Which system is the priority in the treatment of Guillain-Barré syndrome (GBS)?
b. Cognitive perception c. Respiratory system d. Sensory functions ANS: C Clients with GBS have muscle weakness, possibly to the point of paralysis. If respiratory muscles are paralyzed, the client may need mechanical ventilation, so the respiratory system is the priority.
What is included in the nursing evaluation for Guillain-Barré syndrome?
The nurse will complete urinary, cognitive, and sensory assessments as part of a thorough evaluation. 2. The nurse learns that the pathophysiology of Guillain-Barré syndrome includes segmental demyelination.
Can corticosteroids be used to treat Guillain-Barré syndrome?
Corticosteroids for treating Guillain-Barré syndrome Corticosteroids should not be used in the treatment of Guillain-Barré syndrome. If a patient with Guillain-Barré syndrome needs corticosteroid treatment for some other reason its use will probably not do harm.
Is intravenous immunoglobulin beneficial in Guillain‐Barré syndrome?
Guillain‐Barré syndrome (GBS) is an acute, paralysing, inflammatory peripheral nerve disease. Intravenous immunoglobulin (IVIg) is beneficial in other autoimmune diseases. This is an update of a review first published in 2001 and previously updated in 2003, 2005, 2007, 2010 and 2012.
What treatment is used for Guillain-Barré syndrome?
The most commonly used treatment for Guillain-Barré syndrome is intravenous immunoglobulin (IVIG). When you have Guillain-Barré syndrome, the immune system (the body's natural defences) produces harmful antibodies that attack the nerves. IVIG is a treatment made from donated blood that contains healthy antibodies.
What is the first line treatment of GBS?
However, as plasma exchange is only available in centres that are experienced with its use and seems to produce greater discomfort and higher rates of complications than IVIg in children, IVIg is usually the first-line therapy for children with GBS91.
Can Guillain-Barré syndrome be treated?
There's no cure for Guillain-Barre syndrome. But two types of treatments can speed recovery and reduce the severity of the illness: Plasma exchange (plasmapheresis). The liquid portion of part of your blood (plasma) is removed and separated from your blood cells.
Which medication should be avoided for intubating a patient with severe acute Guillain Barré?
Corticosteroids. Although corticosteroids are a highly effective therapy for chronic inflammatory demyelinating polyneuropathy (CIDP), they are generally avoided in GBS.
Which is better IVIg or plasmapheresis?
Furthermore, there was a significant decrease in average hospitalization costs and charges over 5 years with an average of $115,950 for IVIg patients vs $158,000 for those receiving plasmapheresis (p=0.001) Conclusions: IVIg performed significantly better than plasmapheresis in all our metrics, with the exception of ...
Does IVIg cure GBS?
IVIG is a proven effective treatment for GBS. Not all patients, however, recover enough after a standard IVIG dose. Several clinical factors are associated with the outcome.
How does plasma exchange help Guillain Barre?
Many people who develop GBS have had a recent chest or intestinal infection that may cause an allergic attack on the nerves. Antibodies against the infection also target the nerves and cause GBS. Plasma exchange removes soluble factors including antibodies from the blood and is used as treatment.
Why is the patient with suspected Guillain-Barré syndrome GBS hospitalized immediately?
People with Guillain-Barré syndrome are hospitalized immediately because symptoms can worsen rapidly. Immune globulin given intravenously or plasma exchange speeds recovery.
How do you administer IVIg in GBS?
IVIg is administered in a standard dose of 2 g/kg divided over 3-5 days; however, despite this therapy, some patients still make a slow or incomplete recovery. A recent study (Kuitwaard et al, 2009) aimed to examine whether pharmacokinetics of IVIg in individual patients was related to outcome.
Why are steroids not used for GBS?
In conclusion, corticosteroids inhibit the recruitment of scavengers, which are helpful for the nerve regeneration, resulting in the delay of clinical improvement in GBS.
Do steroids help Guillain-Barré syndrome?
Reviewer's conclusions: Corticosteroids should not be used in the treatment of Guillain-Barré syndrome. If a patient with Guillain-Barré syndrome needs corticosteroid treatment for some other reason its use will probably not do harm.
What type of ventilation is used for Guillain-Barré syndrome?
Background: Patients with Guillain-Barré syndrome are commonly exposed to prolonged mechanical ventilation.
How long does it take to recover from Guillain Barre syndrome?
Complete recovery may take months to years. Chronic GBS may occur if complete recovery has not occurred after several years.
What is the priority for a GBS client?
Clients with GBS have muscle weakness, possibly to the point of paralysis. If respiratory muscles are paralyzed, the client may need mechanical ventilation, so the respiratory system is the priority. The nurse will complete urinary, cognitive, and sensory assessments as part of a thorough evaluation.
What is Eaton-Lambert syndrome?
ANS: D. Eaton-Lambert syndrome is a type of myasthenia gravis that occurs with lung carcinoma. The patient experiences weakness of the pelvic muscles and shoulder muscles. Pyridostigmine is a cholinesterase inhibitor prescribed for Eaton-Lambert syndrome.
Why does cerebrospinal fluid protein increase in GBS?
An increase in the cerebrospinal fluid protein level occurs in GBS due to the release of plasma proteins from inflammation and damage to nerve roots. This release does not affect serum protein levels, which remain normal. The rheumatoid factor is not elevated in this disease and the erythrocyte sedimentation rate could rise.
What is the best treatment for Bell's palsy?
Corticosteroids and antiviral medications are useful in the treatment of Bell's palsy. Antiepileptics and dopamine agonists are prescribed for restless leg syndrome. The peripheral nerves are injured in a patient with peripheral nerve trauma, and this patient does not have a history of this.
Why is amitriptyline not appropriate for older patients?
Amitriptyline is a tricyclic antidepressant and is considered inappropriate for use in older clients due to concerns of anticholinergic effects, confusion, and safety risks. The nurse should tell the client to have help getting up, place the client on safety precautions, and consult the provider. Since this drug is not appropriate for older clients, cutting the dose in half is not warranted.
Does demyelination slow nerve impulses?
Demyelination leads to slowed nerve impulse transmission. The other options are not correct.
How does IVIG affect GBS?
Many potential reasons for the beneficial effect of IVIg in autoimmune diseases have been proposed. Possible mechanisms in GBS include: blockade of Fc receptors on macrophages preventing antibody‐targeted attack on the Schwann cell membrane and myelin; regulation of autoantibodies or cytokines by anti‐idiotypic or anti‐cytokine antibodies in the pooled immunoglobulin; up‐regulation of the inhibitory Fc‐gamma receptor IIB on B cells (Tackenberg 2009); down‐regulation of B cell activating factor (Bick 2013) and interference with the complement cascade or regulatory effects on T cells (Dalakas 2004). According to an alternative hypothesis, the high concentrations of circulating immunoglobulin accelerate the breakdown of immunoglobulin G (IgG). Circulating IgG is picked up by specialised receptors, FcRn, on the endothelial cell surface, which endocytose the IgG and return it intact to the circulation. Excessive amounts of IgG exceed the capacity of the recycling system and divert the excess to the lysosomes where it is broken down (Yu 1999).
What causes GBS?
The favoured hypothesis is that it is due to an autoimmune response directed against antigens in the peripheral nerves that is triggered by a preceding bacterial or viral infection. The triggering mechanism is not understood but may be the consequence of molecular mimicry whereby antibodies or T cells stimulated by antigenic epitopes on the infecting microbe cross‐react with neural epitopes. In the commonest form of GBS in Europe and North America the underlying pathological process is an acute inflammatory demyelinating polyradiculoneuropathy. The responsible antigen is likely to be in the Schwann cell membrane or the myelin sheath. The axonal forms of the disease are much less common in Europe and North America but more common in China, Japan, India and Central America. In the axonal varieties the axolemma is probably the target of the immune response. Distinguishing the different forms of the disease during life is difficult but this has been attempted with neurophysiological studies (Hadden 1998).
What is IVIG in blood?
Intravenous immunoglobulin (IVIg) is a treatment in which antibodies from donated blood are injected into a person's vein. We wanted to find out whether IVIg can speed up recovery from Guillain‐Barré syndrome (GBS).
Can corticosteroids be used for GBS?
Corticosteroids have been used to treat GBS because of the inflammatory, autoimmune nature of the disease. An updated Cochrane systematic review concluded that they offered no benefit apart from a possible faster recovery in one trial when intravenous methylprednisolone was given in combination with intravenous immunoglobulin (IVIg) (Hughes 2012; van Koningsveld 2004). Four of five randomised trials of plasma exchange (PE) reported that this treatment hastened recovery compared with supportive treatment alone (French Co‐operative Group 1987; French Co‐operative Group 1992; French Co‐operative Group 1997; GBS Study Group 1985; Greenwood 1984; Osterman 1984). Its use in severe GBS has been endorsed by a consensus conference (NIH Consensus Development 1986). A Cochrane systematic review concluded that PE is beneficial in GBS (Raphaël 2012).
Is IVIG after immunoabsorption good?
Giving IVIg after immunoabsorption provided no extra benefit over immunoabsorption alone. No conclusions can be drawn from the trial comparing IVIg with immunoabsorption.
Does IVIG affect disability?
Five of the trials comparing IVIg and PE measured change in disability. IVIg and PE produced a similar amount of improvement in disability in the 536 trial participants. This evidence was of moderate quality. Harmful effects were no more frequent with PE or IVIg, but people were more likely to finish a course of IVIg.
Is IVIG more likely to be completed than PE?
Adverse events were not significantly more frequent with either treatment, but IVIg is significantly much more likely to be completed than PE.
Why should a patient be evaluated for Down syndrome?
The patient's family history of AD or Down's syndrome should be evaluated because AD may be a genetic disorder.
Why do nurses use the dorsal surface of the hand?
The nurse should use the dorsal surface of the hand to assess and compare different sites for increased temperature because there is an abundance of temperature receptors on the dorsal surface and this provides for more accurate assessment. A skin thermometer will not provide information that is as accurate.
What is GBS associated with?
GBS is associated with bacterial infection, especially infection with Campylobacter jejuni. Influenza, Epstein-Barr, and cytomegalovirus viral infections have also been associated with GBS.
Why does cerebrospinal fluid protein increase in GBS?
An increase in the cerebrospinal fluid protein level occurs in GBS due to the release of plasma proteins from inflammation and damage to nerve roots. This release does not affect serum protein levels, which remain normal. The rheumatoid factor is not elevated in this disease and the erythrocyte sedimentation rate could rise.
What is the priority of interdisciplinary care?
The priority for interdisciplinary care is safety. Chronic confusion and physical deficits place the patient with Alzheimer's disease at high risk for injury. The rest of the problems are usually the result of long-term care and not a priority for a short hospital stay.
How to prevent transmission of the gene for those affected?
The only way to prevent transmission of the gene for those affected is to avoid having biological children. The use of prescribed medication regularly is the general health teaching provided for any disease. Sharing a bathroom with the family does not lead to spread of the disease.
Why should serum drug levels be monitored?
Serum drug levels should be monitored frequently to maintain the therapeutic action and adjust the dosage as needed . Adverse reactions and side effects should be documented and reported to the primary health care provider to prevent complications.
What is the best indicator that the client is receiving enough nutrition?
Weight gain is the best indicator that the client is receiving enough nutrition. Being able to chew and swallow is important for eating, but adequate nutrition can be accomplished through enteral means if needed. Swallowing without difficulty indicates an intact airway. Since the question does not indicate what the client's meals and snacks consist of, eating 75% may or may not be adequate. Intake and output refers to fluid balance.
Does demyelination slow nerve impulses?
Demyelination leads to slowed nerve impulse transmission. The other options are not correct.
Can you limit eating with trigeminal neuralgia?
Clients with trigeminal neuralgia are often afraid of causing pain, so they may limit eating, talking, dental hygiene, and socializing. The nurse first assesses the client for feelings related to having the disorder to determine if a psychosocial link is involved. The other options may be needed depending on the outcome of the initial assessment.