Guillain Barré
Patho
- Affects Myelin Sheath
- Peripheral Nervous System
- Cranial Nerves
Causes
- Recent Upper respiratory infectionÂ
- Epstein-Barr
- + stool culture Campylobacter Jejuni
- HIV/AIDS
- Cytomegalovirus (CMV)
- Vaccine (Flu or swine flu)
Symptoms
- Starts with numbness and tingling of hands and feet.
- Symmetrical Ascending Paralysis. Starts in feet
- Autonomic Nervous System Involvement
- Respiratory Failure.
- Cardiac Dysrhythmias
- Altered body Temperature
- Orthostatic Hypotension (BP changes)
- Bladder Distension
Priority
- Respiratory is priority
- Assess for shortness of breath
- Dyspnea
- Weak Cough
- Shallow breathing
- May need Mechanical Ventilation
Complications
- Respiratory Failure
- Dysrhythmias
- BP changes
- Temperature Irregularities
- ↓ gastric motility and paralytic ileus
- Bladder Distension
- Remember autnomic system is involved (temp, heart, BP, bladder, GI)
Treatment/Interventions
- Treatments may speed up recovery
- Corticosteroids
- Immunoglobulins and plasmapheresis must be done within 2 weeks of the onset of symptoms to be effective.
- Immunoglobulins are given to stop antibodies from damaging myelin sheath. Monitor BP.
- Plasmapheresis (Few treatments help with respiratory function). It filters blood to remove antibodies. Watch for hypokalemia (Think: it’s like dialysis)
- Intubation
- Connect to EKG
- Assess Swallowing (may need NG tube)
- Monitor Bowel sounds, gastric residuals, & HOB ↑
- Monitor I & O
Diagnosis
- Nerve Conduction Studies
- Electromyography
- Lumbar Puncture (Hallmark feature of the diagnosis ↑ protein and normal WBC count in CSF)
Lumbar Punture
- Void before Lumbar puncture
- Keep flat after lumbar puncture to prevent headache
- Hydrate/Encourage fluids
- +Guillain-Barre = High protein with normal WBCs in Cerebral Spinal Fluid