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A Case Study on

Guillain Barré
Syndrome
Margaja, Dominique Dawn
Mendoza, Kathreen Glaiza
Nalzaro, Sheena Ann
Remollo, Albert
Parcon, Raina Vanessa
BSN – 4E
Introduction
• Guillain-Barré syndrome is a disorder in which the
body's immune system attacks part of the peripheral
nervous system.
• The first symptoms of this disorder include varying
degrees of weakness or tingling sensations in the
legs.
• In many instances, the weakness and abnormal
sensations spread to the arms and upper body.
• These symptoms can increase in intensity until the
muscles cannot be used at all and the patient is
almost totally paralyzed.
• In these cases, the disorder is life-threatening and is
considered a medical emergency. The patient is
often put on a respirator to assist with breathing.
• Guillain-Barré syndrome is rare.
• Usually Guillain-Barré occurs a few days or weeks
after the patient has had symptoms of a respiratory
or gastrointestinal viral infection.
• Occasionally, surgery or vaccinations will trigger
the syndrome.
• The disorder can develop over the course of hours
or days, or it may take up to 3 to 4 weeks.
• No one yet knows why Guillain-Barré strikes some
people and not others or what sets the disease in
motion.
• What scientists do know is that the body's immune
system begins to attack the body itself, causing
what is known as an autoimmune disease.
• Guillain-Barré syndrome occurs one among
one hundred thousand people worldwide.
• It occurs mostly in elderly people and in young
adults ages 20-35.
• In 2004 statistics by the US census,
international data base there are 2,936
recorded cases in the united states while 325
cases in Canada and 826 cases in the
philippines. (
http://www.wrongdiagnosis.com/g/guillain_barre_
)
• The student nurses decided to choose this
case as a subject for their case study
because it is a rarely occuring autoimmune
disease and it only occurs less often
worldwide.
• We want to know and understand why such
rare condition exists and for us to know
proper applications of specific nursing
interventions if ever we encounter patient's
having the same illness.
• By having this case study we, the student
nurses will learn more regarding the proper
management and treatment of such condition.
Objectives
General Objectives:
• To conduct a thorough and comprehensive study
about Mr.V’s disease according to data that was
gathered by conducting a series of interviews and
through the use of data gathered from extensive
research.

Specific Objectives:
• To organize our patient’s data for the establishment
of good background information
• To show the family health history as well as the
history of past and present illness for the knowledge
of what could be the predisposing factors that might
contribute to the patient’s illness
• To present the Family’ Genogram containing
information that will help out in tracing hereditary
risk factors
• To trace the psychological development of our
patient through analysis of different developmental
theories with comparison to the patient’s data
• To give different definitions of the complete
diagnosis of our patient for better understanding of
unfamiliar terms
• To present the data from the Physical assessment
performed on our patient for a good interview of his
over-all health
• To elaborate on the anatomy and physiology of
different organs involved and affected during GBS
• To establish whether several factors, signs and
symptoms are present or absent in our patient
• To organize a flow chart showing the
pathophysiology of GBS for a clear visualization
of how GBS affects a person
• To list the different orders of the physicians
assigned to our patient together with their
rationale for a general knowledge of what consists
of the medical management for GBS
• To present the different results of our patient’s
diagnostic exams together with comparisons of
normal values for the understanding of what
changes during the disease
• To present the different drugs used by our patient
to have a better understanding of its functions and
purposes
• To analyze the different nursing theories
that can be applied to our patient
• To come up with the different Nursing
Care Plans applicable to our patient
• To formulate an appropriate discharge
plan
• To create a reasonable prognosis basing
on the gathered data
• To have our over-all Conclusion and
recommendations about the case study
• To gather all the references used upon
making this case study
Anatomy and Physiology

• The nervous system consists of the brain,


spinal cord, and a complex network of
neurons. This system is responsible for
sending, receiving, and interpreting
information from all parts of the body.
• The nervous system monitors and coordinates
internal organ function and responds to
changes in the external environment.
• This system can be divided into two parts: the
central nervous system and the peripheral
nervous system. Let's take a look at the
peripheral nervous system.
• There are two types of cells in the peripheral
nervous system.
• These cells carry information to (sensory
nervous cells) and from (motor nervous cells)
the central nervous system (CNS).
• Cells of the sensory nervous system send
information to the CNS from internal organs or
from external stimuli.

Peripheral Nervous System Divisions


The peripheral nervous system is divided into
the following sections:
• Sensory Nervous System - sends information
to the CNS from internal organs or from
external stimuli.
• Motor Nervous System - carries information
from the CNS to organs, muscles, and
glands.
• Somatic Nervous System - controls skeletal
muscle as well as external sensory organs.
• Autonomic Nervous System - controls
involuntary muscles, such as smooth and
cardiac muscle.
• Sympathetic - controls activities that
increase energy expenditures.
• Parasympathetic - controls activities
that conserve energy expenditures.
Cells of the Nervous System

Neurons
• Neurons or nerve cells receive stimuli and
transmit action potentials to other neurons
or to effector organs.
• Each neuron consists of a cell body and
two types of processes: dendrites and
axons.
• Each neuron cell body contains a single
nucleus.
• As with any other cell, the nucleus of the
neuron is the source of information for
protein synthesis.
• If an axon, which is one of the neuron cell
processes, is separated from the cell body,
it dies because it has no connection to the
nucleus, and no protein synthesis occurs in
the axon.
• Extensive rough endoplasmic reticulum,
golgi apparatus and mitochondria surround
the nucleus.
• Large numbers of neuro filaments and
microtubules course through the cytoplasm
in all directions and separate the rough ER
into distinct areas in the cell body.
• The areas of rough ER concentration, when
stained with a specific dye appear as
microscopic granules called Nissl bodies.
• Dendrites are short, often highly branching
cytoplasmic extensions that are tapered
from their bases at the neuron cell body to
their tips.
• Most dendrites are extensions of the
neuron cell body, but dendrite like
structures also project from the peripheral
ends of some sensory axons.
• Dendrites usually function to receive
information from other neurons or sensory
receptors and transmit the information
toward the neuron cell body.
• An axon is a long cell processes extending
from the neuron cell body.
• Where the axon leaves the neuron cell
body is an area called the axon hillock,
which is devoid of Nissl bodies.
• Each axon has a constant diameter and
may vary in length from a few
millimeters to more than a meter.
• Axons of motor neurons conduct action
potentials away from the CNS and
axons of sensory neurons conduct
action potentials toward the CNS.
• Axons also conduct action potentials
from one part of the brain or spinal cord
to another part.
• Each motor neuron has a single axon
that extends from the CNS toward a
target tissue.
• Axons are surrounded by neuroglia
called Schwann cells, which form a
highly specialized insulating layer of
cells called the myelin sheath.
Myelin Sheaths
• The Myelin Sheath of a neuron
consists of fat-containing cells that
insulate the axon from electrical
activity.
• This insulation acts to increase the
rate of transmission of signals.
• The myelin sheath (a tubular case or
envelope) gives the whitish
appearance to the white matter of the
brain. Myelin cells are included in the
category of glial cells.
• Glial cells function to support the
processes of neurons in a variety of
ways.
• The glial cells forming myelin sheaths
are called oligodendrocytes in the
central nervous system and Schwann
cells in the peripheral nervous
system.
• The gaps (approximately
1micrometer wide) formed between
myelin sheath cells long the axons
are called Nodes of Ranvier.
• Since fat serves as a good insulator,
the myelin sheaths speed the rate of
transmission of an electrical impulse
along the axon.
• The electrical impulse jumps from
one node to the next at a rate as
fast as 120 meters/second.

• This rapid rate of conduction is


called saltatory conduction.

• Myelinated axons are rare in the


autonomic nervous system and
absent in the nervous system of
invertebrates.
Spinal Cord
• The Spinal Cord is connected to the brain
and is about the diameter of a human
finger.
• From the brain the spinal cord descends
down the middle of the back and is
surrounded and protected by the bony
vertebral column.
• The spinal cord is surrounded by a clear
fluid called Cerebral Spinal Fluid (CSF),
that acts as a cushion to protect the
delicate nerve tissues against damage from
banging against the inside of the vertebrae.
• The anatomy of the spinal cord itself,
consists of millions of nerve fibres which
transmit electrical information to and from
the limbs, trunk and organs of the body,
back to and from the brain.
• The brain and spinal cord are referred to
as the Central Nervous System, while the
nerves connecting the spinal cord to the
body are referred to as the Peripheral
Nervous System.
• The nerves within the spinal cord are
grouped together in different bundles
called Ascending and Descending tracts.
• Ascending tracts within the spinal cord carry
information from the body, upwards to the
brain, such as touch, skin temperature, pain
and joint position.
• Descending tracts within the spinal cord
carry information from the brain downwards
to initiate movement and control body
functions.
• Nerves called the spinal nerves or nerve
roots come off the spinal cord and pass out
through a hole in each of the vertebrae
called the Foramen to carry the information
from the spinal cord to the rest of the body,
and from the body back up to the brain
• Cervical Nerves "C”: (nerves in the
neck) supply movement and feeling to
the arms, neck and upper trunk.

• Thoracic Nerves "T”: (nerves in the


upper back) supply the trunk and
abdomen.

• Lumbar Nerves "L" and Sacral Nerves


"S”: (nerves in the lower back) supply
the legs, the bladder, bowel and sexual
organs.
Nursing Theory
Dorothea E. Orem (Self-Care Deficit Theory)

• Orem explicated self-care as a human need


and nursing as a human service; she
emphasized nursing’s special concern for a
person’s need for self-care actions on a
continuous basis to sustain life and health or
to recover from disease or injury.
• She formalized the Self-Care Deficit Theory
of nursing as a general theory composed of
the following three related theories: 1.) the
Theory of Self-Care, 2.) the Theory of Self-
Care Deficit, and 3.) the Theory of Nursing
Systems.
• Her work identifies three types of nursing
systems: 1.)wholly compensatory (doing for
the patient), 2.) partly compensatory (helping
the patient do for himself or herself), and 3.)
supportive-educative (helping the patient
learn to do for himself or herself and
emphasizing the important role of the nurse
in designing nursing care.)

• We, as nurses require a continuous and


practical action to our patient to enable them
to know and meet therapeutic self-care
demands to let them be aware of certain
limitations that could help them develop
independence towards their needs necessary
for their living.
• When we had our interview to Mr. V, first, we
were able to developed trust towards the
patient which is very important.
• And as we go through our interaction, we had
provided guided teachings to help them
resolve their problems but with limitations.
• Limitations in which we only give some
alternatives and they will be the one to help
their selves function on the things they need
to work with.
• Through a good therapeutic communication
Mr. V was able to gain a lot of information in
which it made him think to make some
changes with regards to his life style.
Imogene King (Goal Attainment Theory)

• King’s theory of goal attainment focuses on


the interpersonal system and the interactions
that take place between individuals,
specifically in the nurse-patient relationship. In
the nursing process, each member in the dyad
perceives the other, makes judgements, and
takes actions.
• Together this activities culminate in reaction.
• Interaction results and, if perceptual
congruence exist and disturbances are
conquered, transactions occur.
• The system is open to permit feedback
because each phase of the activity potentially
influences perception.
• It is very much important that we establish rapport
to our patient so that we could extract some
information available from research in nursing and
related fields.
• In this case, we have gained enough information
about the client’s background.
• We have made an appropriate approach because
the patient was able to verbalize his own feelings
of his current condition.
• And as much as possible we were being careful
of the questions being asked to the patient,
because we might hurt his feelings and later on
he might not gave us the appropriate answers.
• We have also provided some individualized plan
of care which helped in encouraging the patient to
participate.
• Jean Watson (Human Caring Relationship
Theory)
• Jean Watson proposed that the ultimate aim of nursing
is caring with the purpose of preserving the dignity and
wholeness of humans.
• She emphasizes that caring may occur without curing,
but curing cannot occur without caring.
• Nursing as a discipline is devoted to caring, to health,
and to healing in their many meanings and
interpretations.
• Nursing occurs in caring occasions or moment through
the use of ten creative factors in a nurse-patient
relationship known as transpersonal caring.
• The practice of nursing is both a science and an art
and focuses on the goals of growth, meaning, and self-
healing rather than the problem solving seen in the use
of the nursing process.
• As a student nurse our goal is to help the patient
gain a higher degree of harmony within the mind,
body, and soul which generates self-knowledge,
self reverence, self-healing, and self-care.
• During our interview to our patient with regards to
his condition, we were able to gain his trust
through the aspect of caring.
• We were able to develop the helping-trust
relationship that is why the patient was able to
voice out his positive and negative feelings about
his condition.
• There was an effective communication because
we were able to get the trust of the patient and we
showed some concern and care towards her state
of condition.
Recommendation
For the family
• We recommend that the family will still continue to
give the patient love and support even though they
lack support on their financial needs.
• It could still help the patient survive when there is a
strong bond of relationship within the family.
• The family must learn to understand the patient’s
situation.
• They must also be aware of some medications that
are really needed for the patient.
• They must find ways and means to comply with
such certain meds, because if patient is left
untreated then it will lead to certain complications
that will even more add up to the expected amount.
For the patient
• The patient should be aware with his condition.
• He must be well oriented of the facts about the
things that he should be alarmed of.
• We recommend that the patient must comply with
all the medications given to him by the physician.
• And as a patient he must follow all the doctor’s
guidelines.
• He must discipline himself to all the things that
must be avoided.
• Also, patient must learn the importance of proper
hygiene and adequate intake of nutritious and
vitamin filled foods.
• Since the patient has weakness on his lower
extremities we recommend him to lessen
strenuous activities to prevent injury.
For the community
• Guillan Barre’ Syndrome is a rare type of disease.
• It is not fatal if medical intervention is given
promptly.
• We recommend that all those who work in the
baranggay health centers must conduct a seminar
regarding these kind of diseases so that if a person
within a community happens to experience this
kind of illness they would know that this seeks for
immediate action and may worsen if medical
attention is not given promptly.
• Guillain Barre’ Syndrome may not be that serious
but if ignored may cause someone’s life because of
respiratory failure that may developed at the severe
phase of the disease.