Guillain-Barre Syndrone (GBS) -infectious polyneuritis -is acute, rapid segmental demyelination of peripheral nerves and some cranial

nerves -acute demyelinating polyneuropathy with a progressive -usually ascending flaccid paralysis. Less often affected than adult Children between ages 4 and 10 years old have higher susceptibility Male/Female ratio is 1.5:1 Peak time period is adolescence and young adulthood Increase incidence in pregnant women and post partum women Congenital GBS is rare Maybe seen in neonatal period -consist of hypotonia -weakness -decrease or absent reflex Predisposing Factors Vaccination Pregnancy Surgery Respiratory or G.I. infection PATHOPHYSIOLOGY -Cell mediated and humoral immune attack on peripheral nerve protein -Inflammatory molecular demyelination -Infectious microorganism contains an amino acid that mimics the peripheral nerve myelin protein. -The immune system cannot distinguish between the two proteins and attack and destroy peripheral nerve myelin -Auto immune and other immune mediated agents attack myelin and cause inflammation, destruction and interruption of nerve conduction and axonal loss. Clinical Manifestation Muscle tenderness or sensitivity to slight pressure Lower limb pain and back pain Paresthesia of hands and feet due to demyelination of sensory fibers Paralysis ascends from lower extremities Facial nerve affectation Tendon reflexes are depressed or absent Paralysis is flaccid, may involve facial, extraocular, labial, lingual, pharyngeal, and laryngeal muscles. Evidence of intercostal and phrenic nerve involvement includes -breathlessness in vocalization -shallow, irregular respiration Urinary incontinence or retention Constipation

Diagnostic Evaluation Evoked potential studies demonstrate progress loss of nerve conduction velocities Motor and sensory conduction are greatly reduced CSF analysis reveals increase protein concentration History of viral illness Therapeutic Management Respiratory therapy/ Mechanical Ventilation Anticoagulant agents and anti-embolism stockings or sequential compression boots to prevent thrombosis and pulmonary emboli Plasmapheresis and IV immunoglobulin (IVIG) Continues ECG monitoring

Nursing Care management Observe for possible difficulty in swallowing and respiratory involvement Monitor respiratory function Fed via nasogastric or gastrostomy tube -oxygen source, insufflations bag and mask -endotracheal intubation -suctioning equipment -tracheotomy tray -vasoconstrictor drug Are kept available Monitor Level and consciousness and vital signs Maintenance of an open airway with suctioning, and postural changes to prevent pneumonia in children with oral involvement Passive range-of-motion exercises when disease stabilizes and recovery begins.