2. Objectives
At the end of session participants will be able to:
• introduce guillain barre syndrome.
• state incidence of guillain barre syndrome.
• state aetiology of guillain barre syndrome.
• state types of guillain barre syndrome.
• state pathophysiology of guillain barre syndrome.
• list clinical manifestations of guillain barre syndrome.
3. Objectives
• state diagnostic evaluation of guillain barre
syndrome.
• describe therapeutic management of guillain barre
syndrome.
• describe nursing management of guillain barre
syndrome.
• list complications of guillain barre syndrome.
4. Introduction
Guillain-Barré syndrome (GBS):
• It is serious autoimmune disorder in which the
immune system attacks healthy nerve cells in
peripheral nervous system.
• Known as infectious polyneuritis.
• Usually ascending flaccid paralysis.
• Acute peripheral motor weakness.
5. Introduction
• The paralysis usually occurs approximately 10 days
after a nonspecific viral infection.
• GBS has also been reported after administration of
certain vaccines (e.g., rabies, influenza, polio, and
meningococcal).
8. Incidence
• Children are less often affected than adults.
• Those between ages 4 and 10 years have higher
susceptibility.
• The male-to-female ratio : 1.5 to 1.
• Common in late adolescence and young adulthood .
• Congenital GBS is rare, yet may occur in the neonatal
period
9. Types
a. Acute inflammatory demyelinating
polyradiculoneuropathy (AIDP) :
• Common type of Guillain-Barré syndrome
• The immune response damages myelin
• Cause is unknown
10. Contd…
b. Acute motor axonal neuropathy (AMAN):
• Axons themselves are damaged by the immune
response.
• Only the axons of motor neurons are damaged.
• It is caused by anti-GQ1b and anti-GT1a antibodies
11. Contd…
c. Acute motor-sensory axonal neuropathy (AMSAN):
• The axons themselves are damaged by the immune
response.
• The axons of motor neurons and sensory neurons are
damaged.
• Affected individuals can lose the ability to sense the
position of their limbs and can have abnormal or
absent reflexes (areflexia).
• It is caused by anti-GM1 and anti-GD1a antibodies.
12. Contd…
d. Miller Fisher Syndrome:
• Involves cranial nerves, which extend from the brain
to various areas of the head and neck.
• It is axonal or demyelinating.
• It is caused by anti-GQ1b and anti-GT1a antibodies.
• Characterized by three features: ophthalmoplegia,
ataxia, and areflexia.
13. Contd…
e. Pharyngeal-cervical-brachial variant (PCB) :
• Rapidly progressive oropharyngeal (facial palsy,
dysarthria) and cervicobrachial weakness, associated
with upper limb weakness and hypo/areflexia
• The presence of monospecific IgG anti-GT1a
antibodies is associated.
f. Acute panautonomic neuropathy:
• Cardiovascular involvement and associated
dysrhythmias.
14. Aetiology
The exact cause is unknown
Associated factors are:
• Influenza
• Diarrhea(Campylobacter jejuni infection)
• Undercooked food, especially poultry
• Cytomegalovirus
• Epstein-Barr virus infection
• Mycoplasma pneumonia
• HIV/AIDS
• Vaccination: days or weeks after receiving a
vaccination
15. Pathophysiology
• Various viral or bacterial infections such as Infectious
mononucleosis, measles, mumps, Campylobacter
jejuni (gastroenteritis), cytomegalovirus etc or
the administration of certain vaccines.
Activation of both cell mediated and humeral immune
mechanisms
Sensitization of T cells occurs
16. Pathophysiology
• Pathologic changes in spinal and cranial nerves
consist of inflammation and edema with rapid,
segmented demyelination and compression of nerve
roots within the dural sheath.
• Nerve conduction is impaired, producing ascending
partial or complete paralysis of muscles innervated
by the involved nerves.
17. Pathophysiology
GBS has three phases:
1. Acute Phase
• Starts when symptoms begin and continues until
new symptoms stop appearing or deterioration
ceases.
• last as long as 4 weeks.
2. Plateau
• Symptoms remain constant without further
deterioration.
• last from days to weeks.
19. Clinical Manifestations
• Tingling or prickly sensations in finger and toes(first
symptom)
• Muscle weakness in legs that travels to upper body
and gets worse over time (hallmark sign)
• Difficulty walking steadily
• Difficulty moving eyes or face, talking, chewing or
swallowing
• Severe lower back pain
• Loss of bladder control
20. Contd…
• Tendon reflexes are depressed or absent
• Some children may experience the features of
autonomic nervous system involvement which
includes orthostatic hypotension, hypertension,
pupillary dysfunction, sweating abnormalities, and
sinus tachycardia.
21. Diagnostic Evaluation
• History taking and Physical Examination:
Progressive ascending weakness with hypo/areflexia
• CSF analysis: Elevated protein concentration, and
fewer than 10 WBCs/mm3 and normal glucose level.
• EMG(electromyography): Motor nerve conduction
velocities are greatly reduced. Sensory nerve
conduction time is often slowed.
22. Contd…
• Spine MRI: Nearly 2 weeks after presentation of
symptoms, lumbosacral MRI can show enhancement
of the nerve roots.
• Other laboratory studies are usually noncontributory.
23. Therapeutic Management
a. At initial stage, supportive treatment:
• Ventilatory support in the event of respiratory
compromise
• Intravenous (IV) administration of immunoglobulin
(IVIG)
• Steroids, plasmapheresis and immunosuppressive
drugs may also be used.
• low-molecular-weight heparin to prevent deep vein
thrombosis (DVT)
24. Contd…
• A mild laxative or stool softener to prevent
constipation
• Pain medication such as acetaminophen.
• Histamine-antagonist to prevent stress ulcer
formation
• Chronic neuropathic pain after GBS may be treated
with gabapentin / carbamazepine.
25. Contd…
b. Rehabilitation: physical therapy, occupational
therapy, and speech therapy.
Additional consideration should be given to
problems of general weakness and retraining for
toileting and feeding.
26. Contd…
Prognosis:
• Better outcomes are associated with younger age
• Recovery usually begins within 2 to 3 weeks, and
most patients regain full muscle strength.
• The recovery of muscle strength progresses in the
reverse order of onset of paralysis.
27. Contd…
Poor prognosis with subsequent residual effects in
children is reportedly associated with:
• Cranial nerve involvement
• Extensive disability at time of presentation
• Intubation
28. Nursing Management
Nursing Assessment
• Take history of recent infection and immunization
• Assess for ascending muscle weakness, tingling or
prickly sensations in finger and toes, difficulty in
walking, difficuilty in moving eyes or face, talking,
chewing or swallowing, loss of bladder control etc
29. Contd…
Nursing Diagnosis
• Impaired physical mobility related to muscle
weakness
• Ineffective breathing pattern related to paralysis of
respiratory muscles
• Impaired gas exchange related to ventilator
associated pneumonia
• Impaired swallowing related to weakness of muscles
30. Contd…
• Pain related to neuromuscular impairment
• Urinary retention related to paralysis of urinary
bladder muscles
• Constipation related to decreased peristalsis
• Risk for impaired skin integrity realted to
immobilization
32. Contd…
Oxygen source, appropriate size insufflation bag and
mask, endotracheal intubation and suctioning
equipment, tracheostomy tray, and vasopressor drugs
are kept available.
If intubation is required:
• Requires close monitoring of oxygenation status
(usually by pulse oximetry and sometimes arterial
blood gases).
• Maintenance of an open airway with suctioning.
• Postural changes to prevent pneumonia.
33. Contd…
Vital signs are monitored frequently, as well as
neurologic signs and level of consciousness.
Children with oral and pharyngeal involvement may be
fed via a nasogastric or gastrostomy tube to ensure
adequate feeding.
Pain management :
• Objective pain scales should be used.
• Gabapentin and carbamazepine may be used to manage
neuropathic pain in patients with GBS.
34. Contd…
Preventing infections:
• Meticulous oral care.
• Hand washing and control visitors.
• Strict asepsis with suctioning equipment
Consider the possibility of stress ulcers in such
patients and to administer a proton pump inhibitor.
35. Contd…
Urinary retention :
• Temporary urinary catheterization.
• Maintain intake output chart.
Prevention from constipation
Meticulous skin care
Passive range-of-motion exercises and application of
orthoses to prevent muscle contracture are important
when paralysis is present.
36. Contd…
Prevention of DVT :
• Pneumatic compression (antiembolism) devices.
• Administration of a lowmolecular- weight heparin.
• Early mobilization and ambulation.
38. Contd…
Autonomic dysfunction may be life threatening: thus
close monitoring of vital signs in the acute phase is
essential.
It is important for nursing care to involve
communication with the child or adolescent
regarding procedures and treatments.
Encourage parents to talk to the child and make eye
and physical contact and to reassure the child.
39. Contd…
Physical therapy: This may include active exercise,
gait training, and bracing.
Throughout the course of the illness, child and
parent support are paramount.
Send patient to supporting group in community.
41. Complications
• Breathing difficulties
• Residual numbness or other sensations
• Heart and blood pressure problems
• Pain
• Bowel and bladder function problems
• Blood clots
• Pressure sores
• Relapse
42. Summary
It is serious autoimmune disorder in which the
immune system attacks healthy nerve cells in
peripheral nervous system.
The exact cause is unknown. Associated factors are
bacterial and viral infection, vaccination.
Types:
• Acute inflammatory demyelinating
polyradiculoneuropathy (AIDP)
• Acute motor axonal neuropathy (AMAN)
• Acute motor-sensory axonal neuropathy (AMSAN)
• Miller Fisher syndrome
43. Summary
• Pharyngeal-cervical-brachial variant (PCB)
• Acute panautonomic neuropathy
Clinical features includes ascending muscle
weakness, tingling or prickly sensations in finger and
toes, difficulty in walking, difficuilty in moving eyes
or face, talking, chewing or swallowing, loss of
bladder control etc
44. Summary
Management: symptomatic management,
corticosteroid, plasmapheresis, immunoglobulin etc
Nursing management includes monitor vital sign,
administer medication, promotion of physical
activity, provide nutrition, improve pulmonary gas
exchange, bladder and bowel care, rest and exercise,
emotional support to parents etc
45. Assignment
• Define guillain barre syndrome. (2)
• State aetiology of guillain barre syndrome. (2)
• State clinical features of guillain barre syndrome. (3)
• Describe therapeutic management of guillain barre
syndrome. (5)
• Describe nursing management of guillain barre
syndrome. (5)
46. References
• Hockenberry, M.J., Wilson, D. and Rodgers,C.C. (2018).
Wong’s Essentials of Pediatric Nursing. 2nd ed. India: Reed
Elsevier.
• Uprety, K. (2018).Essential of Child Health Nursing. 1st
edition. Kathmandu: Akshav Publication.
• Shrestha, T. (2016). Essential Child Health Nursing. 2nd
edition. Kathmandu: Medhavi Publication.
• Kyle, T. and Carman, S.(2013). Essentials of Pediatric
Nursing.2nd edition. Philadelphia:Wolters Kluwer Health.
• Ball, J., Bindler, R., Cowen, K., Shaw, M.(2017). Principles of
Pediatric Nursing. 7th edition. America: Pearson Education.
47. References
• Panesar, K.(2014). Guillain Barre Syndrome. Retrived
on 18/8/2020 from
https://www.uspharmacist.com/article/guillain-
barre-syndrome
• US National Library of Medicine. (2020). Guillain
Barre Syndrome. Retrived on 18/8/2020 from
https://ghr.nlm.nih.gov/condition/guillain-barre-
syndrome
