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blierman
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What is Guillain-Barre Syndrome
- Demyelination of the peripheral nerves, progressive motor weakness and sensory abnormalities
- Ascending paralysis
- Result of a variety of related immune-mediated pathologic processes
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Clinical Manifestations of Guillain-Barre Syndrome
- Muscle weakness and pain have abrupt onset; cause remains obscure.
- Cerebral function or pupillary signs are not affected.
- Cranial nerve involvement.
- Autonomic dysfunction
- Weakness and paresthesia begin in the lower extremities and progress upward toward the trunk, arms, and cranial nerves in ascending GBS.
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Interventions for Guillain-Barre Syndrome
- Drug therapy
- Plasmapheresis
- Monitoring respiratory status and managing the airway
- Managing cardiac dysfunction
- Improving mobility and preventing complications of immobility
- Managing pain
- Promoting communication
- Providing emotional support
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Plasmapheresis
- Plasmapheresis removes the circulating antibodies assumed to cause the disease.
- Plasma is selectively separated from whole blood; the blood cells are returned to the patient without the plasma.
- Plasma usually replaces itself, or the patient is transfused with albumin.
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Myasthenia Gravis
- Chronic disease characterized by weakness primarily in muscles innervated by cranial nerves, as well as in skeletal and respiratory muscles
- Thymoma—encapsulated thymus gland tumor
- Progressive paresis of affected muscle groups that is partially resolved by resting
- Most common symptoms—involvement of eye muscles, such as ocular palsies, ptosis, diplopia, weak or incomplete eye closure
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tensilon testing for Myasthenia Gravis
- Within 30 to 60 sec after injection of Tensilon, most myasthenic patients show marked improvement in muscle tone that lasts 4 to 5 minutes.
- Prostigmin is also used.
- Cholinergic crisis is due to overmedication.
- Myasthenic crisis is due to undermedication.
- Atropine sulfate is the antidote for Tensilon complications.
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nonsurgical management for Myasthenia Gravis
- Respiratory support
- Promoting mobility
- Drug therapy: Cholinesterase inhibitor drugs, Immunosuppression, Plasmapheresis
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Cholinesterase Inhibitor Drugs
- Drugs include anticholinesterase and antimyasthenics.
- Enhance neuromuscular impulse transmission by preventing decrease of ACh by the enzyme ChE.
- Administer with food.
- Observe drug interactions.
- Too much=cholinergic crisis
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Myasthenic crisis
- an exacerbation of the myasthenic symptoms caused by undermedication with anticholinesterases
- Tensilon test is performed.
- Priority for nursing management is to maintain adequate respiratory function.
- Cholinesterase-inhibiting drugs are withheld because they increase respiratory secretions and are usually ineffective for the first few days after the crisis begins
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Cholinergic crisis
- an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs
- Anticholinergic drugs are withheld while the patient is maintained on a ventilator.
- Atropine may be given and repeated, if necessary.
- Observe for thickened secretions due to the drugs.
- Improvement is usually rapid after appropriate drugs have been given
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Management of MG
- Immunosuppression
- Plasmapheresis
- Respiratory support
- Promoting self-care guidelines
- Assisting with communication
- Nutritional support
- Eye protection
- Surgical management usually involving thymectomy
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Teachging for MG
- Factors in exacerbation include infection, stress, surgery, hard physical exercise, sedatives, enemas, and strong cathartics.
- Avoid overheating, crowds, overeating, erratic changes in sleeping habits, and emotional extremes.
- Teach warning signs.
- Teach importance of compliance
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Peripheral Nerve Trauma
- Vehicular or sports injury or wounds to the peripheral nerves
- Degeneration and retraction of the nerve distal to the injury within 24 hours
- Perioperative and postoperative care
- Rehabilitation through physiotherapy
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Restless Legs Syndrome
Leg paresthesias associated with an irresistible urge to move; commonly associated with peripheral and central nerve damage in the legs and spinal cord
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Management of restless leg syndrome
symptomatic, involving treating the underlying cause or contributing factor, if known
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What is Trigeminal Neuralgia?
Affects trigeminal or fifth cranial nerve
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Surgical and Nonsurgical management of trigeminal neuralgia
- Nonsurgical management of facial pain—drug therapy
- Surgical management—microvascular decompression, radiofrequency thermal coagulation, percutaneous balloon microcompression
- Postoperative care—monitoring for complications
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Facial Paralysis or Bell's Palsy
- Acute paralysis of seventh cranial nerve
- Medical management—prednisone, analgesics, acyclovir
- Protection of the eye
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Management of Bell's Palsy
- Nutrition
- Massage; warm, moist heat; facial exercises
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