Guillan Barre´s Syndrome (GBS)

A 34-year-old male is admitted to the ward with a history of being unable to walk for two days. A diagnosis of Guillan Barre´s Syndrome (GBS) was arrived at.

  • Describe the pathophysiology of GBS
  • State the two diagnostic tests for GBS
  • Describe the specific management of the patient for the next 48 hours

Discussion

Guillain-Barré syndrome is an autoimmune attack on the peripheral nerve myelin. The result is acute, rapid segmental demyelination of peripheral nerves and some cranial nerves, producing ascending weakness with dyskinesia (inability to execute voluntary movements), hyporeflexia, and paresthesias(numbness).

An antecedent event (most often a viral infection) precipitates clinical presentation Infectious agents; Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, Mycoplasma pneumoniae, H. influenzae, and HIV are the most common infectious agents that are associated with the development of Guillain-Barré syndrome

Pathophysiology;

Myelin is a complex substance that covers nerves, providing insulation and speeding the conduction of impulses from the cell body to the dendrites. The cell that produces myelin in the peripheral nervous system is the Schwann cell. In Guillain-Barré syndrome, the Schwann cell is spared, allowing for remyelination in the recovery phase of the disease.

Guillain-Barré syndrome is the result of a cell-mediated and humoral immune attack on peripheral nerve myelin proteins that causes inflammatory demyelination.

An infectious organism contains an amino acid that mimics the peripheral nerve myelin protein. The immune system cannot distinguish between the two proteins and attacks and destroys peripheral nerve myelin. The exact location of the immune attack within the peripheral nervous system is the ganglioside GM1b. With the autoimmune attack, there is an influx of macrophages and other immunemediated agents that attack myelin and cause inflammation and destruction, interruption of nerve conduction, and axonal loss.

Diagnostic Tests:

  • Elevated protein levels are detected in CSF evaluation, without an increase in other cells.
  • Evoked potential studies demonstrate a progressive loss of nerve conduction velocity.

Nursing Diagnoses; Based on the patient assessment.

• Ineffective breathing pattern and impaired gas exchange related to rapidly progressive weakness and impending respiratory failure

• Impaired bed and physical mobility related to paralysis

• Imbalanced nutrition, less than body requirements, related to inability to swallow

• Impaired verbal communication related to cranial nerve dysfunction

• Fear and anxiety related to loss of control and paralysis

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