Unit 7 Chapter 38 Guillian Barre Syndrome , and Myasthenia Gravis Flashcards

1
Q

What is Gullian Barre Syndrome?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

A. feet

Weakness starts at the legs and moves upwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

A. Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What can cause Gullian Barre Syndrome?

A

RECENT VIRAL ILLNESS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

C. Guillian Barre Syndrome

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

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**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

S/S OF Gullian Barre Syndrome

A

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

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

A

B. Yes
monitor client while eating for aspiration

AsPIRATION PRECAUTIONS

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is one Aspiration Precaution

A

*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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Phases of GB

A
  1. Acute or Initial period (1-4 weeks) – from onset of symptoms and ends when
    no further deterioration occurs
    1. Plateau period (several days to 2 weeks)
    1. 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dx of Gb

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

D. Anticipated Mechanical ventilation

if respiratory paralysis occurs, anticipate intubation for mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mechanical Vent Nursing Care

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Complications of GB

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Interdiscplinary Managment of GB

A
  • 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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Priority for GB clients

A

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

18
Q

What should you tell a client regarding recovery of GB?

A

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

19
Q

Gullian Barre Syndrome Medical treatment

A
  • Plasmapheresis – filters blood to decrease circulating bad antibodies that attack the nerves.
  • IVIG – immunoglobulin therapy: Increases the amount of good antibodies for the patient
20
Q

Myasthenia Gravis

A

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

21
Q

Function of Acetylcholine

A

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.

22
Q

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

A

A.Head

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

23
Q

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

A

A. Myasthenia gravis

24
Q

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

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

25
Is MG an autoimmune disorder a. no b. yes
b. yes In MG, the person’s own antibodies prevent the receptors for the acetylcholine therefore preventing the muscle contraction.
26
Interdisciplinary Managment of MG
- 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)
27
S/s of Myasthenia Gravis
*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
28
Would a patient with MG require a mechanical ventilator? A.yes B. no
A.yes Can lose muscle strength for breathing and need a ventilator
29
Dx for MG
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
30
Medical Tx for Myastenia Graves
**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
31
Myastenia Gravis Nursing Managment and PRIORITIES
**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)
32
When should you administer PYRODSTAGMINE?
* **Administer anticholinesterase drugs as prescribed (45-60 before meals)** **ALSO IN THE MORNING**
33
What can cause Myasthinia Crisis?
**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**
34
S/s Mystenia Crisis
-**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
35
Nursing Management of Myasthenia Gravis
**GIVE PYRIDOSTIGAMINE IV** due to lack of available acetylcholine in the body
36
Whta can occur if there too much acetylcholine available in the body? A. Cholinergic Crisis B.Myasthenia Crisis
A. Cholinergic Crisis * Causes: * Too high of a dose of cholinergic meds
37
S/s of Cholinergic Crisis
-**Flaccid paralysis** -**respiratory failure** Low BP * Look for s/s of cholinergic -pupil constriction -**bradycardia** -stool incontinence -urine incontinence -teary eyes -**hypotension**
38
What is the medication of choice for a client going through Cholinergic Crisis? A. Acetominophen B. Atropine C. Diphenhydramine D. Dopamine
B. Atropine
39
Do you stop Cholisterase medication when cholinergic crisis is present? A. No B. Yes
B. Yes Stop all anticholinesterase meds * Treat with Atropine (speed pt up increase heart rate and bp,)
40
Nursing Care for MG
* 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