Guillain-Barré Syndrome(GBS)

Guillain-Barré Syndrome (GBS)

• A rare disorder affecting the peripheral and spinal nerve roots.
• Recovery typically takes about 1 month to 1 year.
• Peripheral nerves can heal due to the presence of stem cells.
• Etiology is unknown but is believed to be an autoimmune reaction.

Risk Factors

• Recent bacterial or viral infection, especially in the respiratory tract.
• Recent surgery.
• Recent vaccination for a viral disease like influenza
• Malignant disease.

Signs and Symptoms

• Ascending pain/paralysis: Tingling and/or pain starts in the arms and legs, progresses to upper body areas
• Affects muscles of respiration, leading to dyspnea.
• Difficulty in chewing, talking, and swallowing.
• Double vision or inability to move the eyes.

Diagnostic Procedures

• Diagnosis involves clinical assessment, supportive lab findings, and electrodiagnostic tests
• Neurological examination.
• Lumbar puncture: CSF shows elevated protein levels without a significant increase in white blood cell count.
• Electromyography, electrophysiologic studies, and blood tests.

Nursing Interventions

• Monitor for respiratory distress and infections, including pneumonia.
• Maintain weakened or paralyzed extremities in functional positions for immobility and muscle weakness.
• Monitor for aspiration in those with impaired swallowing.
• Perform passive and active ROM.
• Promote comfort and nonpharmacological pain management.
• Ease anxiety by acknowledging feelings and active listening.
• Anticipate mechanical ventilation to support weakening pulmonary function and promote adequate oxygenation.

Medical Management

• Plasmapheresis or plasma exchange: whole blood is removed, plasma is separated, discarded, and replaced with substitution fluid (albumin or saline) to filter out antibodies attacking the immune system.
• Plasmapheresis shortens the course of the disease if performed within the first 2 weeks.
• Watch out for hypotension, dizziness, feeling cold and tingling in the finger and around the mouth during plasmapheresis.
• Immunoglobulin therapy: healthy antibodies from blood donors are administered IV to block damaging ones, it is given after the symptoms of GBS show to enhance improvement

Meningitis

• Inflammation of the meninges.
• Etiology: infectious microorganisms like bacteria, viruses, fungi, or parasites.
• Pathophysiology: Microbes cross the blood-brain barrier into the subarachnoid spaces, leading to microbe growth and multiplication
• Aseptic Meningitis is not caused by bacteria, but it is viral or caused by cancer
• Septi Meningitis is caused by bacteria such as Neisseria meningitides (children), Haemophilus influenzae (adult), or Streptococcus pneumoniae
• Risk Factors include brain trauma/surgery, ENT infections, genetic malformations, or secondary infection.
• Signs and Symptoms: altered mental status, severe headache, N/V, nuchal rigidity, Kernig's and Brudzinski's signs, photophobia, opisthotonos, restlessness, and seizures.
• Diagnostic Procedures: Lumbar puncture (primary diagnostic tool) shows increased pressure/protein, decreased glucose, increased WBCs/RBCs presence, and cloudy CSF.
• Other diagnostics are CBC (WBC), culture and sensitivity.
• Nursing Interventions: Monitor vital signs/neurological status. fluid intake

Monitor fluids

• Give fluids as indicated to prevent decreased cerebral perfusion associated with hypovolemia. Restrict fluids if hypertension occurs to prevent decreased cerebral perfusion associated with cerebral edema.
• Maintain patent airway, protect from secondary injury/falls, protect from sharp objects during seizure episodes, raise side rails, keep the bed in low position when the client is alone.
• Promote comfort and nonpharmacological pain management.
• Practice infection control and droplet precautions. Health teaching: infection control, hand hygiene, and cough etiquettes.
• Medical Management: antibiotic therapy and corticosteroids.

Encephalitis

• Inflammation of the brain, affecting CNS
• Overlapping clinical features exist between encephalitis and meningitis, making distinction difficult, both conditions have similar symptoms, and so nursing interventions being done are similar.
• "Meningoencephalitis" acknowledges overlap.
• Etiology: Infectious microorganisms (viruses are common), chemicals (lead, arsenic, carbon monoxide).
• Pathophysiology: Microbial invasion of the blood-brain barrier, travels to cerebral tissue, microbes grow and multiply, the inflammatory process begins.
• Risk Factors: Infection, immunosuppression or weakened immune system.
• Signs and Symptoms: High fever, severe headache, altered mental status, seizures, neurological defects, N/V, nuchal rigidity, photophobia.
• Diagnostic Procedures: Lumbar puncture is the primary tool.

Diagnostics

• Increased pressure and protein, decreased glucose, increased IgM antibodies, CSF clear.
• Additional diagnostics: CT scan and MRI, EEG (slow waveforms), CBC (↑ WBC), and culture and sensitivity.
• Nursing and Medical Management: Same as meningitis.

Multiple Sclerosis (MS)

• Chronic, progressive disease of the peripheral nerves.
• Etiology: Unknown; considered an autoimmune disorder triggered by genetic susceptibility.
• Pathophysiology: Exposure and production of myelin-specific antibodies, oligodendrocyte loss, astrocytic scarring, loss of myelin sheath, death of neuron and brain atrophy.
• Risk Factors: start at early adulthood (20-40 y/o) with family history, infections, vitamin D deficiency, genetic makeup (chromosome 6p21), immunosuppression/weakened immune system, smoking/obesity.

Signs and Symptoms

• Scanning speech
• Intention tremors (during voluntary movement)
• Nystagmus (involuntary eye movement)
• Double vision
• Ataxia (motor incoordination)
• Paraplegia (paralysis of both legs) and fatigue.

Subtypes

• Relapsing/Remitting: Exacerbations, acute relapses.
• Primary Progressive: least common, no remissions.
• Secondary Progressive: initially relapsing, then worsens every relapse.
• Progressive Relapsing: steadily worsening, often more acute relapse and severe symptoms.