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  1. What is Guillain-Barre syndrome?
    • Acute, rapidly progressive inflammation of peripheral motor/sensory nerves
    • Motor weakness and paralysis ascends from lower extremities (majority)
    • Polyneuritis that affects the peripheral nerves connecting the skin and muscles to the CNS
  2. Etiology & patho
    • No known causes-autoimmune reaction is suspected
    • Often develops after viral infection, immunizations, fever, injury, surgery
    • Immune system attacks itself
    • Antibody formation targets peripheral nerve myelin-damages myelin sheath and disrupts conduction
    • Nerve remyelinizes in opposite direction of demyelinization
  3. Clinical manifestations
    • Weakness, partial paralysis progressing upward and then to total paralysis
    • Paresthesias and pain
    • Muscle aches, cramping, nighttime pain
    • Respiratory compromise/failure, decreasing O2 saturation, abnormal ABG's
    • Difficulty c extraoccular eye mvmnts, dysphagia, diplopia, difficulty speaking
    • Orthostatic hypotension, hypertension, change in HR, bowel/bladder dysfunction, flushing, diaphoresis
  4. Immunizations
    • Have side effects including GB syndrome
    • Seasonal influenza vaccine
    • Meningococcal vaccine
    • Human papilloma virus
  5. Diagnostic & lab findings
    • Nerve conduction test results diminished
    • CSF- elevated proteins
    • Electromyogram (EMG)
    • WBC-leukocytosis
  6. Stages of GBS
    • Initial period-1-4wks, onset-neurologic detrioration stops
    • Plateau period-several days-2wks,no deterioration, no improvement
    • Recovery period-4-6mnths up to 2yrs, remyrlination, return of muscle strength
  7. Treatment
    • Supportive care to maintain function of body systems
    • Plasmapheresis-effective during first 2 wks
  8. Medication therapy
    • IV immunoglobulin
    • Adrenocorticotropic hormone
    • Corticosteroids
    • Antiinflammatories
    • Supportive meds-stool softeners, antacids, analgesics, antiplatelets, low molecular weight heparin
  9. Planning & implementation
    • Monitor resp status: rate, depth, breath sounds, vital capacity, gag/cough swallow reflex
    • Monitor cardiac status: HR, BP, dyrhythmias
    • Chest physiotherapy & pulonary hygeine measures: TCDB/IS
    • Maintain adequate nutrition: fluid intake to 3500 mL/day
    • Monitor bowel/bladder function
    • HOB 45 degrees
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