Guillain Barre Syndrome ("gbs syndrome")
This is segmented demelination of peripheral nerves its an acute, rapidly progressive, potentially fatal syndrome.
Demylination occurs, leading to inflammation, oedema and nerve root compression, which causes decreased nerve root condition and rapidly ascending paralysis. There is both sensory and Motor impairment. The condition is also known as poly radiculitis or demyelinating polyneuropathy.
The cause is unknown but can be association with the following;
- Immunologic attack on peripheral nerve in response to a virus.
- Rabies Vaccination
- Swine Influenza Vaccination
- Tumor Malignancy
- Spinal Aneasthesia
In GBS syndrome, an immunologic reaction causes segmental demyelination of the peripheral nerves, which prevents normal transmission of electrical impulse along the senorimotor nerve roots. The myelin sheath, which covers the nerve axons and conduct electrical impulses along the nerve pathways, degenerates for unknown reasons leading to inflammation, swelling and patchy demyelination.
As the myelin sheath is destroyed the nodes of Ranvier that aid action potential at the junctures of the myelin sheaths widen thereby delaying and impairing impulse transmission.
- Numbness and fighting of the fecta (parasthesia)
- Muscle weakness
- Ascending Paralysis starting in the legs
- Respiratory of GI infection
- Muscles stiffness
- Loss of sensation
- CSF analysis may reveal increased CSF Pressure and protein count in severe disease.
- Electro physiologic testing may reveal marked slowing of nerve conduction velocities of peripheral nerves.
- Treatment is primarily supportive
- Intubation and mechanical ventilation
If respiratory Paralysis develops.
- Electrocardiography monitoring is necessary to identify the autonomic is symptoms such as cardiac arrhythmias.
- High dose immunoglobuline therapy
- Analgesic are given for pain
- Plasmaapheresis (Plasma exchange) which produces temporally reduction of circulating antibodies. This is most effective during the first few weeks of the disease.
- Marked hypotension may require fluid replacement.
- Maintain airway patency respiratory status through vital capacity measurement rate and depth of respirations.
- Provide ventilation nutrition, as ordered or require.
- Prevent skin beak down especially if patient is paralyzed.
- Promote adequate nutrition, asses chewing and swallowing ability; if function is inadequate provide alternate feeding. Encourage a well-balanced nutritious diet in small frequent feedings and soft meals.
- Develop a communication system with patients who cannot speak
- Encourage patient to verbalize feelings and provide explanation and assurance.
- Administer analgesic as required monitor for adverse reactions, such as hypotension, nausea and vomiting and respiratory depression.
- Instruct patient in breathing exercise, teach patient to wear good supportive and protective shoes while out of bed to prevent injuries due to weakness and parathesias
- Encourage scheduled rest period to avoid fatigue
- Encourage patient to obtain from future influenza vaccination
- Ineffective breathing pattern related to weakness/paralysis of respiratory muscles, evidence by dyspnea.
- Impaired physical mobility related to paralysis
- Impaired nutrition less than body requirement related to cranial nerve dysfunction evidence by inability to speak
- Pain related to disease pathology evidence by patient coplain.
- Respiratory failure
- Cardiac Dyshythmias
- Pressure sores