Unit 7 Chapter 38 Guillian Barre Syndrome , and Myasthenia Gravis

Question 1

What is Gullian Barre Syndrome?

Answer 1

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

Question 2

Where does Gullian Barre start?
A. feet
B. head

Answer 2

A. feet

Weakness starts at the legs and moves upwards

Question 3

Are clients with Gullian Barre Fall risk?
A. Yes
B. No

Answer 3

A. Yes

Question 4

What can cause Gullian Barre Syndrome?

Answer 4

RECENT VIRAL ILLNESS

Question 5

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

Answer 5

C. Guillian Barre Syndrome

Viral infections usually occur 1-3 weeks prior or have taken the flu vaccine
sudden onset muscle weakness or paralysis

Question 6

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

Answer 6

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**

Question 7

S/S OF Gullian Barre Syndrome

Answer 7

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

Question 8

What medications would you suspect being administered for a Guillian Barre client?
A. Acetaminophen
B. Diphenhydramine
C. Prednisone
D. Ibuprohen

Answer 8

C. Prednisone : decreases the immune system and bad antibodies that affect the myelin sheath

Question 9

Are clients with GB at risk for dysphagia?
A. No
B. Yes

Answer 9

B. Yes
monitor client while eating for aspiration

AsPIRATION PRECAUTIONS

due to the movement of muscle weakness or paralysis from the leg up

Question 10

What is one Aspiration Precaution

Answer 10

*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.

Question 11

Phases of GB

Answer 11

1. Acute or Initial period (1-4 weeks) – from onset of symptoms and ends when
   no further deterioration occurs

• 2. Plateau period (several days to 2 weeks)
• 3. 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

Question 12

Dx of Gb

Answer 12

LP – elevated WBC’s
Nerve Conduction
MRI
-US of peripheral nerves
-Antibody biomarkers

Question 13

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

Answer 13

D. Anticipated Mechanical ventilation

if respiratory paralysis occurs, anticipate intubation for mechanical ventilation

Question 14

Mechanical Vent Nursing Care

Answer 14

• 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

Question 15

Complications of GB

Answer 15

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

Question 16

Interdiscplinary Managment of GB

Answer 16

• 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

Question 17

Priority for GB clients

Answer 17

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

Question 18

What should you tell a client regarding recovery of GB?

Answer 18

it may take a minimum of 1 month to 2 years to recover

Question 19

Gullian Barre Syndrome Medical treatment

Answer 19

• Plasmapheresis – filters blood to decrease circulating bad antibodies that attack the nerves.
• IVIG – immunoglobulin therapy: Increases the amount of good antibodies for the patient

Question 20

Myasthenia Gravis

Answer 20

A rare progressive autoimmune disease characterized by muscle weakness as a result of impaired acetylcholine receptors.

Question 21

Function of Acetylcholine

Answer 21

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.

Question 22

Where the muscle weakness for Mg originate?
A.Head
B. Legs

Answer 22

A.Head

Weakness starts at head – leads to respiratory complication
(EXTREME FATIGUE)

Question 23

Is Dyspnea, Aspiration, or Dysphagia sooner with Myasthenia gravis or Gullian Barre?
A. Myasthenia gravis
B. Gullian Barre?

Answer 23

A. Myasthenia gravis

Question 24

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”

Answer 24

a. “I have a hard time with brushing my hair”

Question 25

Is MG an autoimmune disorder a. no b. yes

Answer 25

b. yes In MG, the person’s own antibodies prevent the receptors for the acetylcholine therefore preventing the muscle contraction.

Question 26

Interdisciplinary Managment of MG

Answer 26

- we need a physical therapist: MOVEMENT OF LOWER EXTREMITIES -we need an operational therapist: MOVEMENT OF UPEER EXTREMITIES - we need a speech pathologist: SWALLOW TEST -we need a dietician: TPN OR ASPIRATION PRECAUTION INITIATION -we need respiratory therapist(NEED FOR MECHANICAL VENT)

Question 27

S/s of Myasthenia Gravis

Answer 27

*S/S start at the head **CAUSES A DISRUPTION IN ADL'S)** * Diplopia * **MUSCLEWEAKNESS** * Ptosis(DROPPING EYES) * **Problems with chewing or swallowing** *SOB *Muscle weakness with exercise that subsides rest * Decreased senses such as smell and taste *Thymus hyperplasia * Limited facial expressions * Slurred speech * Weakness of arms

Question 28

Would a patient with MG require a mechanical ventilator? A.yes B. no

Answer 28

A.yes Can lose muscle strength for breathing and need a ventilator

Question 29

Dx for MG

Answer 29

EMG tests of muscle fibers * ICE packs on eyes for resolution of ptosis (tape eyes shut when sleeping) * CT or MRI of thymus gland (will be enlarged – remember this is where the T-Cells are made) * ANA test: used to help diagnose autoimmune disorders

Question 30

Medical Tx for Myastenia Graves

Answer 30

**PYRADOSTYGAMINE**Anticholinesterases: Increases available acetoCHOLINESTASEE to increase muscle functioning * Corticosteroids:to decrease immune system * High dose IVIG: increases good antibodies in blood * Plasmapheresis: filters out bad antibodies in the blood * Surgical – remove the Thymus gland

Question 31

Myastenia Gravis Nursing Managment and PRIORITIES

Answer 31

**MAINTAIN PATENT AIRWAY** * The priority for nursing management of the patient in crises is maintaining adequate respiratory function to promote gas exchange. *** Assess gag reflex & ability to swallow * Provide oral hygiene as needed * Collaborate with dietitian** *** Cut food into small bites or soft diet** * **Observe for choking/aspiration** * Keep HOB elevated during meals for 30-60 min after patient eats * Consider thickening liquids * Daily weights * Administer anticholinesterase drugs as prescribed (45-60 before meals)

Question 32

When should you administer PYRODSTAGMINE?

Answer 32

* **Administer anticholinesterase drugs as prescribed (45-60 before meals)** **ALSO IN THE MORNING**

Question 33

What can cause Myasthinia Crisis?

Answer 33

**Nonadherance to medication regimen or tx, skipping dose** *Abrubtly stopping the medication. *No knowledge of having Myasthenia Gravis come into ED with the crisis **Usually immediately after a resp infection** **Can also be after other things that cause response to stress**

Question 34

S/s Mystenia Crisis

Answer 34

-**HYPERTENSION** **RESPIRATORY DEPRESSION** **SEVERE MUSCLE WEAKNESS** Also: * Diplopia * Ptosis * Problems with chewing or swallowing * Decreased senses such as smell and taste * Limited facial expressions * Slurred speech * Weakness of arms

Question 35

Nursing Management of Myasthenia Gravis

Answer 35

**GIVE PYRIDOSTIGAMINE IV** due to lack of available acetylcholine in the body

Question 36

Whta can occur if there too much acetylcholine available in the body? A. Cholinergic Crisis B.Myasthenia Crisis

Answer 36

A. Cholinergic Crisis * Causes: * Too high of a dose of cholinergic meds

Question 37

S/s of Cholinergic Crisis

Answer 37

-**Flaccid paralysis** -**respiratory failure** Low BP * Look for s/s of cholinergic -pupil constriction -**bradycardia** -stool incontinence -urine incontinence -teary eyes -**hypotension**

Question 38

What is the medication of choice for a client going through Cholinergic Crisis? A. Acetominophen B. Atropine C. Diphenhydramine D. Dopamine

Answer 38

B. Atropine

Question 39

Do you stop Cholisterase medication when cholinergic crisis is present? A. No B. Yes

Answer 39

B. Yes Stop all anticholinesterase meds * Treat with Atropine (speed pt up increase heart rate and bp,)

Question 40

Nursing Care for MG

Answer 40

* The priority for nursing management of the patient in crises is maintaining adequate respiratory function to promote gas exchange. *** Assess gag reflex & ability to swallow * Provide oral hygiene as needed * Collaborate with dietitian** *** Cut food into small bites or soft diet** * **Observe for choking/aspiration** * Keep HOB elevated during meals for 30-60 min after patient eats * Consider thickening liquids * Daily weights * Administer anticholinesterase drugs as prescribed (45-60 before meals) *Assist with ambulation