1. Guillane Barre Syndrome (Peripheral Polyneuritis)
 An autoimmune atack of the peripheral nerve myelin
 Immune system atacks the gangliosides.
 Hallmark: ASCENDING WEAKNESS
 Predisposing events:
o Respiratory or gastrointestinal infection (Campylobacter jejuni)
o Cytomegalovirus
o Epsteinbarr virus
o HIV
o Haemophilus influenza virus
o Vaccination
o Surgery
 Incidence:
o 0.6 – 1.9 cases per 1000,000
o 89% of ptxs. Recoverin with residual symptoms
o Death occurs 3-8% due to respiratory failure
 The result of a cell mediated immune attack on the peripheral nerve myelin proteins.
 Does not affect cognitive function.
 MOLECULAR MIMICRY – most accepted theory
 Schwann cells are not affected, causing the axons to regenerate.
 Clinical manisfestations:
o Characteristics feature is ascending weakness.
o Bilateral Paresthesia in the limbs may occur early in the course of the illness. (sock-glove distribution)
o Two dangerous features:
 Respiratory muscle weakness + Cardiac dysrhythmias
 Autonomic neuropathy
 Phases:
o Initial phase
 Occurs 2 weeks after the predisposing event
o Plateau phase
 Disease no longer seem to progress but the client does not recovery functions initially last.
o Recovery phase
 Improvement and recovery occurs with remyelination (in descending pattern)
 Assessment and diagnostic findings:
o History of a viral illness
o CSF evaluation reveals elevated protein levels without pleocytosis.
o Electromyography (EMG) revelas loss of nerve conduction velocity. It test the action potentials of the
skeletal muscles.
 Management:
o There is no known cure for GBS
o However, there are therapies that lessen the severity of the illness.

2.  Medical mgt:
o Problems:
 Immobility
 Incontinence (stool and urine
 Abdominal distention
 Respiratory failure - therapy or mechanical ventilation
 Dysrhythmias
o Plasmapheresis
 Also known as therapeutic plasma exchange
 To remove plasma proteins containing antibodies
 Just like hemodialysis
o Intravenous immunoglobulin G (IV IG)
 Prevention of Complications
o Anitcoagulant therapy
o Thigh-high elastic compression stockings of sequential compression boots
o ECG monitoring
o Management of tachycardia and hypertension
 Prognosis
o Usually good 75%
o Recovery may take weeks to months
o DTR are last to recover
 Nursing interventions
o Maintaining respiratory function
 Incentive spirometry and chest physiotherapy
 Suctioning as needed
 Mechanical ventilation may be required
o Enhancing physical mobility
 Support paralyzed extremity in functional position
 Passive range of motion exercises at least twice daily
 Prevent DVT and pulmonary embolism
• ROM exercises
• Thigh high elastic compression stockings or sequential compression boots
• Adequate hydration
 Prevention of pressure ulcers
• Padding over bony prominences
• Consistent position changes every 2 hours
• Evaluation of laboratory test results that may indicate malnutrition or dehydration
 Provide adequate nutrition
• IV fluids and parenteral nutrition as prescribed
• Gastrostomy tube may be placed to administer nutrients
• Assess the return of the gag reflex and bowel sounds before resuming oral nutrition
 Improving communication
• Establish some form of communication with picture cards or an eyeblink system
 Decreasing fear and anxiety

3. • Diversional activities
• Encourage visitors
 Monitoring potential complications
• Assessment of respiratory function at regular intervals
o Signs and symptoms of impeding respiratory failure:
 Breathlessness while speaking
 Shallow and irregular breathing
 Use of acceory muscles
 Tachycardia
 Changes in respiration function
o If there is relapse, GB is worsening - Aggressive treatment should be done like plasmapheresis and IV IG.
o Watch for progressive muscle weakness.
o Checking for increasing mobility
o IV IG
 contains healthy antibodies, as treatment for GBS, contain high doses of immunoglobulin
 Should not be used more than 5 days if so, it will result to renal failure and hepatitis
o Plasmapheresis