Medical surgical Nursing | Neuromuscular Disorders | Guillain-Barré Syndrome (GBS)

 

Guillain-Barré Syndrome (GBS)

Definition

Guillain-Barré Syndrome (GBS) is an acute, immune-mediated disorder of the peripheral nervous system characterized by rapidly progressive muscle weakness, diminished reflexes, and, in severe cases, respiratory paralysis. It is often triggered by infections or other immune system activators.


Causes

  1. Infections:
    • Bacterial: Campylobacter jejuni (most common), Mycoplasma pneumoniae
    • Viral: Epstein-Barr virus (EBV), Cytomegalovirus (CMV), Influenza, Zika virus, SARS-CoV-2
  2. Vaccinations: Rarely, as an immune response to certain vaccines.
  3. Surgery or Trauma: In rare cases, these can trigger GBS.
  4. Idiopathic: In some cases, no identifiable trigger is found.

Signs and Symptoms

  1. Early Symptoms:
    • Tingling or “pins and needles” sensations in the hands and feet.
    • Mild weakness starting in the lower limbs and progressing upward.
  2. Progressive Symptoms:
    • Muscle weakness or paralysis, usually symmetrical.
    • Loss of reflexes.
    • Difficulty breathing or swallowing in severe cases.
  3. Autonomic Dysfunction:
    • Fluctuations in blood pressure.
    • Cardiac arrhythmias.
    • Bowel and bladder dysfunction.

Investigation and Assessment

  1. Clinical History and Physical Examination:
    • Rapid progression of symmetrical weakness.
    • History of recent infection.
  2. Diagnostic Tests:
    • Lumbar Puncture: Elevated protein levels in cerebrospinal fluid (CSF) with normal white blood cell count (albuminocytologic dissociation).
    • Electromyography (EMG) and Nerve Conduction Studies (NCS): Slowed conduction velocity or conduction block.
    • MRI: To rule out other conditions like transverse myelitis.
  3. Additional Tests:
    • Blood tests to rule out metabolic causes of neuropathy.
    • Pulmonary function tests to assess respiratory involvement.

Medications

  1. Immunotherapy:
    • Intravenous Immunoglobulin (IVIG): Administered over 3–5 days.
    • Plasmapheresis: To remove antibodies causing the disease.
  2. Symptomatic Treatment:
    • Analgesics for neuropathic pain.
    • Anticoagulants to prevent deep vein thrombosis.
  3. Supportive Medications:
    • Beta-blockers for autonomic instability.
    • Laxatives for bowel dysfunction.

Acute Management

  1. Hospitalization:
    • ICU admission for severe cases, especially with respiratory or autonomic involvement.
    • Monitoring of cardiac and respiratory status.
  2. Emergency Interventions:
    • Initiate IVIG or plasmapheresis early in the disease course.
    • Mechanical ventilation for respiratory failure.

Nursing Care

  1. Monitoring:
    • Regular assessment of respiratory function, including oxygen saturation and vital capacity.
    • Neurological assessments to monitor the progression of weakness.
  2. Respiratory Support:
    • Ensure readiness for mechanical ventilation in case of respiratory failure.
    • Suctioning and chest physiotherapy as needed.
  3. Preventing Complications:
    • Frequent repositioning to prevent pressure ulcers.
    • Passive range-of-motion exercises to avoid contractures.
    • Thromboprophylaxis to prevent deep vein thrombosis.
  4. Psychosocial Support:
    • Reassure the patient and family about the potential for recovery.
    • Address anxiety and provide emotional support.

Recovery Phases

  1. Initial Recovery:
    • Gradual improvement in muscle strength over weeks to months.
    • Physical and occupational therapy to restore mobility and function.
  2. Rehabilitation:
    • Long-term physical therapy to address residual weakness and improve endurance.
    • Speech therapy if swallowing difficulties persist.
  3. Psychological Recovery:
    • Counseling for coping with prolonged recovery.
    • Support groups for patients and families.

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