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Guillain-Barre Syndrome Care Plan Nursing


Definition of Guillain-Barre Syndrome

Guillain-Barre Syndrome is an autoimmune disease, in which the immunological process directly on the peripheral nervous system.

Guillain-Barre Syndrome (GBS) is an acute disorder of the nervous system, and diffuse the spinal roots and peripheral nerves and sometimes cranial nerve, which usually occurs after an infection.


Etiology of Guillain-Barre Syndrome

The etiology of Guillain-Barre Syndrome is still not yet known with certainty and is still a matter of debate. Scientists have theorized now is a disorder immunobiology, both in the primary immune response and immune-mediated process. Latent period between infection and symptoms polineuritis gives the notion that there is the possibility of a disorder caused by an allergic reaction in response to peripheral nerve. In many cases, the infection was not previously found, except sometimes the peripheral nerves and spinal ventral and dorsal fibers, there were also disturbances in the spinal cord and medulla oblongata.


Some state / diseases that precede and may have something to do with the occurrence of Guillain-Barre Syndrome, among others:

1. Viral or bacterial infection

Guillain-Barre Syndrome often associated with non-specific acute infection. The incidence of cases of Guillain-Barre syndrome associated with this infection approximately between 56% - 80%, ie 1 to 4 weeks before neurological symptoms arise such as upper respiratory infections or gastrointestinal infection. Acute infection associated with GBS:
a. Viruses: CMV, EBV, HIV, varicella-zoster virus, Vaccinia / smallpox, influenza, measles, mumps, rubella, hepatitis, Coxsackie, Echo.
b. Bacteria: Campylobacter, Jejeni, mycoplasma, Pneumonia, Typhoid, Borrelia B, paratyphoid, brucellosis, Chlamydia, Legionella, Listeria.
2. Vaccination.
3. Surgery, anesthesia.
4. Disease systematic, such as malignancy, systemic lupus erythematosus, thyroiditis, and Addison's disease.
5. Pregnancy or during childbirth.
6. Endocrine disorders.


Clinical Manifestations of Guillain-Barre Syndrome

1. The latent period

The time between infection occurs or circumstances preceding and current prodromal onset of neurological symptoms. The length of the latency period ranging from one to 28 days, an average of 9 days. At this latency period no clinical symptoms arise.

2. Symptoms Clinical

a. Paralysis
The main clinical manifestation is paralysis of the muscles of the lower extremity motor neurone type of limb muscles, body and face sometimes. In most patients, paralysis of both lower extremities begins later spread asenderen to the body, upper limbs and cranial nerves. Sometimes it can also be subject to the four limbs simultaneously, and then spreads to the body and cranial nerves. Paralysis of these muscles symmetrical and followed by hyporeflexia or areflexia. Usually the degree of paralysis of the muscles of the proximal portion of the distal portion is heavier, but it can also be as demanding, or more severe distal part of the proximal portion.

b. Impaired sensibility
Paresthesia is usually more pronounced in the distal extremities, face also may be subject to circumoral distribution. Objective sensory deficit is usually minimal and often with patterns of distribution such as socks and gloves. Exteroceptive sensibility is more commonly known than the proprioceptive sensibility. Muscle pain such as pain often encountered after a physical activity.

c. cranial nerves
Cranial nerves are most commonly known is N.VII. Paralysis of facial muscles often begin on one side but then soon became bilateral, so that the weight could be found between the two sides. All cranial nerves may be subject except N. I and N.VIII. Diplopia could occur from involvement N.IV or N.III. When exposed N.IX and N. X will cause a swallowing difficulty, dysphonia, and in severe cases cause respiratory failure due to paralysis of n. laryngeal.

d. Impaired autonomic function
Impaired autonomic function observed in 25% of patients with GBS. The disorder in the form of sinus tachycardia, sinus bradycardia, or more rarely, so red face (facial flushing), hypertension or hypotension fluctuating, episodic loss of sweating or profuse diaphoresis. Urinary retention or urinary incontinence are rare. This rare autonomic disorder that lasts more than one or two weeks.

e. Respiratory failure
Respiratory failure is a major complication that can be fatal if not treated properly. Respiratory failure is caused by paralysis of the diaphragm and the paralysis of the respiratory muscles, which is found in 10-33 percent of patients.

f. Papilledema
Sometimes encountered papilledema, the cause is not known with certainty. Allegedly due to elevation of the protein content in muscles that cause blockage of fluid arachoidales villi that absorption of cerebrospinal fluid is reduced.


Nursing Diagnosis for Guillain-Barre Syndrome

1. Ineffective breathing pattern
related to:
weakness or paralysis of the respiratory muscles.

2. Disturbed Sensory perception
related to:
changes in reception and transmission.

3. Ineffective Tissue perfusion
related to:
autonomic nervous system dysfunction that causes vascular buildup with decreased venous return.

4. Impaired physical mobility
related to:
neuromuscular damage.

5. Imbalanced Nutrition: less than body requirements
related to:
damage affecting neuromuscular reflex swallowing and GI function.

6. Anxiety
related to:
situational crisis.

7. Pain Acute / Chronic
related to:
neuromuscular damage (paresthesias, disestesia)

8. Knowledge Deficit
related to:
less remembering, cognitive limitations.

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