Guillain-Barre Syndrome (GBS)

Guillain-Barre Syndrome (GBS)

• Autoimmune attack on peripheral nerve myelin

• Precipitated by an event

  • Illness (most often viral infection), couple weeks after GBS symptoms start

Why do people with GBS recover but not MS? (3)

• It has to do with the schwan cells

• In GBS, schwan cells aren’t attacked so they can recover

• In MS schwan cells are attacked

GBS signs + symptoms (8)

• Progresses very quickly

• Symmetrical muscle weakness

• Distal paresthesia's –feet first, then hands

• Absent or depressed deep tendon reflexes

• Ascending weakness – lower limbs, upper extremities, face & respiratory muscle

  • Ascending pattern involving lower limbs first, then the upper extremities, followed by the face and respiratory

• May progress to complete paralysis

• Pain

• Complication – respiratory failure

  • mechanical ventilation, ICU

Pain in GBS

Categorized as neuropathic pain described as prickling (paresthesia), burning, shooting, or stabbing

Diagnostic studies (7)

• History & physical

  • symptoms

  • history of recent viral infection

• CSF - protein

  • + result for protein supports diagnosis, inflammation causes + result

• EMG & nerve conduction studies

  • what kind of impulses travelling through the periphery

If you had GBS once can you get it again?

Yes, having GBS once increases risk of getting it again

Interprofessional care (5)

• Can’t stop ascending weakness but can treat pain

• Supportive

  • Ventilation

  • Prevent DVT & PE, skin breakdown

  • IVIG

Prevent DVT & PE (2)

Paralysis not moving so want to prevent DVT and PE

• Anticoagulants

Skin breakdown (2)

• Frequent turning/positioning

• Incontinence, change frequently

IVIG

• Helps boost immune system

• Take healthy one and put into patient

Nursing management (8)

• Assessment

• Pain management

• Prevent skin breakdown

• ICU during acute phase

• Fear & anxiety

• Urinary retention

• Eye care

• Nutrition

Assessment (10)

• Ascending paralysis

• Respiratory function

  • pulse oximetry

• ABG levels

  • oxygen, CO2

• Gag, cough, corneal & swallowing reflexes

  • corneal reflex: involuntary blink when cornea is touched

• Vitals

• ECG

  • sometimes can have dysrhythmias 

ICU during acute phase

Maintaining airway

Fear & anxiety

communication may be affected

Urinary retention (2)

• In/out cath

• if in ICU & fully paralyzed would have catheter 

Eye care (2)

If corneal reflex gone:

• Eye drops

• Lubrication

Nutrition (3)

• Monitor electrolytes

• Daily weight maybe

• Feeding tube

Priorities once patient “turns corner” (4)

• Rehab: learning to do things again

• Trajectory different for everyone

• Celebrate small victories

• Patience