GBS: Nursing and collaborative management

Management of Guillain-Barré syndrome (GBS) is aimed at supportive care, particularly ventilator support, during the acute phase. Plasmapheresis is used in the first 2 weeks. Intravenous administration of high dose immunoglobulin has been as effective as plasma exchange and is more readily available.

Assessment of the patient is the most important aspect of nursing care during the acute phase. During the routine assessment, monitor the ascending paralysis; assess respiratory function; monitor arterial blood gases (ABGs); and assess the gag, corneal, and swallowing reflexes. Reflexes are usually decreased or absent.

Monitor blood pressure (BP) and cardiac rate and rhythm during the acute phase because dysrhythmias may occur. Orthostatic hypotension secondary to muscle atony may occur in severe cases. Vasopressor agents and volume expanders may be needed to treat the low BP. However, the presence of inappropriate antidiuretic hormone (SIADH) may require fluid restriction.

The objective of therapy is to support body systems until the patient recovers. Respiratory failure and infection are serious threats. Monitoring the vital capacity and ABGs is essential. If the vital capacity drops to less than 800 mL or the ABGs deteriorate, endotracheal intubation or tracheostomy may be done so that the patient can be mechanically ventilated. If fever develops, obtain sputum cultures to identify the pathogen. Appropriate antibiotic therapy is then initiated.

Nutritional needs must be met in spite of possible problems associated with delayed gastric emptying, paralytic ileus, and potential for aspiration if the gas reflex is lost. In addition to testing for the gag reflex, note drooling and other difficulties with secretions that may indicate an inadequate gag reflex. Initially, enteral or parenteral nutrition may be used to ensure adequate caloric intake. Because of delayed gastric emptying, assess residual volumes of the feedings at regular intervals or before feedings.

Throughout the course of the illness, provide support and encouragement to the patient, caregiver, and family. Although 85% to 95% of patients almost completely recover, it is generally a slow process that takes months to years. About 30% of those with Guillain-Barré syndrome (GBS) have some residual weakness.

Coping and support

A diagnosis of Guillain-Barre syndrome can be emotionally difficult. Although most people eventually recover fully, the condition is generally painful and requires hospitalization and months of rehabilitation. Limited mobility and fatigue must be adjusted.

To manage the stress of recovery from Guillain-Barre syndrome, consider these suggestions:

1. Maintain a strong support system of friends and family

2. Contact a support group, for yourself or for family members

3. Discuss your feelings and concerns with a counselor.

The writer can be reached at:

[email protected]

 

GBS: Nursing and collaborative management

Management of Guillain-Barr syndrome (GBS) is aimed at supportive care, particularly ventilator support, during the acute phase. Plasmapheresis is used in the first 2 weeks. Intravenous administration of high dose immunoglobulin has been as effective as plasma exchange and is more readily available. Assessment of the patient is the most important aspect of nursing care during the acute phase. During the routine assessment, monitor the ascending paralysis; assess respiratory function; monitor arterial blood gases (ABGs); and assess the gag, corneal, and swallowing reflexes. Reflexes are usually decreased or absent. Monitor blood pressure (BP) and cardiac rate and rhythm during the acute phase because dysrhythmias may occur. Orthostatic hypotension secondary to muscle atony may occur in severe cases. Vasopressor agents and volume expanders may be needed to treat the low BP. However, the presence of inappropriate antidiuretic hormone (SIADH) may require fluid restriction. The objective of therapy is to support body systems until the patient recovers. Respiratory failure and infection are serious threats. Monitoring the vital capacity and ABGs is essential. If the vital capacity drops to less than 800 mL or the ABGs deteriorate, endotracheal intubation or tracheostomy may be done so that the patient can be mechanically ventilated. If fever develops, obtain sputum cultures to identify the pathogen. Appropriate antibiotic therapy is then initiated. Nutritional needs must be met in spite of possible problems associated with delayed gastric emptying, paralytic ileus, and potential for aspiration if the gas reflex is lost. In addition to testing for the gag reflex, note drooling and other difficulties with secretions that may indicate an inadequate gag reflex. Initially, enteral or parenteral nutrition may be used to ensure adequate caloric intake. Because of delayed gastric emptying, assess residual volumes of the feedings at regular intervals or before feedings. Throughout the course of the illness, provide support and encouragement to the patient, caregiver, and family. Although 85% to 95% of patients almost completely recover, it is generally a slow process that takes months to years. About 30% of those with Guillain-Barr syndrome (GBS) have some residual weakness. Coping and support A diagnosis of Guillain-Barre syndrome can be emotionally difficult. Although most people eventually recover fully, the condition is generally painful and requires hospitalization and months of rehabilitation. Limited mobility and fatigue must be adjusted. To manage the stress of recovery from Guillain-Barre syndrome, consider these suggestions: 1. Maintain a strong support system of friends and family 2. Contact a support group, for yourself or for family members 3. Discuss your feelings and concerns with a counselor. The writer can be reached at: [email protected]