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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
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.
Interventions for Guillain-Barre Syndrome
- Drug therapy
- Monitoring respiratory status and managing the airway
- Managing cardiac dysfunction
- Improving mobility and preventing complications of immobility
- Managing pain
- Promoting communication
- Providing emotional support
- 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.
- 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
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.
nonsurgical management for Myasthenia Gravis
- Respiratory support
- Promoting mobility
- Drug therapy: Cholinesterase inhibitor drugs, Immunosuppression, Plasmapheresis
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
- 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
- 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
Management of MG
- Respiratory support
- Promoting self-care guidelines
- Assisting with communication
- Nutritional support
- Eye protection
- Surgical management usually involving thymectomy
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
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
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
Management of restless leg syndrome
symptomatic, involving treating the underlying cause or contributing factor, if known
What is Trigeminal Neuralgia?
Affects trigeminal or fifth cranial nerve
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
Facial Paralysis or Bell's Palsy
- Acute paralysis of seventh cranial nerve
- Medical management—prednisone, analgesics, acyclovir
- Protection of the eye
Management of Bell's Palsy
- Massage; warm, moist heat; facial exercises