Guillain-Barré Syndrome Quiz

ADPIE Review

• ADPIE is the nursing process: Assessment, Diagnosis, Planning, Intervention, Evaluation.
• Consider ABC's (Airway, Breathing, Circulation) when prioritizing nursing interventions.
• Use Maslow's Hierarchy of Needs to guide your nursing care.
• Nursing Diagnoses:
  • Risk diagnoses - potential problems.
  • Active diagnosis - current problems.

Neurological Function

• Normal Intracranial Pressure (ICP): 10-20 mmHg.
• The skull is a rigid structure, so the brain cannot expand.
• The brain compensates for increased ICP by displacing Cerebrospinal Fluid (CSF) or blood.
• If compensation fails, ICP increases, leading to cerebral edema and brain damage.

Cerebral Perfusion Pressure (CPP)

• CPP: Mean Arterial Pressure (MAP) - ICP.
• Normal CPP is 70-100 mmHg.
• CPP below 50 mmHg results in permanent brain damage.

Clinical Manifestations of ICP:

• Early Signs:
  • Changes in level of consciousness (LOC).
  • Restlessness, confusion, increasing drowsiness, increased respiratory effort, purposeless movements.
  • Pupillary changes and impaired ocular movements.
  • Weakness in one extremity or one side.
  • Headache: constant, increasing, aggravated by movement or straining.
• Late Signs:
  • Further deterioration of LOC (stupor to coma).
  • Hemiplegia, decortication, decerebration, flaccidity.
  • Respiratory alterations (Cheyne-Stokes breathing, respiratory arrest).
  • Loss of brainstem reflexes (pupil, gag, corneal, swallowing).

Cushing's Triad:

• Signals brainstem herniation.
• Characteristics:
  • Hypertension: Increased systolic blood pressure.
  • Bradycardia: Decreased heart rate.
  • Irregular Respiration: Breathing pattern changes.

ICP Monitoring:

• External Ventricular Device (EVD): A catheter placed in the ventricle to drain CSF and monitor ICP.

Complications of ICP Management:

• Infection: Risk of infection due to catheter placement.
• Brain stem herniation: Serious neurological complication.
• Diabetes Insipidus: Excessive urine output due to decreased antidiuretic hormone (ADH) production.
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH): Excessive ADH production, leading to fluid retention and low sodium levels.

Medical Management of ICP:

• Goal: Maintain cerebral perfusion and reduce ICP.
• Treatments:
  • Drainage of CSF: With EVD or lumbar puncture.
  • Decrease Cerebral Edema: Medications like Mannitol (avoid in CHF) or other osmotics.
  • Maintain Cerebral Perfusion:
    • Dobutamine: Inotropic agent to increase cardiac output.
    • Levophed: Vasopressor to increase blood pressure.
  • Control Fever: Fever increases ICP.
  • Maintain Oxygenation: Critical for brain function.
  • Reduce Metabolic Demands: Minimize activity and stimulation.

Nursing Interventions for ICP:

• Maintain a patent airway and breathing pattern: Monitor for respiratory distress, provide supplemental oxygen if needed.
• Optimize cerebral tissue perfusion: Elevate head of bed (HOB) 0-60 degrees, avoid hip flexion, Valsalva maneuver, and other ICP-increasing activities.
• Maintain negative fluid balance: Administer IV fluids slowly, monitor for dehydration and fluid overload.
• Prevent infection: Use strict aseptic technique when managing EVD, monitor for signs of infection.
• Monitor and manage complications (infection, brain stem herniation, diabetes insipidus, SIADH): Early detection is crucial.

Intracranial Surgery:

• Craniotomy: Opening the skull to access the brain.
  • Supratentorial: Incision on the forehead.
  • Infratentorial: Incision at the back of the skull.
  • Transsphenoidal: Through the nose or mouth.
• Burr Holes: Drilling holes in the skull to relieve pressure.
• Medical Management after Surgery:
  • Manage seizures, cerebral edema, and infection.

Seizures:

• Definition: Abnormal brain activity due to sudden excessive firing of neurons.
• Types:
  • Partial: Originates in one hemisphere.
    • Simple: Consciousness remains intact.
    • Complex: Impairment of consciousness.
  • Generalized: Bilateral involvement.
  • Unknown: Epilepsy spasms.
• Provoked: Seizures related to an acute, reversible condition.
• Causes:
  • Cerebrovascular disease.
  • Hypoxemia.
  • Fever.
  • Head injury.
  • Hypertension.
  • Infections.
  • Metabolic and toxic conditions.
  • Brain tumor.
  • Drug and alcohol withdrawal.
  • Allergies.

Nursing Observations During a Seizure:

• Before the Seizure:
  • Aura: Unusual sensation preceding the seizure.
  • Focal Onset: Where the seizure begins.
  • Motor Movements: Type and area involved.
  • Pupils: Dilation, constriction, reactivity.
  • Turning of the Head: Direction and movement.
  • Automatisms: Involuntary motor activities.
  • Incontinence: Urinary or fecal incontinence.
• During the Seizure:
  • Duration: How long the seizure lasts.
  • Loss of Consciousness: Level of consciousness.
  • Paralysis: Paralysis of limbs.
  • Speech: Slurred speech, difficulty speaking.
  • Movements: Type and distribution of movements.
• After the Seizure:
  • Sleep: Post-ictal sleep.
  • Confusion: Cognitive impairment post-seizure.

Seizure Precautions:

• Protect the client:
  • Safe position: Side-lying to prevent aspiration.
  • Protect the head: Protect from injury during seizure activity.
  • Loosen clothing: Prevent restriction of breathing.
  • Clear the area: Remove objects that could cause injury.
  • Raise and pad side rails: Prevent falls.
  • Bed in lowest position: Reduce risk of falls.
  • Suction set-up: Required in case of airway obstruction.

Guillain-Barré Syndrome:

• An autoimmune disease affecting the peripheral nervous system, leading to muscle weakness and paralysis.
• Clinical Manifestations:
  • Weakness and paralysis, typically starting in the lower extremities and progressing upward.
  • Bulbar weakness (affecting muscles controlling speech, swallowing, and breathing).
  • Cranial nerve symptoms.
  • Cardiovascular instability (tachycardia, bradycardia, hypertension, hypotension).
• Management:
  • Medical Management: Plasmapheresis (removing antibodies from blood) or intravenous immunoglobulin (IVIG) to suppress the immune response.
  • Nursing Management: Maintain respiratory function (mechanical ventilation may be needed), enhance physical mobility, provide adequate nutrition, improve communication, decrease fear and anxiety, monitor and manage complications.
  • Recovery: Gradual recovery with physical and occupational therapy.

Trigeminal Neuralgia:

• Also known as "tic douloureux".
• Characterized by excruciating pain episodes in the face, usually affecting the second and third branches of the trigeminal nerve.
• Treatment:
  • Medications: Antineuralgics, anticonvulsants.
  • Surgery: To interrupt pain signals.

Spinal Cord Injuries:

• Complete: Total loss of sensation and motor function below the level of the injury.
• Incomplete: Some function remains below the level of injury.
• Levels of Injury:
  • Cervical: Affects arms, hands, and legs.
  • Thoracic: Affects the chest, abdomen, and legs.
  • Lumbar: Affects the legs, feet, and bowel and bladder control.
  • Sacral: Affects the bowels and bladder.
• Complications:
  • Spinal shock: Temporary loss of reflexes below the level of the injury.
  • Autonomic dysreflexia: Dangerous condition characterized by sudden, uncontrolled rise in blood pressure.
• Management:
  • Medical Management: Stabilize the spine, prevent further injury, manage pain and spasms, prevent complications.
  • Nursing Management: Maintain spinal alignment, prevent pressure ulcers, promote bowel and bladder control, provide emotional support.

Stroke:

• Definition: A brain injury caused by a disruption of blood flow to a specific portion of the brain.
• Types:
  • Ischemic: Caused by a blockage of a blood vessel.
  • Hemorrhagic: Caused by a ruptured blood vessel.
• Clinical Manifestations:
  • Sudden onset of neurological deficits: Weakness/paralysis, numbness/tingling, speech difficulties, vision changes, altered mental status, headache.
  • Symptoms vary depending on the affected area of the brain: Left brain stroke (right side paralysis), right brain stroke (left side paralysis).
• Management:
  • Medical Management: Focuses on restoring blood flow to the brain, preventing further damage, and managing complications.
  • Nursing Management: Maintain airway and breathing, monitor vital signs, protect from injury, promote communication, provide emotional support.
  • Rehabilitation: Physical, occupational, and speech therapy to optimize function.

Meningitis:

• Definition: Inflammation of the meninges (membranes surrounding the brain and spinal cord).
• Causes: Bacterial, viral, or fungal infections.
• Clinical Manifestations:
  • Fever, headache, stiff neck, photophobia (sensitivity to light), nausea, vomiting, altered mental status, rash (in some cases).
• Management:
  • Medical Management: Antibiotics for bacterial meningitis, antiviral medications for viral meningitis.
  • Nursing Management: Monitor vital signs, assess neurological status, administer medications, prevent complications (seizures, increased ICP), provide comfort measures.

Multiple Sclerosis (MS):

• Definition: Autoimmune disease that attacks the myelin sheath (protective covering of nerve fibers) in the brain and spinal cord.
• Clinical Manifestations: Widely variable, including:
  • Fatigue.
  • Weakness.
  • Numbness/tingling.
  • Dizziness.
  • Impaired vision.
  • Bowel and bladder dysfunction.
  • Cognitive impairment.
• Management:
  • Medical Management: No cure, focus on symptom management and slowing disease progression.
  • Nursing Management: Provide education about the disease, manage symptoms, promote independence, optimize quality of life, provide emotional support.

Parkinson's Disease:

• Definition: Neurodegenerative disorder that affects movement, resulting from loss of dopamine-producing cells in the brain.
• Clinical Manifestations:
  • Tremors: Involuntary, rhythmic shaking of the hands, legs, or head.
  • Rigidity: Stiffness and resistance to movement in the muscles.
  • Bradykinesia: Slowness or absence of movement.
  • Postural instability: Difficulty maintaining balance.
• Management:
  • Medical Management: Medications to increase dopamine levels or block the effects of acetylcholine.
  • Nursing Management: Assist with activities of daily living, promote safety, promote mobility, provide education about the disease, provide emotional support.

Alzheimer's Disease:

• Definition: A progressive neurodegenerative disease that causes dementia, characterized by deterioration of brain cells.
• Clinical Manifestations:
  • Memory loss.
  • Confusion.
  • Difficulty with language.
  • Impaired judgement.
  • Behavioral changes.
  • Personality changes.
• Management:
  • Medical Management: No cure, focus on symptom management and slowing disease progression.
  • Nursing Management: Provide a safe environment, manage behavioral changes, maintain cognitive function, provide emotional support for the patient and family.

Traumatic Brain Injury (TBI):

• Definition: Injury to the brain caused by an external force, such as a blow to the head, a penetrating injury, or a sudden movement of the head.
• Severity: Ranges from mild concussion to severe, life-threatening injury.
• Clinical Manifestations:
  • Headache.
  • Dizziness.
  • Nausea and vomiting.
  • Blurred vision.
  • Confusion.
  • Memory loss.
  • Loss of consciousness (in more severe cases).
• Management:
  • Medical Management: Depends on severity of injury, may include surgery, medications for managing ICP, seizures, and pain.
  • Nursing Management: Monitor vital signs, assess neurological status, maintain airway and breathing, prevent ICP, provide support and education for the patient and family.

Test your knowledge on Guillain-Barré Syndrome with this quiz. Explore its symptoms, critical aspects of medical management, treatments, and common nursing interventions. Challenge your understanding of this neurological condition.