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Guillain-Barre Syndrome

You are lying in the bathtub, helpless, unable to move. The water is rushing in through the faucet.  All you can do is stare at the running water. You can’t move your body. You are terrified that you will drown. You try to flicker your toes in desperate attempt to move the drain. You can’t. You can’t feel your legs. The water is now up to your chin. Your body feels so heavy. Try again. Try again…

Is this scenario reality or a nightmare? You wonder; you have just been diagnosed with Guillain-Barre Syndrome.

Your task is to write a three-page report answering the following questions:

  1. What is Guillain-Barre Syndrome (GBS)?
  2. What are the risk factors for GBS?
  3. What is the Pathophysiology for GBS?
  4. How is GBS diagnosed?
  5. How is GBS treated?
  6. What is it like to have GBS?

Evaluation

How did you do?
   
Did you follow all the directions?  
(20 pts)
Did you complete all the questions?
(20 Pts)
Would you be able to explain this disease to a patient who had it?  
(20 Pts)
Where you able to find all the information easily?   
(10 Pts)
Did you learn new facts about the disease?     
(10 Pts)
Do you understand how frightened patients would be having this diagnosis?
(10 Pts)
Can you identify with patients frustration with this disease?
(10 Pts)
 
100 pts
Grading Score
90-100
Excellent
80-89
Great
70-79
Good
60-69
Fair
Below 60
Poor
Congratulations!! You have just completed the Guillain-Barre Syndrome web quest. Hopefully, you will have gained a better understanding of this disease than when you first started. For more information you can access these additional sites.


Resources:

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Case Study

You are a nurse working the night shift in the ICU.  K.D. is a 36-year-old mother of two who developed an URI while caring for her son who had the same.  Three weeks later she presented to her primary physician with weakness numbing and burning in her feet that seemed to her was progressing up her body.  Her physician had her admitted to the hospital.  Within days her legs and arms were paralyzed, breathing had become a job that was just too much for her; she was intubated and placed on a ventilator.  She has been in your unit 10 days.  The physicians aren’t sure how long the paralysis will last.

You’ve been curious about this case and along with other ICU nurses have been researching this disease on the internet, since you don’t see it very often even in a large Medical Center such as yours.  Now put your knowledge to the test and answer some questions.

  1. Were the initial symptoms K.D. presented with typical?
  2. Why does respiratory insufficiency occur?
  3. How do you anticipate that K.D.’s nutritional needs are being met?
  4. Describe nursing interventions to manage bladder and bowel elimination for K.D.
  5. What are some of the things you can do to decrease K.D.’s fear and anxiety?
  6. You remember in nursing school learning about risk for nursing diagnosis’s, what are three potential complications for this pt.
  7. What measures can be taken to prevent pressure ulcers?
You and your PCA are bathing K.D., when you think you see her right arm move.  You ask her to move it purposely and she is able to move it a little bit.
  1. Is this typical at this time in the disease process for K.D.?
  2. What types of rehabitation will she be going through?
You and other ICU nurses start talking about the long road to recovery for K.D.
  1. How long will it take K.D. to recover from this?
  2. How would you feel if you were totally dependent on others for your simplest needs?
  3. How would something like this affect your family life?

Answers

  1. Yes, the numbness, tingling, burning, progressing from the feet up, happening 3 weeks past an infection, immunization or surgery are all initial symptoms of GBS.
  2. The muscle paralysis of GBS includes the respiratory muscles.
  3. Through a nasal-gastric tube or hyperalimentaion.
  4.   For bladder control use of a foley catheter and perineal care.  For bowel control assess for bowel sounds and abdominal distension, if pt becomes incontinent be sure to clean her up as soon as possible.
  5. Talk to her, remember she can hear and understand everything that is being said.  Explain all tests and procedures to her; tell her everything that is going to happen before it happens.
  6. Respiratory failure, pulmonary emboli, pneumonia, pressure ulcers, mal-nourishment, bladder infection, muscle atrophy.
  7. Turn Q2H, passive range of motion, keep patient clean and dry, and assess skin frequently for breakdowns.
  8. Yes, GBS generally begins to reverse itself about this time.
  9. Rehabilitation will probably include PROM to maintain joint integrity, P.T., O.T., feeding, bowel and bladder training.
  10. 4-6 months. 85% of patients reach nearly complete recovery, while 5-15% will have severe long-term disabilities.
  11. There would be feelings of helplessness and uselessness.  Lack of independence creates loss of self-esteem, which could create feelings of hopelessness.
  12. Family roles will change, the family will need to support the patient physically and mentally and take on greater responsibilities.  Financially the family life will change as more money goes out to medical bills, changes that may have to be made around the house to accommodate the patient.

Resources:

This Web Quest produced by Alicia Couture and Carol Olday
Nursing 2221
Fall 2003