Nursing Notes
I.
Guillain-Barré syndrome (GBS)
a. an autoimmune neuro condition where the immune system attacks the nerves in the
peripheral nervous system and cranial nerves
i. What specifically on the nerve cell is the immune system attacking? The immune
system, which was attacking an illness, starts to confuse the cranial and PNS nerves
for the illness and attacks the myelin sheath (demyelination occurs), which affects
nerve transmission. The myelin sheath normally functions as an insulator to help
nerve transmission, but when they become damaged this leads to a decrease or
complete loss of nerve signaling.
b. Why is this happening? Guillain-Barré syndrome can happen in any person at any age!
There is no cure, but treatment (IV immunoglobulin therapy or plasmapheresis) can help
decrease signs and symptoms.
c. Guillain-Barré syndrome tends to peak with its signs and symptoms at about 2 weeks, and
then remyelination starts to occurs (so the patient's signs and symptoms will start to
resolve). Most patients will fully recover to their baseline in 1-2 years. The road to recovery
can be long and difficult for many patients.
d. In GBS, most patients report experiencing a previous infection. This is usually one to two
weeks from the onset of signs and symptoms associated with GB. Illnesses reported are
either an upper respiratory or gastrointestinal infection.In addition, experiencing the
Epstein-Barr virus, HIV/AIDS, or receiving the flu or swine flu vaccine have been associated
with Guillain-Barré syndrome.
e. There are various types of GBS and cases can vary from mild to very severe. The most
common type in the United States is called
i. Acute Inflammatory Demyelinating Polyneuropathy (AIDP), which is what we will
concentrate on in this lecture. Patients who experience this type of GBS tend to
have paralysis/weakness or a tingling sensation that starts symmetrically in the
lower extremities that will migrate upward over time. It can progress to where the
patient actually becomes paralyzed.
f. How is Guillain-Barré syndrome diagnosed?
i. An electromyography and nerve conduction study along with a lumbar puncture
(elevated protein without elevated white blood cells)
g. Guillain-Barré syndrome symptoms include:
i. tingling or numbness in lower extremities that spread upward over time to other
areas of the body (paresthesia), absent or diminished reflexes, paralysis, facial
paralysis, dysphagia, dysarthria, severe muscle pain/cramps, respiratory failure,
autonomic issues etc.
h. Complications can arise from Guillain-Barré syndrome which include:
i. respiratory failure, infection, blood clots, pressure ulcers (injuries), facial paralysis,
aspiration, difficulty swallowing or speaking, urinary retention, autonomic
dysfunction (orthostatic hypotension, paroxysmal hypertension, dysrhythmiasetc.),
constipation etc.
i.
II.
III.
Nursing interventions for Guillain-Barré syndrome:
i. please watch the video for an in-depth review of these interventions.
Myasthenia gravis
a. What is myasthenia gravis?
i. It is an autoimmune condition where the body attacks the receptors that allow for
voluntary muscle control, which leads to muscle weakness.
ii. In myasthenia gravis, the nicotinic acetylcholine receptors are attacked by
antibodies created by the immune system. This limits the amount of acetylcholine
that can transmit to the receptor leading to muscle weakness. In addition, the
thymus gland plays a role in myasthenia gravis in that it may create the antibodies
that attack the nicotinic receptors.
b. Symptoms of myasthenia gravis include:
i. weakness of the neck, face, arms/legs, eye drooping (ptosis), mask-like appearance
that looks sleepy, recurrent gagging or choking while eating (difficulty swallowing),
strabismus, slurred speech.
c. Treatment for myasthenia gravis includes:
i. anticholinesterase medications (Pyridostigmine) which will make more acetylcholine
available at the receptor site to increase muscle strength. Also, corticosteroids or
immune suppressors can be ordered. In addition, a thymectomy (removal of the
thymus gland) can be performed along with plasmapheresis with IV immunoglobulin
therapy.
d. A tenslion test can be performed to diagnosed myasthenia gravis or differentiate between
myasthenic crisis vs. cholinergic crisis. During this test signs and symptoms will improve
after the administration of Edrophonium if myasthenia gravis or myasthenic gravis is
present, but worsen if cholinergic crisis is present.
i. CORRECTION: At 14:58, when I discuss Edrophonium (the Tensilon Test) it should
say that Edrophonium is a acetylcholinesterase inhibitor (which is a cholinesterase
inhibitor) NOT ANTIcholinesterase.
e. Nursing interventions for myasthenia gravis include:
i. monitoring airway, assessing neuromuscular status, monitoring for aspiration,
education about food and activities, following speech pathologist recommendations
etc.