Guillain-Barré Syndrome Nursing NCLEX | Guillain-Barré Symptoms, Treatment, Causes

this is cereth registered nurse or en comm and in this video I want to be going over Keon Berets syndrome in this video is part of an Inc Lex review series over the neurosystem and as always at the end of this YouTube video you can access the free quiz that will test you on this condition so let's get started gamma ray syndrome also called GBS is an autoimmune condition where the immune system actually attacks the nerves in the body now what nerves are we talking about we are talking about the peripheral nerves so those nerves in the peripheral nervous system and the cranial nerves so let's talk a little bit about the peripheral nervous system okay where are those nerves located they're located outside of the brain and the spinal cord so that's what makes GBS different than let's say multiple sclerosis those nerves being affected were in the central nervous system so in the brain and the spinal cord but we're talking about the peripheral nervous system here so just remember that now our peripheral nervous system can be divided into two parts we have the somatic which controls your voluntary functions and then we have the autonomic which controls our involuntary functions now if GBS is severe enough it can actually extend into the autonomic nervous system and whenever we go a little bit over the path and what's going on the body you will see what is happening with autonomic dysfunction now what is happening in Gion bere Syndrome well we learned the immune system is attacking the nerve cell but what part of the nerve cell is being attacked the myelin sheath what's happening is d Malin ization is occurring and in order for that nerve to work correctly the myelin sheath has to be there to do its job so let's talk a little bit about nerve cell anatomy and physiology so what's the whole purpose of a nerve it receives and transmit signals so some type of action can occur for instance you have all these nerves and your legs and your feet so you can feel sensation so you can move then you have nerves going to those muscles on your chest so you can breathe in and breathe out but if they're not working you're not going to feel sensation you're not going to be able to breathe very well you can go into respiratory failure which is one of the big things I want you to take away with guillain-barre syndrome respiratory failure can occur as this disease progresses so the nerve receives some type of signal at the dinner dendrites it transfers that down to the soma of the nerve the body then that signal goes down through the axon and notice the area on the axon has these blue areas that's the myelin sheath and the myelin sheath insulate that excellent so that signal can easily just go down through there and not be interrupted and then that signal goes out through the axon terminal and our action happens whatever that nerve supplies but what's happening is that the immune system is attacking that now why is it actually attacking it well a lot of times with patients who have GBS they've suffered some type of illness so that's why as the nurse you want to ask your patient and extensive medical history ask what's been going on with you since you're all of a sudden presenting with these signs and symptoms because GBS can affect anyone of any age any gender race anything like that everyone is at a possible risk for developing this so remember that and there's also no cure for this condition but there are some treatment so we're going to talk about a little bit later that can help improve and increase recovery so you've had this patient who's had some type of illness and the immune system was fighting that illness but somewhere along the way it got confused and it started to attack these myelin sheath and then you start having all these problems now again Gyan bray syndrome can also be called GBS and to help me remember I remember that there's gradual block of sensation going on and there's various types of the hombre syndrome the most common type here in the u.s. is acute inflammatory demyelinating polyneuropathy say that ten comes fast but with that type it tends to start in the feet so the patient will have this weird sensation in their feet paresthesia are like tingling numbness and then and it'll migrate upwards it of sins and it's symmetrical so it starts ascending up this body all the way to the head until the patient is paralyzed so that's one thing you want to remember about this you can also have different types like miller fisher syndrome and that's where the palace's starts in the eyes but we're really going to concentrate on the other type so whenever that happens myelin sheath of course is being attacked you're not going to get this signal eventually the nerves are just going to quit working and the patient's going to have a lot of issues so again let's talk about the why okay we talked about the mean system attacking the myelin sheath because of a recent illness so a lot of times you'll have patients who have normally been healthy but they may report to you yeah about one to two weeks ago I had this severe upper respiratory infection or I had a gastrointestinal infection caused by Campylobacter jejuni and an interesting statistic by cdc.gov states this as many as 40% of GBS cases in the United States are thought to be triggered by the Campylobacter infection so that is pretty staggering so always ask your patients what's been going on with you what are your signs and symptoms prior to these signs and symptoms that you're presenting here with today it's also been linked with patients who've had the epstein-barr infection along with hiv/aids and some cases have developed due to a recent vaccine they received like the swine flu influenza and things like that now let's talk about how GBS is diagnosed because as a nurse you be familiar with the type of tests that can be used to assess for this condition one test is called an electro Maya graphi and nerve conduction studies and what this does is it assesses for D modernization of the nerves by determining the muscles ability to respond to nerve stimulation and here on the left you can see a picture of that test being done also one test I really want you to remember is a lumbar puncture now what this is just like the name says they will puncture the lumbar area and they will drain off cerebral spinal fluid and they're looking for something they're looking for elevated protein without elevated white blood cells I will be a positive result that will test positive for Gyan bere syndrome now some things I want to go over with you quickly about your role with the lumbar puncture before you want to make sure the patient empties their bladder why is that so there isn't a risk of the bladder being puncture during the procedure and then deering if you have to assist with this and they will most likely be positioned in the lateral recombinant position with knees up to the abdomen and bending the chin to the chest now afterwards post-op after this you want to keep the patient flat this will help decrease a headache and keep them flat throughout however much time the physician has prescribed and they'll need to consume fluids to help replace that fluid that was lost during the lumbar puncture so that will help decrease a headache too so you'll want to encourage your patient to consume that now let's talk about the pathophysiology along with the signs and symptoms and the nursing interventions because patho lets us know the sign of the symptom the sign of the symptom lets us know the nursing intervention and while we're doing these certain things so let's blend the two so hopefully it'll make sense in your mind and you won't have to just memorize a bunch of information okay so let's talk about this scenario we have this patient in their 30s relatively healthy has like no health history but they've came to because in their lower extremities specifically their feet and both of them they've noticed that they're having numbness and tingling and it's got so bad that they're having issues walking and they say they haven't injured them or anything like that but the one thing that stands out to you as you're getting their medical history is that they report about two weeks ago having a severe GI illness so all those bells are going off oh no you know this is in the lower extremities they just had an infection about two weeks ago could this be the beginning of guillain-barre syndrome okay so first sign and symptom we have paresthesia typically going to be in that lower extremities those feet and as time goes on it's going to migrate symmetrically it's going to ascend upward and why is that happening because those peripheral nerves that are assigned to those areas down there are not working they're experiencing D modernization of that myelin sheath so that transfer that signal is not going so person can't really feel it and it's going to get so severe that they're going to get paralysis so they're going to lose reflexes you're not gonna have that they're gonna lose like their muscles home they can't control their muscles so as it goes up they can become paralyzed from the waist down so here you have this healthy person all of a sudden is paralyzed from the waist down very scary for them for everyone involved then as it progresses because in two weeks GBS tends to hit its peak that's when the worst signs and symptoms happen and then after that ramona's ation starts to occur so the patient starts to slowly get better and these symptoms start subsiding but it takes about one to two years for that patient to get back to their baseline just because of all really the damage that's done from being paralyzed from sometimes the neck and down and as you here in a moment you're going to see why that road to recovery is going to be so long so it migrates up hands affected arms affected can't move those don't have reflexes can affect our muscles that allow us and help us to pull that in air in and out so you got to watch for your patient saying you know it's just getting really hard to breathe it feels like I can't take a deep breath in I can't breathe in there they have a weak ineffective call you're having to go in their room and suction them because those SATs are dropping and they're not doing good so as the nurse intervention wise you want to make sure you have airway management at the bedside that suction set up anything that you're going to need for this patient because respiratory issues is what we're really watching out for with these patients then it can migrate up all the way up into the brain until it starts hitting the cranial nerves and the cranial nerves whenever that starts to become affected they can have promises of their face can't move their face at all so you go to watch with the eyes pointment drops for the eyes to keep that moist they can also have issues swallowing so they're at risk for aspiration they aspirate what can happen they can develop pneumonia so make sure you're assessing their swallowing abilities and they can have issues speaking communicating with you they can't articulate it so the patient knows what's going on they're very fearful they're very scared they don't really know what's going on so it's very important you know how to communicate with them like a whiteboard or something like that and reassure remind the patient that this is probably temporary you're going to hopefully be recovering and being able to get sensation back they can also have vision issues as well now as I said at the beginning of the lecture if this is a severe case of guillain-barre syndrome that autonomic nervous system can be affected which is our parasympathetic and pathetic system which is our fight-or-flight system so as a nurse you really have to watch out for those signs and symptoms associated with that because medications and stuff like that will need to be ordered to help combat that so watching that blood pressure that heart rate looking for any type of dysrhythmias like bradycardia tachycardia anything like that also orthostatic hypotension or paris's --ml hypertension and you'll want to be looking at their temperature because they will lose the inability to regulate their temperature and GI system can be involved as well you want to watch out for constipation because there's a decrease in gastric motility those nerds that are feeding your intestines aren't really going to be working very well so the motility is going to decrease so a lot of times patients have feeding tubes to help maintain that nutrition because they have the issue swallowing it's not safe for them to swallow so they'll have feeding tubes so you always want to make sure you're listening for those vowel sounds because paralytic ileus can sometimes occur because they're immobile and that can increase the risk for that and you'll want to check those gastric residuals prior to starting new feedings because the food just isn't going through those intestines as fast as it should and you'll want to make sure that the residuals aren't too high renal system can be affected as well that sphincter that controls the flow of urine can not work and the patient can start to retain urine so bladder standing that bladder how much urine is in there how much urine are they putting out their eyes and O's and they may need an in and out calf or they may need a catheter in addition the patient can experience pain which is sort of a paradox isn't it because they are having paralysis down through their body where these nerves aren't working so you would think that they wouldn't have pain but a lot of patients report severe pain specifically in the muscles like cramping of the muscles where those peripheral nerves are damaged so communication again is even more important because you want to help the patient with their pain because they can't tell you they're in pain if they have the cranial nerves being affected because they can't speak so you'll want to make sure that you're treating it appropriately and that they're getting the medication they need in addition a lot of patients as this progresses up to the respiratory system they have a severe case of this they will need to be intubated or have a trach place so they can get respiratory assistance in addition that puts them at risk for infection associated being on like a ventilator so watch that also they're at risk for urinary tract infection if they're retaining urine so monitoring your patient for that also blood clots why are they at risk for blood clots well they're immobile they're paralyzed they can't move around so that blood stays stagnant they can have a blood clot so they'll most likely be on anticoagulants and you'll need SCDS making sure that you're monitoring them for deep vein thrombosis or a pulmonary embolism they don't have signs and symptoms associated with that they're also at risk for pressure ulcers also called pressure injuries and that's again related to the immobility so turning them frequently performing range of motion making sure they're getting off those bony prominences they're also at risk for weight loss because of everything going on so monitoring their weights daily decrease in muscle tone that they can have so physical therapy you'll be working with them as well preventing those contractures and trying to maintain muscle integrity as much because as a lot of patients that they have a severe cases of this as they start to recover a lot of patients after they get discharged from the hospital will have to go to a rehab facility to build back up their muscle strength because their muscle tone is gone a lot of patients have to learn to walk all over again and just how to do those normal activities of daily living now let's quickly go over the treatment for Gyan bere syndrome some important things to remember about these treatments I'm about to go over is that they're not a cure they don't cure this syndrome but they can help speed up recovery time so decrease recovery and decrease those signs and symptoms but the catch with these treatments in order for them to really work is that they have to be administer two weeks from the onset of symptoms or they don't really get a decrease in signs and symptoms the first thing is immunoglobulin therapy this is where IV immunoglobulin from a donor is given to the patient to stop the antibodies that are damaging the nerves another thing is plasmapheresis this is where a machine will actually filter the blood to remove the antibodies from the patients plasma that are attacking the myelin sheath so again remember that this needs to be administered within like two weeks of those onset of the symptoms for it to be most effective okay so that wraps up this review over guillain-barre syndrome thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos

Channel: RegisteredNurseRN

Views: 537,341

Keywords: guillain-barre syndrome, guillain barre syndrome nursing, guillain barre symptoms, guillain barre treatment, guillain barre diagnosis, guillain barre causes, guillain barre lecture, guillain barre recovery time, guillain-barre nclex, guillain-barre nclex review, GBS nursing, GBS, GBS syndrome, Campylobacter jejuni, Epstein barr virus, gbs symptoms, gbs treatment, guillain barre pronounciation, Acute inflammatory demyelinating polyneuropathy

Id: WovsOgA7cGs

Length: 18min 26sec (1106 seconds)

Published: Fri Jul 20 2018