Guillain - Barre Syndrome: Icu / Picu

Guillain – Barre
Syndrome
Presented by:
ICU / PICU
January 31, 2019
Objectives
By the end of this presentation:
To identify GBS assessment methods,

pathophysiology and management.
To enhance knowledge and skills through
additional research about the nature of the
disease and its different types.
To formulate the appropriate nursing intervention
and plan of care to prevent further
complications as well as to promote wellness.
Gullain Barre Syndrome
Is an acute inflammatory demyelinating
polyneuropathy characterized by
progressive muscle weakness and
araflexia.
Guillain-Barre syndrome is now the most

common cause of acute flaccid paralysis
in healthy people.
Gordons Functional Health Pattern
Health Perception and Management

Nutrition / Metabolism
Elimination
Activity / Exercise
Sexuality / Reproductive
Cognitive/ Perceptual
Roles / Relationship
Self-Perception / Self Concept
Guillain-Barre syndrome
destroys the protective
covering of the
peripheral nerves
(myelin sheath),
preventing the nerves
from transmitting signals
to the brain.
PATHOGENESIS
Peripheral nerve demyelination in

Guillain-Barré syndrome is believed to
be immunologically mediated
Humoral factors and

cell-mediated immune
phenomena have been
implicated in the damage of
myelin and/or the
myelin-producing Schwann cells
The exact cause of Guillain-Barre
syndrome isn't known. The disorder usually
appears days or weeks after a respiratory
or digestive tract infection.
In Guillain-Barre syndrome, your immune

system —which usually attacks only
invading organisms begins attacking the
nerves.
It usually begins to affect the nerves after

you've had a viral or bacterial infection.
Often it is after an infection of the lungs or
stomach and intestines.
Infections that may trigger it include:
Campylobacter jejuni : cause a type of food poisoning.
Mycoplasma Pneumonia: cause pneumonia.
Cytomegalovirus (CMV) : cause fever, chills, sore throat, swollen glands,

body aches, and fatigue.
Epstein-Barr virus (EBV) : cause mononucleosis (mono).
Varicella Zoster virus : can cause chickenpox and shingles.

Case Overview
47 year old male, with known history of hypertension, experienced
on and off numbness and URTI one week prior to admission,
presented to ER with flaccid paralysis and dysphagia.
Patient was admitted to ICU, CT brain was done from ER and its
result was normal. Lumbar puncture was done bedside, after 3
days electively intubated and was tracheostomize after 2 weeks.
Undergone MRI Spine, on Intravenous Immunoglobulin (IvIG)

treatment and Plasmapheresis.
Clinical Manifestations
Prickling, "pins and needles" sensations in fingers, toes, ankles or wrists
Ascending weakness
Unsteady walking or inability to walk or climb stairs
Difficulty with eye or facial movements, including speaking, chewing or swallowing
Severe pain that may feel achy or cramp-like and may be worse at night
Difficulty with bladder control or bowel function
Rapid heart rate

DIAGNOSTIC STUDIES
Spinal tap (lumbar

Electromyography MRI BRAIN
puncture)
3 Components of Management
Monitoring, Supportive and Critical Care
Immunotherapy
Rehabilitation
Monitoring, Supportive, Critical Care
Monitoring vital parameters
Nutrition
DVT prophylaxis
Ventilator Assistance
Managing Autonomic Dysfunction
Chest and general physiotherapy
Proper positioning and skin care

Immunotherapy
• IvIg Immunoglobulin
✔ preferred as initial therapy
• Plasmapheresis
✔ it is the removal, treatment and return of
components of blood plasma from blood circulation
thru a central placed catheter.
NURSING CARE during Plasmapheresis
• Teach about the procedure and what
to expect
• Check with physician about holding
medications until after the procedure
Pre-procedure • Assess vitals signs and weight, lab
care: reports, blood type and cross match
During and post procedure
Observe for dizziness, hypotension and hypovolemia.
Apply pressure dressing to access site.
Monitor for infection and bruises at the access site.
Monitor electrolytes
Reevaluate preproduce laboratory data.

Rehabilitation
Provide patient and caregiver education and training
Educate yourself to assess patients lifestyle, interest

and support systems
Anticipate the need for assistive devices and other

adaptive equipment.
Use gentle passive ROM exercises
Teach breathing and coughing exercises

Nursing Care Plan
Ineffective airway clearance related to Neurological disease
Ineffective breathing pattern r/t to respiratpry muscle weakness
Risk for impaired skin integrity r/t muscle weakness and changes in sensation.
Imbalance nutrition less than body requirements r/t difficulty in chewing and
swallowing.
Impaired elimination r/t inadequate food intake and immobilization.

Impaired Physical mobility related to loss of muscle tone and strength associated with
Neurological Deficit
Impaired verbal communication r/t presence of tracheostomy.
Ineffective coping r/t patients disease state
Fear of Anxiety related to threat of permanent worsening of Health Status and

possible disability
Risk for Fall related to neuromuscular impairment
Knowledge deficit r/t disease, treatment and prognosis

REFERENCES:
• Medical-Surgical Nursing: Assessment and Management 10th edition
by LEWIS.,BUCHER., HEITKEMPER, HARDING p. 256-257
• Nursing Care Plans: Diagnoses, Interventions, and Outcomes
by Meg Gulanick, Judith L. Myers p. 109
• http://nursing-diagnosis-intervention.blogspot.com/2015/02.htm
THANK YOU!
michelle
apang, RN 1

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Guillain – Barre

To identify GBS assessment methods,

Guillain-Barre syndrome is now the most

Health Perception and Management

Peripheral nerve demyelination in

Humoral factors and

In Guillain-Barre syndrome, your immune

It usually begins to affect the nerves after

Campylobacter jejuni : cause a type of food poisoning.

Mycoplasma Pneumonia: cause pneumonia.

Cytomegalovirus (CMV) : cause fever, chills, sore throat, swollen glands,

Epstein-Barr virus (EBV) : cause mononucleosis (mono).

Varicella Zoster virus : can cause chickenpox and shingles.

Undergone MRI Spine, on Intravenous Immunoglobulin (IvIG)

Unsteady walking or inability to walk or climb stairs

Difficulty with eye or facial movements, including speaking, chewing or swallowing

Difficulty with bladder control or bowel function

Rapid heart rate

Spinal tap (lumbar

Monitoring, Supportive and Critical Care

Managing Autonomic Dysfunction

Chest and general physiotherapy

Proper positioning and skin care

Observe for dizziness, hypotension and hypovolemia.

Apply pressure dressing to access site.

Monitor for infection and bruises at the access site.

Reevaluate preproduce laboratory data.

Provide patient and caregiver education and training

Educate yourself to assess patients lifestyle, interest

Anticipate the need for assistive devices and other

Use gentle passive ROM exercises

Teach breathing and coughing exercises

Ineffective breathing pattern r/t to respiratpry muscle weakness

Impaired elimination r/t inadequate food intake and immobilization.

Impaired verbal communication r/t presence of tracheostomy.

Ineffective coping r/t patients disease state

Fear of Anxiety related to threat of permanent worsening of Health Status and

Risk for Fall related to neuromuscular impairment

Knowledge deficit r/t disease, treatment and prognosis

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