Guillain-Barré syndrome /gēyan″bärā″/ [Georges Guillain, French neurologist, 1876–1951; Jean A. Barré, French neurologist, 1880–1967] , an idiopathic, peripheral polyneuritis that may occur 1 to 3 weeks after a mild episode of fever associated with a viral infection or with immunization but that can also occur with no preceding illness. Symmetric pain and weakness affect the extremities, and paralysis may develop. The neuritis may spread to the trunk and face. Symptoms vary in intensity from mild to severe enough to require critical nursing care, including ventilator assistance. Immediate treatment consists of supportive care and high IV doses of immunoglobulins. Recovery depends on the extent of neuritis and may take weeks to many months. A coordinated interprofessional approach that considers long-term rehabilitation during the acute phases of the disease is necessary for optimal outcomes. Also called acute febrile polyneuritis, acute idiopathic polyneuritis, infectious polyneuritis. ▪ OBSERVATIONS: Manifestations may range from mild to severe and generally develop 1 to 3 weeks after an upper respiratory or gastrointestinal infection. The first sign is symmetric muscle weakness in the distal extremities accompanied by paresthesia. This weakness spreads upward to the arms and trunk and then to the face. This ascension usually peaks about 2 weeks after onset. Deep tendon reflexes are commonly absent. Difficulty chewing, swallowing, and speaking may occur, and respiratory paralysis may develop. Signs of autonomic nervous system dysfunction, such as facial flushing, profuse diaphoresis, bowel and bladder atony, postural hypotension, hypertension, tachycardia, and heart block, may develop. Deep, aching muscle pain is also common. The diagnosis is based on history and clinical presentation. Lumbar puncture results typically reveal an increase in cerebrospinal fluid protein without an increase in lymphocyte count. Electromyography is markedly abnormal with reduced nerve conduction velocity. A small percentage of those affected die of respiratory failure. Some have permanent residual neurological deficits. Most patients make a full recovery, but the recovery time may be as long as 3 years. ▪ INTERVENTIONS: Treatment is supportive, with the use of IV immunoglobulins or plasmapheresis to counteract neurological defect and speed recovery of neurological deficit. Subcutaneous heparin is given to prevent thromboembolism. Tracheostomy and mechanical ventilation are necessary to treat respiratory paralysis, and breathing function tests should be performed and followed closely. Continuous cardiac monitoring is done to detect possible sinus tachycardia and/or bradyarrhythmias. Physical and occupational therapy interventions can ameliorate the impact of neurologic deficits and prevent many of the problems associated with immobility. ▪ PATIENT CARE CONSIDERATIONS: Care for patients with Guillain-Barré disease is complex and multifaceted. In acute disease, careful assessment of ascending paralysis and monitoring of respiratory function to ensure airway patency and adequate gas exchange are imperative. Continuing assessments are needed of corneal, gag, and swallow reflexes. Blood pressure is monitored for fluctuations; cardiac rate and rhythm are monitored for tachycardia, bradycardia, heart block, and asystole. Pain assessment and management are required for paresthesias, hyperesthesias, muscle cramps, and deep muscle aches. Complications related to autonomic dysfunction, paralysis, and immobility (e.g., pressure sores, thromboemboli, aspiration, urinary retention, fecal impaction, and nerve palsies) must be prevented. This includes a rigorous turning and positioning schedule, regular passive range-of-motion exercises, careful pulmonary toilet and feeding routines, application of thromboembolic stockings, and institution of bowel and bladder programs. Communication systems may be needed if the individual is on a ventilator or has facial paralysis. Emotional and social support are needed to reduce fear and anxiety. Rehabilitation may be indicated for recovery of functional abilities and long-term adaptation to permanent neurological deficit.
