnosis would you suspect?
A. Amyotrophic Lateral Sclerosis
B. Trigeminal Neuralgia
C. Guillian Barre Syndrome
D. Myasthenia Gravis
C. Guillian Barre Syndrome
Viral infections usually occur 1-3 weeks prior or have taken the flu vaccine
sudden onset muscle weakness or paralysis
Which patient response requires further teaching for a patient diagnosed with Gullian Barre?
A. I should expect the medical treatment to include plasmapheresis which kills the bad
antibodies
B. Since I have Gullian Barre, to prevent it again I will get the flu vaccine every season.
C. This disease is not life long.
D. Treatment of this disease may take up to 2 years
B. Since I have Gullian Barre, to prevent it again I will get the flu vaccine every season.
After a client has gotten GB there may NEVER take the flu vaccine again.
(ALWAYS WEAR AMASK DUE TO NOT GETTING FLU SHOT**
S/S OF Gullian Barre Syndrome
Motor–sudden onset of ascending bilateral symmetric muscle
weakness to flaccid paralysis
Decrease deep tendon reflexes,
respiratory compromise,
**loss of bowel & bladder control &
ataxia: uncordinated movements*
Sensory – paresthesia(numbness and tingling) and muscle cramping-like pain
- Cranial nerve–facial weakness, dysphagia, diplopia & difficulty speaking *
Autonomic manifestations **(INCONTINENCE) - Labile BP – loss of BP control * Cardiac dysrhythmias * Tachycardia
What medications would you suspect being administered for a Guillian Barre client?
A. Acetaminophen
B. Diphenhydramine
C. Prednisone
D. Ibuprohen
C. Prednisone : decreases the immune system and bad antibodies that affect the myelin sheath
Are clients with GB at risk for dysphagia?
A. No
B. Yes
B. Yes
monitor client while eating for aspiration
AsPIRATION PRECAUTIONS
due to the movement of muscle weakness or paralysis from the leg up
What is one Aspiration Precaution
*SMALL BITES.
*SMALL SIPS.
*Alternate liquid and solid swallows.
*Ensure oral clearance after each bite.
*Sit upright (90 degrees) when eating and drinking and for 30 minutes after eating.
*Multiple swallows per bite/sip.
*Small, frequent meals throughout the day.
*Consume one pill at a time.
Phases of GB
- Acute or Initial period (1-4 weeks) – from onset of symptoms and ends when
no further deterioration occurs
- Plateau period (several days to 2 weeks)
- Recovery phase (gradually over 4-6 months, maybe up to 2 years)
- If permanent neurologic deficits remain, their condition is referred to as Chronic GBS
Dx of Gb
LP – elevated WBC’s
Nerve Conduction
MRI
-US of peripheral nerves
-Antibody biomarkers
Nursing Intervention for Respiratory Paralysis for GB?
A. Assess lung sounds
B. Apply bag valve mask with 100% oxygen
C. Increase head of head
D. Anticipated Mechanical ventilation
D. Anticipated Mechanical ventilation
if respiratory paralysis occurs, anticipate intubation for mechanical ventilation
Mechanical Vent Nursing Care
- drain fluid from circuit
-monitor for cuff leak or low or high pressure alarms
-tpn must be initiated
-GI prophyxasis must be on board
-turn pt q2
Complications of GB
Total paralysis
Potentially dangerous fluctuations in Pulse and BP
Dysrhythmias may occur
25% unable to breathe without respiratory assistance
*VITAL CAPACITY
Muscles for eye movement, speaking, chewing and swallowing also may become weak or paralyzed
Often need long-term rehabilitation to regain normal independence
As many as 15% experience lasting physical impairment
In 3% – 8% can be fatal d/t complications
Interdiscplinary Managment of GB
- we need a physical therapist
-we need an operational therapist - we need a speech pathologist
-we need a dietician
Frequent Resp/Cardiac monitoring * PT/OT, Speech-language therapies, along with dietitian
Priority for GB clients
KEEP AIRWAY PATENT
Signs of aspiration?
-choking
-drooling
HOB elevated
C&DB
Q2H/spirometry/chest physiotherapy
Monitor neuro, respiratory and cardiac status frequently
Pain management – beginning of motor and sensory remyelination
Promote communication
Psychological Support(due to loss of motor and sensory function
Long term care – may go home on ventilator
What should you tell a client regarding recovery of GB?
it may take a minimum of 1 month to 2 years to recover
Gullian Barre Syndrome Medical treatment
- Plasmapheresis – filters blood to decrease circulating bad antibodies that attack the nerves.
- IVIG – immunoglobulin therapy: Increases the amount of good antibodies for the patient
Myasthenia Gravis
A rare progressive autoimmune disease characterized by muscle weakness as a result of impaired acetylcholine receptors.
Function of Acetylcholine
Acetylcholine (ACh) is an important neurotransmitter that plays a role in brain functions, such as memory, and body functions, such as muscle contractions to move your muscles.
Where the muscle weakness for Mg originate?
A.Head
B. Legs
A.Head
Weakness starts at head – leads to respiratory complication
(EXTREME FATIGUE)
Is Dyspnea, Aspiration, or Dysphagia sooner with Myasthenia gravis or Gullian Barre?
A. Myasthenia gravis
B. Gullian Barre?
A. Myasthenia gravis
A nurse is assessing a client who has myasthenia gravis. Which of the following client statements should indicate to the nurse that the client needs a referral for occupational therapy?
a. “I have a hard time with brushing my hair”
b. “I would rather be in a wheelchair than use a walker to get around”
c. “I’ve been having problems with bladder control”
d. “I have difficulty swallowing food”
a. “I have a hard time with brushing my hair”