Gullian Barre

GULLIAN BARRE’ SYNDROME GULLIAN BARRE’ • •

An inflammatory disease of unknown etiology characterized by widespread involvement of peripheral, cranial, and spinal nerves A patient can recover from this syndrome

PATHOPHYSIOLOGY • • • •

Acute patchy demyelination found in nerve roots, root ganglia, and spinal, cranial and peripheral nerves resulting from inflammatory cells entering the perivascular spaces Thought to be an autoimmune response resulting from a viral infection or vaccine which the myelin of the peripheral nerves are attacked. The myelin sheath can regenerate itself that is why the people can recover where as with MS they cannot Usually follows a respiratory or gastrointestinal infection. (typically the flu) Will have paralysis

INCIDENCE • •

Found worldwide and occurs in all seasons Usually affects young adults of both sexes

Watch for RESPIRATORY FAILURE

MANIFESTATIONS • • • •

Rapid occurrence of symmetrical muscle tingling and weakness usually beginning at the feet, legs and ascending  to the trunk, arms and face producing total motor paralysis within a few days If the cranial nerves become involved the person may have varying degrees of difficulty in swallowing, speaking, breathing, and chewing. Pain in calf and back of legs although totally paralyzed Progression can cease at any stage

PROGNOSIS • • • • •

A good prognosis – If the survive the first few days Progression can cease at any stage A plateau typically occurs then improvement begins – 1-2 weeks Recovery is generally good with the majority of patients making a full recovery over several months to 2 years About 10% are left with residual disability

DIAGNOSIS • •

Made on S/S Lab markedly show elevated CSF protein content

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Hx of recent viral infection Bels Palsy on both sides of the face May also do lumbar puncture

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A Medical Emergency No specific treatment Constant monitoring and assessment is imperative and supportive measures Keep near the nurses station During the acute phase the nurse is to provide all care for the patient Respiratory assistance is begun at the first sign of respiratory distress  ICU Respiratory insufficiency and failure may develop quickly and is the main threat to life Medications are not usually utilized Exercise and activity is restricted during the acute stage Provide good overall nursing care; patient is totally dependent Management of totally paralyzed client o ROM, turn, proper positioning, etc o All measures to reduce hazards of immobility o A person’s potential for full recovery is dependent on the type of nursing care he/she receives Emotional Support Keep anxiety very low Plasmapherises o A temporary reduction in titer or circulatory antibodies works well

CLINICAL CARE

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COMPLICATIONS • • • • • • •

Inadequate ventilation Positioning Suctioning Hazards of immobility Altered nutrition Altered elimination Emotional and psychological support

NURSING MANAGEMENT • • • • •

Assess respiratory and cardiac distress Hazards of immobility Rehabilitation Emotional Support Teaching

THINK RESPIRATORY FAILURE