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Dedic
ation
To our parents, siblings and friends for their unselfish love and
overwhelming support and who much of the times have had to manage
without us while we work this case study as well as having to cope with
our struggles and frustrations.
To all GBS patient worldwide, who deeply inspired our hearts and
mind to make a case study about it. We know that it is not easy to handle
that kind of situation. We believe that someday, somehow the cure for
GBS will be discovered.
And to all of us, may this case study will serve us as an eye opener
to call our attention and to be vigilant about GBS, for life is unpredictable
and we don’t know what will happen next.
ACKNOWLEDGEMENT
We have nerves that live outside the central nervous system (the brain and spinal
cord), and deal with our body's senses and movements. These are called our peripheral nerves.
We chose patient R’s case for our case study because we think it is interesting though
it’s rarely seen .It is a culprit condition that can cause temporary paralysis and can affect our
activities of daily living since in GBS we can feel weakness and numbness in our body that’s why
patient couldn’t walk and have limited range of motion. It’s not so depressing though there is a glint
hope with the proper medical attention, the syndrome may be reversed. We are hoping that through
this case study we can impart knowledge and better understanding of GBS to the community for
them to be aware of the said syndrome.
Review of Related Literature
•Mononucleosis
It may also occur with other medical conditions such as systemic lupus erythematosus or
Hodgkin's disease.
Some people may get Guillain-Barre syndrome after a bacterial infection or certain vaccinations (such
as rabies and swine flu). A similar syndrome may occur after surgery, or when critically ill.
Risk factors
Guillain-Barre syndrome can affect all age groups, but you're at greater risk if:
•Surgery
•Epstein-Barr virus
•Hodgkin's disease
•Mononucleosis
• Sensation changes
•Tenderness or muscle pain (may be a cramp-like pain)
•Uncoordinated movement
•Muscle contractions
•Palpitations (sensation of feeling heartbeat)
Talking with a mental health provider can play a critically important role in
helping you cope with the mental and emotional strain of this illness. In
some cases, your therapist may recommend family counseling to help you
and your loved ones adjust to the changes caused by Guillain-Barre
syndrome.
You may also benefit from talking with others who have experienced this
illness. Ask your doctor or mental health provider to recommend a support
group for people and families coping with Guillain-Barre syndrome
When to Contact a Medical Professional
•Tingling that started in your feet or toes and is now ascending upward
through your body
•Choking on saliva
Guillain-Barre syndrome is a serious disease that requires immediate hospitalization
because of the rapid rate at which it worsens. The sooner appropriate treatment is
started, the better the chance of a good outcome.
Alternative Names
Landry-Guillain-Barre syndrome; GBS; Acute idiopathic polyneuritis; Infectious
polyneuritis; Acute inflammatory polyneuropathy
Prevention
Because so little is known about what causes GBS to develop, there are no known
methods of prevention.
What is a 'syndrome'?
A syndrome is a medical condition, characterised by a collection of
symptoms (that the patient feels) and signs (that a doctor can observe or
measure), rather than by a specific organism that causes the disease.
No one knows what causes GBS. Symptoms and signs can vary a great deal in GBS
patients, sometimes making it difficult to diagnose, especially in the early stages.
The terms 'syndrome', 'disease' and 'GBS' are used synonymously in this
website, to indicate Guillain-Barré syndrome.
Diagnosis
Guillain-Barre syndrome can be difficult to diagnose in its earliest stages.
Its signs and symptoms are similar to those of other neurological disorders
and may vary from person to person.
Prognosis
Although some people can take months and even years to recover, most
cases of Guillain-Barre syndrome follow this general timeline:
•Following the first symptoms, the condition tends to progressively worsen for
about two weeks.
•Symptoms reach a plateau and remain steady for two to four weeks.
Treatment
There's no cure for Guillain-Barre syndrome. But two types of
treatments speed recovery and reduce the severity of Guillain-Barre
syndrome: When symptoms are severe, the patient will need to go to
the hospital for breathing help, treatment, and physical therapy.
Plasmapheresis
A method called plasmapheresis is used to remove proteins,
called antibodies, from the blood. The process involves taking blood
from the body, usually from the arm, pumping it into a machine that
removes the antibodies, then sending it back into the body.
This treatment — also known as plasma exchange — is a type of "blood cleansing"
in which damaging antibodies are removed from your blood. Plasmapheresis
consists of removing the liquid portion of your blood (plasma) and separating it
from the actual blood cells. The blood cells are then put back into your body,
which manufactures more plasma to make up for what was removed. It's not clear
why this treatment works, but scientists believe that plasmapheresis rids plasma
of certain antibodies that contribute to the immune system attack on the
peripheral nerves. Plasmapheresis (see Transfusion Medicine: Plasmapheresis)
helps when done early in the syndrome; it is used if γ-globulin is ineffective.
Plasmapheresis is relatively safe, shortens the disease course and hospital stay,
and reduces mortality risk and incidence of permanent paralysis. Plasmapheresis
removes any previously administered γ-globulin, negating its benefits.
•If the diaphragm is week, breathing support or even a breathing tube and
ventilator may be needed.
•Pain is treated aggressively with anti-inflammatory medicines and
narcotics, if needed.
•Proper body positioning or a feeding tube may be used to prevent
choking during feeding if the muscles for swallowing are weak.
•Intensive supportive
care
•Plasmapheresis or IV immune globulin
Instructions
Step 1
Find a good physical therapy program from which you can learn specific
isometric, isotonic and resistance exercises to rebuild weakened muscles. You
may do these exercises on an outpatient basis and continue them at home.
Remember to pace yourself and get adequate rest, as fatigue is to be
expected with Guillain-Barre Syndrome.
Step 2
Step 9
Pay attention to unusual or severe lower back pain, which can signal Guillain-
Barre Syndrome.
ANATOMY AND PHYSIOLOGY
motor neurons running from the CNS to the muscles and glands - called
•
1.Sensory (afferent) - carry information INTO the central nervous system from
sense organs or motor (efferent) - carry information away from the central
nervous system (for muscle control).
2.Cranial - connects the brain with the periphery or spinal - connects the spinal
cord with the periphery.
3.Somatic - connects the skin or muscle with the central nervous system or
visceral - connects the internal organs with the central nervous system
The peripheral nervous system is subdivided into the
- sensory-somatic nervous system and the
- autonomic nervous system
•The first, the preganglionic neurons, arise in the CNS and run to a ganglion in
the body. Here they synapse with
•postganglionic neurons, which run to the effector organ (cardiac muscle,
smooth muscle, or a gland).
•The autonomic nervous system has two subdivisions, the
The preganglionic neuron may do one of three things in the sympathetic ganglion:
•synapse with postganglionic neurons which then reenter the spinal nerve and
ultimately pass out to the sweat glands and the walls of blood vessels near the
surface of the body.
• leave the ganglion by way of a cord leading to special ganglia (e.g. the solar
plexus) in the viscera. Here it may synapse with postganglionic sympathetic
neurons running to the smooth muscular walls of the viscera. However, some of
these preganglionic neurons pass right on through this second ganglion and into
the adrenal medulla. Here they synapse with the highly-modified postganglionic
cells that make up the secretory portion of the adrenal medulla.
The neurotransmitter of the preganglionic sympathetic neurons is
acetylcholine (ACh). It stimulates action potentials in the postganglionic neurons.
•stimulates heartbeat
•raises blood pressure
•dilates the pupils
•dilates the trachea and bronchi
•stimulates the conversion of liver glycogen into glucose
•shunts blood away from the skin and viscera to the skeletal muscles, brain, and
heart
•inhibits peristalsis in the gastrointestinal (GI) tract
•inhibits contraction of the bladder and rectum
•and, at least in rats and mice, increases the number of AMPA receptors in the
hippocampus and thus increases long-term potentiation (LTP)
In short, stimulation of the sympathetic branch of the autonomic
nervous system prepares the body for emergencies: for "fight or flight" (and,
perhaps, enhances the memory of the event that triggered the response).
Bone Marrow -- All the cells of the immune system are initially derived from the
bone marrow. They form through a process called hematopoiesis. During
hematopoiesis, bone marrow-derived stem cells differentiate into either mature
cells of the immune system or into precursors of cells that migrate out of the
bone marrow to continue their maturation elsewhere. The bone marrow
produces B cells, natural killer cells, granulocytes and immature thymocytes, in
addition to red blood cells and platelets.
Thymus -- The function of the thymus is to produce mature T cells. Immature
thymocytes, also known as prothymocytes, leave the bone marrow and migrate
into the thymus. Through a remarkable maturation process sometimes referred to
as thymic education, T cells that are beneficial to the immune system are spared,
while those T cells that might evoke a detrimental autoimmune response are
eliminated. The mature T cells are then released into the bloodstream.
Natural Killer Cells -- Natural killer cells, often referred to as NK cells, are
similar to the killer T cell subset (CD8+ T cells). They function as effector cells
that directly kill certain tumors such as melanomas, lymphomas and viral-
infected cells, most notably herpes and cytomegalovirus-infected cells. NK
cells, unlike the CD8+ (killer) T cells, kill their targets without a prior
"conference" in the lymphoid organs. However, NK cells that have been
activated by secretions from CD4+ T cells will kill their tumor or viral-infected
targets more effectively.
B Cells -- The major function of B lymphocytes is the production of antibodies in
response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are
specialized proteins that specifically recognize and bind to one particular protein
that specifically recognize and bind to one particular protein. Antibody
production and binding to a foreign substance or antigen, often is critical as a
means of signaling other cells to engulf, kill or remove that substance from the
body.
T-cells are highly-specialized cells in the blood and lymph to fight bacteria, viruses, fungi, protozoans, cancer, etc. within
host cells and react against foreign matter such as organ transplants.
There are three kinds of T-cells. Cytotoxic T-cells directly kill invaders. Helper T-cells aid B and other T-cells to do their
jobs, and HIV lives in and kills them. Suppressor T-cells suppress the activities of B- and other T-cells so they don’t
overreact. Allergy injections are supposed to increase the number of supressor T-cells to make the person less
sensitive to allergens.
Health Care Financing and Usual Source of medical Care: Family income
Mode of Admission: carried by his father
Date of Admission: September 25, 2009
Chief Complain: Present condition noted as sudden onset of weakness of left lower
extremities for almost 3 weeks, then after right lower extremities a week after
Admitting Diagnosis: Guillain Barre' Syndrome
129 - 128 lbs patient is only 103.61 lbs, therefore patient is underweight
One day prior to hospitalization, our patient was seen by his mother
crying on the floor of their sala. Patient stated that “ gusto na nako
magpahospital, nahadlok na ako basin dili na ako makalakaw pagbalik. That
incident prompted his mother to bring him to Loreto District Hospital that day
but was referred directly to Caraga Regional Hospital for further assessment
and management.
Laboratory tests were also ordered by the attending physician such as:
•Hematology
•Electrolytes
•Urinalysis
Childhood Illness
Patient’s mother claimed that his son don't have any childhood
illnesses like mumps, chickenpox, rubella and pertussis, etc. He experienced
diarrhea last January 2009 which lasted for almost 2 and a half days
characterized with watery stool yellowish-green in color. After that incidence
he suffered diarrhea again last May 2009 with the same duration and feature
but he was not able to hospitalized. Patient experienced 1 week fever
accompanied with productive cough with thick yellow sputum on the last week
of July 2009.
Immunization
Patient's mother claimed that only BCG had been immunized to her
son since health center is far away from their house.
History of Hospitalization
Patient has no history of hospitalization; in fact this is his first
time of being admitted in the hospital.
Surgical History
Patient claimed that he did not undergo any surgical procedure.
Lifestyle
1. Personal Habit
Before Hospitalization
During Hospitalization
Since patient was weak and can't moved his legs , he just
lied on the bed and sometimes sit but still his legs were in straight and flat
position. Patient has limited movement that made him uncomfortable. He
just sleep and sometimes awake if tingling sensation occur. He also used to
have little conversation to his family. He just keep on smiling whenever
there were people looked at him
2. Diet
Before Hospitalization
Patient typical food is fish since they lived nearby the sea and
his father occupation is fishing and also vegetables. Patient eats his meals 3x a
day but sometimes he doesn’t want to eat in the breakfast. Patient drinks 8-10
glasses of water a day he don't have any special diet or any food restriction.
Patient was fond of eating “kinilaw” with vinegar than cooked. He eats 3 large
meals a day and drinks 5-6 glasses of water. Patient is fond of eating raw egg with
salt. He eats junk foods as his snacks. He drinks coffee and Milo sometimes if it is
available on their kitchen.
During Hospitalization
Patient eat the food that is being serve in the hospital but
sometimes his mother buy food outside like tinolang baka and any food that has
soup. He also eats fruits like orange, banana and mango. And early in the morning
his mother will make milk/milo for him. Sometimes he refuses to eat because he
felt fullness, he drink 3-4 glasses of water a day. He doesn’t have any order of
food restriction or any special diet from the dietician but the doctor ordered 1
banana last September 26, 2009.
3. Sleep and Rest Pattern
Before Hospitalization
Patient usually sleep at 8pm and wake up 6am, before the present
illness he had no difficulties in sleeping, but when he started to felt weakness and
tingling sensation he can't sleep appropriately cause he can't moved his legs side by
side.
During Hospitalization
4. Elimination Pattern
Before Hospitalization
Patient urinate 3x a day characterized by large amount
with yellow in color and defecate once a day characterized by scanty amount
with yellowish/brownish in color with no history of difficulty or pain in urinating
and defecating. Patient did not experience constipation. Before the present
illness , he eliminate with himself but because of his condition he really needs
assistance for elimination purposes, usually his father carried him in going to
comfort room.
During Hospitalization
Patient urinate 4-5x a day, when he void he just sit on the bed
and his mother will offer plastic container of the IVF since he can't go by himself
to the comfort room. Sometimes it takes 3-4 days before he can defecate and his
father carried him going to the comfort room. His last void is scanty and yellow in
color and his fecal is hard stool, yellowish in color.
During Hospitalization
Patient doesn’t have any activities, he just lies on the bed. He
claimed that he was bored; he wants to have some exercise as what he usually
did before his condition. He just has some conversation with his mother and
after that he fined himself sleeping and awakens for a few hours.
6. Recreation and Hobbies
Before Hospitalization
Patient usual recreation and hobbies were watching television
and listen drama in the radio. He used to read pocketbooks when he got
bored. Before his condition he exercised everyday early in the morning and
swimming in the sea.
During Hospitalization
Patient just lies in the bed. When the patient is in fine mood,
he usually chatty and lights up when he is talking to his visitors/parents. He
always war beautiful smiles on his face despite of his condition.
7. Social Data
The patient usually turns to his parents for support during time
of stress and school problem especially about what he felt on his first trimester of
illness. He reported to his parents for every detailed event that happened to his
condition. Patient does not believe in superstitious belief or quack doctors even
though his parent do so. Patient is currently studying first year high school but
eventually stopped because of his condition.
8. Occupational Activity
Integumentary system
Patient has no any allergic reaction to certain foods or
medication, he don’t have any history of itchiness. He has lesions, abrasions
and scars in his lower extremities. No hair dyes, curling or strengthening
preparation.
Head, Eyes, Ears, Nose,
Throat
Patient doesn’t felt any dizziness, lightheadedness and
headache. Sometimes he experienced seizures especially when it is cold and
tingling sensation attack. He doesn’t use any eyeglasses. No hearing
problem patient experienced nasal stuffiness sometimes.
Neck
Patient claimed that he doesn’t have any neck lumps and
was not diagnose with any thyroid problem.
Musculoskeletal System
Hematologic
Patient claims that he doesn’t have any history of anemia.
Endocrine System
Psychiatric
Patient can manage the stress that his having now but he’s
worried about his legs. In fact, he is a happy person. He has a good memory and
but he also tend to get nervous easily when strange people like us talk to him
and he tend to perspire more.
PHYSICAL ASSESSMENT
T = 36.7°C T = 36.8°C
P = 88 bpm P = 90 bpm
R = 20 cpm R = 19 cpm
General Survey:
Patient is awake appeared pale and his legs were numb and weak,
patient lies on bed in a supine position. He appeared untidy with oily face,
hair which is not properly combed and tangled. Patient is coherent and
responsive during our interview; he keeps in smiling and felt shy to answer
our questions. Ongoing IVF solution of D5IMB with the drop rate of
15gtts/min, patently hooked at the right dorsal metacarpal vein.
Integumentary System:
Skin:
•Dandruff noted
Nails:
Neck:
•Patient can turn head left and right, up and down without pain
Posterior Thorax
•Normal curvature
•No tenderness upon palpation
•Symmetric
Anterior Thorax
•Chest is symmetric
•Normal breath sounds noted
•No evidenced of any secretions
Breast and Axillae
•No discharges noted
•Skin uniform in color, areola darken in color
•No evidence of enlargement of liver and spleen
•Audible bowel sounds
Musculoskeletal System
•postural instability,
Urinary System
•Patient urinate 3x a day
•Patient’s urine is yellowish in color
Gastrointestinal System
•No vomiting
•No diarrhea
•No difficulty in swallowing
•Hard stool noted
Neurologic System
Mental Status:
Language
Patient does not have any speech problems. He can understand and converse
well using Bisaya dialect. He used non-verbal communication such as eye
movements, gestures and interaction with the support person. He had a
congruence of non-verbal and verbal expression.
Orientation
Patient is oriented to place, time and is able to answer our questions correctly
during interview.
Memory
He has good memory and can recall what happened in the past.
Attention Span
Score
Eye Opening Spontaneous-open with blinking at baseline__________4pts ****
To verbal stimuli, command, speech________________3pts
To pain only(not applied to face)___________________2pts
No response___________________________________1pt
Verbal Response Oriented______________________________________5pts
Confused conversation, but able to answer question____4pts *****
Inappropriate words_____________________________3pts
Incomprehensible speech_________________________2ptS
No response___________________________________1pt
RIGHT LEFT
BRACHIORADIALIS BRACHIORADIALIS
+1 +1
BICEPS BICEPS
+2 +2
TRICEPS TRICEPS
+2 +2
09/25/09
10:25 am
Pls. admit pt. to pedia misc.
TPR every 4 hour
Labs: CBC, Na, Creatinine, u/a
Urinalysis
AFB AST
Start D5IMB to few at 15
Monitor v/s every 4 hours
Dr. Patiño
11:45 am
refer result when in noted
ascending paralysis
09/26/09
T= 37.2˚C
Vit. B complex
Eat 1 banana
Follow up IVF
Dr. Patiño
10:50 pm
Hydrocortisone 100mg IVTT every 8˚
09/27/09
T= 37.1˚C
Continue medication
09/28/09
09:15am
Continue medication
10:24 pm
IVF to follow D5IMB 500ml
Dr. Mantilla
continue medication
Follow IVF with D5LR IL 15gtts/min.
Decrease Hydrocortisone to 250g and IVTT every 12 hours
10/05/09
continue medication
Follow IVF with D5LR IL 15gtts/min.
10/06/09
May go home
Home medication
Follow up check up at OPD after 2 weeks
LABORATORY TESTS
ELECTROLYTE
September 26,2009
ELECTROLY RESULTS
ELECTROLYTES NORMAL
RESULTS SIGNIFICANC ELECTROLY RESULTS
NORMAL VALUES NORMAL SIGNIFICANC
SIGNIFICANCE
TES VALUES E TES VALUES E
POTASSIUM 5.4 mmol/L 3.5-5.5mmol/L NORMAL POTASSIUM 5.4 mmol/L 3.5-5.5mmol/L NORMAL
Bisacodyl
Indication:
•temporary relief of acute constipation
Adverse Reaction:
•Mild cramping
• nausea,
•diarrhea
•fluid and electrolytes disturbances (especially potassium and calcium).
•GI: nausea, vomiting. Abdominal cramps, diarrhea, burning sensation in
rectum, protein-losing enteropathy, laxative dependence
•Metabolic: alkalosis, hypokalemia
•Musculoskeletal: muscle weakness, tetany
Nursing Implication:
•Add high-fiber foods slowly to regular diet to avoid gas and diarrhea. Adequate fluid intake includes at least 6-8glasses/d.
•Do not breastfeed while taking this drug without consulting physician.
•Give drug at times that don’t interfere with scheduled activities or sleep. Soft, formed stools are usually produced 15 to 60 minutes
after rectal use.
•Before giving for constipation, determine whether pt. has adequate fluid intake, exercise, intake and diet.
•Tablets and suppositories are used together to clean the colon before and after surgery and before and after surgery and before
barium enema.
•Insert suppositoryas high as possible into the rectum , and try to position suppository against the rectal wall. Avoid embedding within
fecal material because doing so may delay onset of action.
Action:
Water-soluble vitamin essential for synthesis and maintenance of
collagen and intercellular ground substance of the body tissues cell,
blood vessels, cartilages, bones, teeth, skin, and tendons.
Indication:
Prophylaxis and treatment of scurvy and as a dietary supplement.
To prevent vit. C deficiency in pt. w/ poor nutritional habits or increased
requirements.
•RDA
•Frank and subclinical scurvy
•Extensive burns, delayed fracture or wound
healing, postoperative wound healing, severe
febrile or chronic dse. State.
Dosage, Route of administration: 1 tab OD, PO
Contraindication:
Adverse Reaction:
Nausea, vomiting, heartburn, diarrhea, or abdominal cramps, acute
hemolytic anemia, sickle cell crisis, headache or insomnia, urethritis,
dysuria, crystauria, hyperlaxalunia, hyperuricemia, mildness soreness
at injection site, dizziness, temporary faintness with rapid IV
administration
Nursing implication:
•High doses of vitamin C are not recommended during pregnancy.
•Take large doses of vitamin C in divided amounts because the body uses only what is needed at
a particular time and excretes the rest in urine.
•Megadoses can interfere with the absorption of vitamin B12.
•Note: vitamin C increases the absorption of iron when taken at the same time as iron rich-foods.
•Do not breastfeed while taking this drug without consulting physician.
• Stress proper nutritional habits to prevent recurrence of deficiency.
•Advise smokers to increase intake of vitamin C.
•When giving for urine acidification, check urine pH to ensure efficacy.
•For pt. receiving vit. C I.M., explain that M.I, route may promote better utilization.
Generic name: Hydrocortisone
Indication:
, to suppress undesirable inflammatory or immune responses. Use as anti-
inflammatory or immunosuppressive agent
Dosage, Route of administration:
Contraindication:
Hypersensitivity to glucocorticoids, idiopathic
thrombocytopenic purpra, psychoses, acute
glomerulonephritis, viral or bacterial diseases of skin.
Adverse Reaction:
euphoria, insomnia, psychotic behavior, pseudotumor cerebri, seizures,
heart failure, hypertension, edema. Arrythmias, thromboembolism,
cataracts, glaucoma, peptic ulceration, gastrointestinal irritation, increase
appetite, pancreatitis, hypokalemia, hyperglycemia, carbohydrate
intolerance, muscle weakness, growth suppression in children, osteoporosis,
hirsutism, delayed wound healing, acne, various skin eruption, easy bruising.
Nursing Implication:
•Teach patient signs of early adrenal insufficiency
•Warn patient about easy bruising
•Advise him to consider exercise or physical therapy
•Warn patient receiving long-term therapy about cushingoid symptom
• Determine whether the pt is sensitive to other corticosteroid.
• Give oral dose with food when possible.pt. may need another drug to prevent GI irritation.
• Most adverse reaction to corticosteroids are dose-duration-dependent.
• Monitor pt. weight BP, and electrolyte level
•Monitor pt. cushingoid effects including moon face, buffalo hump, central obesity, thinning
hair, hypertension and increased susceptibility to infection.
GENERIC NAME: VITAMIN B COMPLEX - ORAL
USES: Vitamins are the building blocks of the body. They are used to prevent or treat a
vitamin deficiency due to poor nutrition, certain illnesses or during pregnancy.
HOW TO USE: Take as directed. Food may affect the absorption of certain
vitamin products. Consult your pharmacist. Chewable tablets
must be chewed thoroughly before swallowing followed with a
glass of water. Timed-release capsules or tablets must be
swallowed whole.
SIDE EFFECTS:
This medication may cause mild nausea or unpleasant taste.
Consult your doctor if any of these effects persist or become
severe. If you notice other effects not listed above, contact your
doctor or pharmacist.
PRECAUTIONS: Before using this medication, tell your doctor or pharmacist
your medical history, especially of: diabetes, blood
disorders such as vitamin B12 deficiency (
pernicious anemia). Tell your doctor if you are pregnant
before using this medication. No problems have been
reported in pregnant or nursing women when this
medication was used in normal doses.
DRUG INTERACTIONS: Tell your doctor if you take any other medication, including
nonprescription. This medication may affect certain urine lab
tests, including some urine glucose tests. Do not start or
stop any medicine without doctor or pharmacist approval.
OVERDOSE:
If overdose is suspected, contact your local poison control center
or emergency room immediately. US residents can call the US
national poison hotline at 1-800-222-1222. Canadian residents
should call their local poison control center directly. Symptoms of
overdose may include diarrhea, loss of coordination; numbness of
the hands or feet; joint pain, or painful urination.
PATHOPHYSIOLOGY
Predisposing factor:
(Diagram) Precipitating factor:
DUAL RECOGNITION
Cell- Humoral
mediated immunity
immunity
Mistaken Activates specific T
Secrete
immune attack lymphocytes or T-
antibodies
may arise cells
Increased level of
Penetration of macrophage and Antibodies
lymphocytes level
antibodies into basement will fight
membrane around nerve fibers foreign
T-cells released
Inflammation of the nerve cells microorganis
lymphokines
ms
Lymphokines
Inflamed cells secrete cytotoxic
produced
substances that affect or damage
macrophages
the Schwann cells
activation
Decreased myelin
production
DEMYELINATION Ascending
paralysis
Tingling Senso
Impaired Immobility of
sensation ry and
transmission the LE
motor
Numbness of nerve
loss Inability to
conduction
perform ADL
Weakness of
the LE
Constipation
GUILLAIN BARRE
SYNDROME
NURSING CARE PLAN #1
September 28, 2009
Subjective cues:
“Pasmo ra man daw ni sa kusog kay manhimasa man ko human baktas” as verbalized by the patient.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
•Apathy noted
•Misinterpretation of information
Diagnosis:
Knowledge deficit related to cognitive limitation
Planning:
After 4 hours of rendering nursing intervention patient will be able to verbalize understanding of condition
disease process and treatment
Intervention: Rationale
1.Determined information the client already knows and move To facilitate learning and determine the client and SO’s
to what the client does not know, progressing from simple to cognitive limitation
complex
1.Explained the cause of the symptoms and disease To provide knowledge
1.Explained the goal of treatment To provide appropriate information
1.Provide an environment that is conducive to learning To facilitate learning
1.Identify support persons or SO requiring information To let the SO aware of the condition of the client
Evaluation:
Goal met. After 4 hours of rendering of nursing intervention the patient was able to participate in
learning process and was able to verbalize understanding of condition of treatment.
NURSING CARE PLAN #2
September 28, 2009
Subjective Cue:
“Dili ko kalakaw ma’am kay wala gajud kusog ako tiil”. As verbalized by the patient
Objective cues:
Limited range of motion, limited ability to perform gross/fine motor skills, difficulty turning,
slowed movement uncoordinated movement, movement induced, postural instability, inability to maintain
activity.
V/S taken as follow:
Temp: 36.5 °C RR: 18 cpm PR: 86 bpm BP : 110/70 mmHg
Nursing Diagnosis:
Impaired physical mobility related to inability to maintain activity as evidenced by limited range
of motion.
Planning:
Within 8 hours of giving appropriate nursing intervention, patient will be able to participate in
Activities of Daily Living and desired activities.
Interventions:
1. Monitor vital signs
•Baseline data during medication of procedures.
2.Observe movement when client is unaware of observation.
To note any incongruence with reports of abilities.
Note emotional/ behavioral responses to problems of immobility.
Feelings of frustration/powerless may impulse attainment of goals.
Encourage participation in self care, diversional activities.
Enhances self concept and sense of independence.
Identify energy- conserving techniques for ADL’s.
Limits fatigue, maximizing participation.
Encourage adequate intake of fluids/ nutritious foods
Promotes well being and maximizes energy production.
Encourage clients/SO’s involvement in decision making as much as possible.
Promotes well being and maximizes energy production.
Evaluation:
Goal was not met. Patient was not able to participate in Activities of Daily livings and desired
activities.
NURSING CARE PLAN #3
September 28, 2009
Subjective cue:
“Waya pa ako kaligo pila na kaadlaw” as verbalized by the patient.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
•Dirty nails noted
•Bad body odor noted
•Dandruff noted
•Halitosis noted
•Patient is not properly groomed
•Dry skin noted
Diagnosis:
Self-care deficit related to impaired physical mobility
Planning:
After 2 hours of rendering nursing intervention patient will be able to perform
self-care activities within physical limitations.
Intervention: Rationale
1. Determined individual strengths and skills /of the client To know the strengths and weaknesses of the client as
basis in giving appropriate interventions
1. Provide for communication among those who are To gain trust and cooperation from the client and SO
involved in caring
1. Provide health teaching to patient about the importance To promote good hygiene to the patient
of good hygiene
1. Develop plan of care appropriate to individual situation, To encourage performance of ADL within physical limitation
scheduling activities to conform to clients normal
schedule
1. Plan time for listening to the client and SO To discover barriers to participation in regimen
1. Demonstrated to the client and SO the basic ways in To provide awareness that self care activities are still
self care such as hand washing, combing the hair, possible even with physical limitations
trimming nails, tooth brushing and bathing
Evaluation:
Goal met. After 4 hours of rendering nursing intervention patient was able to perform self-care
activities such as combing, tooth brushing and trimming of nails.
NURSING CARE PLAN #4
September 28, 2009
Subjective cues:
“ Nanhina man ako maam, murag nawal an ko ug kusog” , as verbalized by the patient.
Objective Cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Decreased physical strength
Decreased mobility
Weakness
Nursing Diagnosis:
Powerlessness related to decreased physical strength.
Planning:
After 8 hours of rendering nursing care the patient will be able to express sense of control over the present
situation and hopefulness about future outcomes.
Interventions:
Encourage client to be active in own health care management and to take responsibility for choosing own actions
and reactions.
Can enhance feelings of power and sense of positive self –esteem.
Express hope for client and encourage review of past experiences with successful strategies.
Show concerns to client as a person.
Accept expressions of feelings, including anger and reluctance, to try to work things out.
Being able to express feelings freely enables client to sort out what is happening and come to a positive
conclusion.
Make time to listen to client’s perceptions of the situation.
Shows concern for client as a person.
Listen to statements client makes which might indicate feelings of powerlessness.
Suggest concerns regarding on power/ ability to control situation.
Monitor vital signs.
To have baseline data.
Evaluation:
Goal met. Patient was able to express sense of control and hopefulness about future outcomes.
NURSING CARE PLAN #5
September 28, 2009
Subjective cue:
“Nabiro ko nga di na ko makalakaw” as verbalized by the patient
Objective cue:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Poor eye contact
Tearfulness during conversation
Verbalization of concerns (refer to subjective cue)
Analysis:
Anxiety related to threat on role function secondary to physical
illness
Planning:
After 8 hours of duty patient will be able to identify healthy ways to deal
with and relieve anxiety
Intervention Rationale
1. Provided opportunities for question and answer session Enhance sense of trust and nurse client relationship
4. Discussed the disease of Guillain-Barre Syndrome To provide information that could help patient understand
5. Enumerated ways the patient may use to relieve anxiety conditions
such as accepting the reality of his condition, To provide information and to boost patient’s hope
optimistic way of seeing things and having faith in
God’s love
Evaluation:
Goal partially met. After 8 hours of intervening, the patient was able to
enumerate ways to relieve anxiety but verbally said, “ Bisan nakasabot na
ko..Dili gajud naku malikayan na mag-isip ng ako kahimtang karon.”
NURSING CARE PLAN #6
September 28, 2009
Subjective cues:
‘ Mahadlok lage ako motindog kay basin matumba ako” as verbalized by the patient.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Diminished productivity
Avoidance behavior
Increased perspiration
Diagnosis:
Fear related to loss of physical support as evidenced by diminished productivity.
Planning:
After two days of rendering appropriate nursing care patient will display appropriate range of feelings lessened fear.
Interventions:
1 .Compare verbal/ non-verbal responses.
To note congruencies as of situation.
2. Stay with the client or make arrangements to have someone else be there.
Sense of abandonment can exacerbate fear.
3. Provide information in verbal and written form. Speak in simple sentences and concrete terms.
Facilitate understanding and retention of information.
4. Provide opportunity for questions and answer honestly.
Enhances sense of trust to nurse-client relationship
5.Present objectives information when available an d allow client to use it freely. Avoid arguing about client
perceptions of the situations.
Limits conflicts when fear response may impair rational thinking.
6.Promote client control where possible and health client identify and accept those things over which control is not
possible.
strengthen internal locus of control
7.Explain procedures within level of clients ability to understand and handle.
To prevent confusion or overload
8.Encourage assist client to develop exercise program.
Provides a healthy outlet for energy generated by fearful feelings and promotes relaxation.
Evaluation:
Goal is met. After 2 days of rendering appropriate nursing care, patient is able to display appropriate range of
feelings and lessened fear.
NURSING CARE PLAN #7
September 29, 2009
Subjective cue:
“Ma’am dili naman ko kalibang tapos tag dugay” as verbalized by
he patient.
Objective cue:
irritable, restlessness, weakness, unable to move, hard stool.
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm
BP:110/70mmHg
Nursing Diagnosis:
Altered Bowel Movement: Constipation related to Insufficient
Physical Activity.
Planning:
After 8 hours of duty, patient will be able to verbalize
understanding of the importance of mobility and diet to normal bowel
movement
Interventions:
INTERVENTIONS RATIONALE
2. Encouraged activity/exercises within personal limitation. -to stimulate abdominal muscle contraction.
3.Provided with privacy and routinely scheduled time -to promote defecation
defecation
4.Educated patient about the importance of mobility and diet -to provide information
to normal bowel movement - sedimentary lifestyle may affect elimination patterns
5.Note energy. Activity level and exercise pattern. - reflecting bowel activity
6. Auscultate abdomen for the characteristics of bowel
sounds
Evaluation:
Goal met. After 8 hours of duty, patient able to defecate and verbalized “
nakalibang na gajud ko maam,importante diay gajud ang exercise ug diet labaw na
adtong tambal na tagsuksuk sa ako lubot.”
NURSING CARE PLAN #8
September 29, 2009
Subjective:
“Dili ko karajaw makatulog” as verbalized by the patient.
Objectives:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Eyebags noted
Frequent yawning noted
Restlessness noted
Sunken eyes noted
Fatigue
Anxiety
Decreased ability to function
Nursing Diagnosis:
Sleep Pattern Disturbance related to environmental factors such as
external noise and lack of sleep privacy.
Planning:
After 8 hours of duty, patient will be able to report improvement in sleep
pattern.
INTERVENTIONS RATIONALE
2. Advised to limit fluid intake in evening -to reduce need for nighttime micturation
3. Encouraged participation in regular exercise program -to aid stress control/release of energy
during day
4. Identified the factors that affect the sleeping pattern -to reduce sleep disturbance
5..Recommended to limit intake of chocolates and Such beverages are stimulants that inhibits sleep
caffeinated beverages
Evaluation:
Goal met. After 8 hours of duty, patient able to sleep comfortably and report
improvement of sleep pattern.
NURSING CARE PLAN #9
September 29, 2009
Subjective cue:
“Maulaw nako sa ako kahimtang karon,” as verbalized by the patient.
Objective cue:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Loss of body function noted
Restlessness noted
Hiding body parts with blanket (lower extremities)
Less eye contact
Weakness and numbness (lower extremities)
Analysis:
Disturbed body image related to physical illness as evidenced by
inability to walk
Planning:
After 8 hours giving appropriate nursing intervention, patient will
acknowledge self as an individual who has responsibility for self.
Intervention Rationale
1.Encouraged family member to treat client normally and not To avoid feeling of isolation or rejection
as invalid.
2.Encouraged expression of feeling regarding his condition. To provide appropriate emotional support
3.Encouraged client to look and touch affected body parts. To begin to incorporate changes into body image
4.Discussed meaning of loss change to client. A change of function such as immobility may be more
different for some to deal with than a change in
appearance
5.Visited client frequently and acknowledged the individual Provides opportunities for listening of patient’s concerns and
as someone who is worthwhile questions.
Evaluation:
Goal met. After 8 hours giving appropriate nursing intervention, patient
verbalized feeling of acceptance and responsibility of his affected body parts
as evidenced by frequent checking and touching of his lower extremities.
NURSING CARE PLAN #10
September 29, 2009
Subjective cue:
“Taglaay na man ko diri sa hospital”, as verbalized by the client.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm
BP:110/70mmHg
Restlessness noted
Frequent yawning noted
Verbal expression of boredom
Keep on lying in bed
Nursing Diagnosis:
Deficient diversional activity related to physical limitations and lack
of sources.
Planning:
After 8 hours of giving appropriate nursing intervention, patient will be
able to engage in satisfying activities within personal limitations.
Intervention: Rationale
1.Acknowledged reality of situation and feelings of the client. To establish therapeutic relationship
2.Provided with diversional activities such as reading To refocus the attention of the client . To relieve boredom.
materials and talking to the client.
6.Developed plan of care appropriate to individual situation, To encourage performance of ADL within physical limitation.
scheduling activities to conform to clients normal
schedule.
Evaluation:
Goal met. After 8 hours of giving appropriate nursing intervention, patient
verbalized feelings of satisfaction in activities engaged with in personal limitations.
NURSING CARE PLAN #11
September 29, 2009
Subjective Cues:
“Kadaghan sad diri tawo, gusto na ako ra isa,” as verbalized by the patient.
Objective Cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
Fatigue
Observed discomfort
Observed use of unsuccessful social in reactions behavior
Insecurity in public
Dysfunctional interaction with others
Diagnosis:
Impaired social interactions related to limited physical mobility.
Planning:
After 8 hours of giving appropriate nursing intervention patient will express desire/be involved in
achieving positive changes in social behaviors and interpersonal relationships.
Interventions:
1. Interview family, SO, and friends.
To obtain observation of clients behavior changes.
2. Determine client use of coping skills and defense mechanism.
Affects ability to be involved in social situation
3. Have client list behaviors that cause discomfort.
Once recognized, client can choose to change.
4. Work with the client to alleviate underlying negative self concepts
Because they after impede social interactions
5. Encourage client to verbalized problems and perceptions of reasons for problems
Active listen to note indications of hopelessness, powerlessness, fear, anxiety, grief, anger, feeling
unloved or unlovable; problems with sexual identity.
Evaluation:
Goal met. After 8 hours of giving appropriate nursing intervention, patient express desire/be involved
in achieving positive changes in social behaviors and interpersonal relationships.
NURSING CARE PLAN #12
Potential Nursing Care Plan
Subjective cue:
Objective cues:
Ascending paralysis noted (from feet to the pelvic part)
Limited ROM
Slowed body movements noted
Weakness
Nursing Diagnosis:
High risk for impaired skin integrity related to immobility as
evidenced by ascending paralysis
Planning:
After 8 hours of rendering appropriate nursing interventions, patient
will be free from any risk of impaired skin integrity.
INTERVENTIONS RATIONALE
1. Changed patient position every 2 hours. -to promote circulation and prevent bed sore and
constipation
3. Developed repositioning schedule for client, involving-to enhance understanding and cooperation.
client in reasons for and decisions about times and
positions in conjunction w/ other activities.
1. Encouraged patient to touch his lower extremities-To remind the patient that his lower extremities are present
every now and then and still needs care
Evaluation:
NURSING CARE PLAN #13
Potential Nursing Care Plan
Subjective cue:
Objective cues:
Physical immobility
Motor dysfunction
Weakness and numbness (lower extremities)
Nursing Diagnosis:
Risk for Injury related to Physical Immobility.
Planning:
Patient will be able to understand of individual factors that contribute to possibility of injury.
Nursing Intervention:
Perform thorough assessment regarding safety issues when planning for client care and/or preparing
for discharge from care.
Failure to accurately assess and intervene or refer these issues can place the client at needless risk and
creates negligence issues for the health care practitioner.
Ascertain knowledge of safety needs/injury prevention and motivation.
To prevent injury in home and community.
Note clients’ developmental stage, decision- making ability, level of cognition/competence.
Affects clients ability to protect self and influence choice of intervention.
Assess mood, coping abilities, personality styles.
That may result in carelessness/increased risk-taking without consideration of consequences.
Assess clients’ muscle strength, gross and fine motor coordination.
To identify risk for falls.
Identify interventions/safety devices.
To promote safe physical environment and individual safety.
Discuss importance of self monitoring of condition/emotions.
That can contribute to occurrence of injury.
Evaluation:
DISCHARGE PLAN
Name: Patient R
Final Diagnosis: Guillain Barre’ Syndrome
Condition upon Discharge: Improved
Date of Discharge: October 06, 2009
Medications:
Instructed patient and SO to take the medication on time.
Completed duration of those of medications take home.
Instructed SO to give patient with Multivitamins.
Environmental Concerns:
Instructed SO to provide clean environment to prevent lodging of infectious microorganisms.
Instructed SO to provide proper disposal of wastes.
Instructed SO to remove or lessen any environmental hazards.
Changes in your home environment can aid in your recovery by making it easier for you to
bathe, dress and prepare meals while your muscles return to normal levels of strength.
Treatments:
Encouraged patient doing light exercise such as walking.
Encouraged patient to have an adequate rest periods.
Encouraged SO to provide comfort measures to the patients.
Instructed SO to change the position of the patient when lying in bed for long periods of time to
prevent bed sores.
Find a good physical therapy program from which you can learn specific isometric, isotonic and
resistance exercises to rebuild weakened muscles. You may do these exercises on an
outpatient basis and continue them at home. Remember to pace yourself and get adequate
rest, as fatigue is to be expected with Guillain-Barre Syndrome.
Health Teachings:
Provided patient health teaching about:
Proper hand washing
Proper personal hygiene
Tell patient to frequently change positions when lying in bed for long periods of time to
prevent bed sores.
Tell patient’s mother about monitoring signs & symptoms or recurring Guillain-Barre Syndrome,
eg. Tingling sensation, difficulty of swallowing, restlessness, fever.
Instructed patient to avoid some heavy works.
Instructed SO to well cook the food.
Wear comfortable shoes and socks to help soothe pain and burning from neuropathy in the feet.
Inspect your feet often to be sure there are no cuts or blisters that you may not have noticed.
Out Patient (follow up check-up):
Encouraged patient to have follow up check-up after 2 weeks.
Instructed patient to notify physician if there is any undesired feeling about the disease.
Diet
Encouraged patient to eat nutritious food like vegetables.
Encourage patient to eat fruits rich in vitamin C for strong immunity.
Advised patient to take low-sodium diet.
Instructed patient to avoid junk foods.
Follow a healthy eating plan with fresh, seasonal fruits and vegetables, lean meat and fish, whole
grains and plenty of colorful salads. Eating well may help you to sustain your energy and can
boost your mood.
Spiritual
Encouraged patient to attend mass as frequent as he can, or even once a week together with his
family.
Encouraged patient to always pray to God to help him to recover immediately.
Encouraged patient thank God for the gift of life.
Encouraged SO to pray for the health of the patient.
Emotional
Seek emotional support to cope with feelings of depression and anxiety that are part of living with
Guillain-Barre Syndrome. Discuss antidepressant medication with your doctor if you are having
trouble with activities necessary for daily living.
SUMMARY OF INTRAVENOUS FLUIDS
Date/Time Started Intravenous Fluids and Drop Rate Number of hours to be
Volume Infused
Autoimmune disease:
An illness that occurs when the body tissues are attacked by its own immune
system . The immune system is a complex organization within the body that is
designed normally to "seek and destroy" invaders of the body, including infectious
agents. Patients with autoimmune diseases frequently have unusual antibodies
circulating in their blood that target their own body tissues.
Definition of Terms
Heart: The muscle that pumps blood received from veins into arteries
throughout the body. It is positioned in the chest behind the sternum
(breastbone; in front of the trachea, esophagus, and aorta; and above
the diaphragm muscle that separates the chest and abdominal
cavities. The normal heart is about the size of a closed fist, and
weighs about 10.5 ounces. It is cone-shaped, with the point of the
cone pointing down to the left. Two-thirds of the heart lies in the left
side of the chest with the balance in the right chest.
See the entire definition of Heart
Heart rate: The number of heart beats per unit time, usually per minute. The
heart rate is based on the number of contractions of the
ventricles (the lower chambers of the heart). The heart rate may
be too fast ( tachycardia ) or too slow ( bradycardia ). The pulse
is bulge of an artery from the wave of blood coursing through the
blood vessel as a result of the heart beat. The pulse is often
taken at the wrist to estimate the heart rate.
See the entire definition of Heart rate
Immune: Protected against infection. The Latin immunis means free, exempt.
Immune system:
A complex system that is responsible for distinguishing us from
everything foreign to us, and for protecting us against infections and
foreign substances. The immune system works to seek and kill
invaders.
Infection: The growth of a parasitic organism within the body. (A parasitic
organism is one that lives on or in another organism and draws its
nourishment therefrom.) A person with an infection has another
organism (a "germ") growing within him, drawing its nourishment
from the person.
Knee: The knee is a joint which has three parts. The thigh bone (the
femur) meets the large shin bone (the tibia) to form the main knee
joint. This joint has an inner (medial) and an outer (lateral)
compartment. The kneecap (the patella) joins the femur to form a
third joint, called the patellofemoral joint. The patella protects the
front of the knee joint
Low blood pressure : Any blood pressure that is below the normal
expected for an individual in a given environment.
Low blood pressure is also referred to as
hypotension.
: Muscle is the tissue of the body which primarily functions as a
Muscle:
source of power. There are three types of muscle in the body. Muscle
which is responsible for moving extremities and external areas of the
body is called "skeletal muscle." Heart muscle is called "cardiac
muscle." Muscle that is in the walls of arteries and bowel is called
"smooth muscle."
Myelin: The fatty substance that covers and protects nerves. Myelin is a
layered tissue that sheathes the axons (nerve fibers). This sheath
around the axon acts like a conduit in an electrical system, ensuring
that messages sent by axons are not lost en route. It allows efficient
conduction of action potentials down the axon. Myelin consists of
70% lipids (cholesterol and phospholipid) and 30% proteins. It is
produced by oligodendrocytes in the central nervous system.
A bundle of fibers that uses chemical and electrical signals to
Nerve:
transmit sensory and motor information from one body part to
another..
Peripheral nervous system (PNS): That portion of the nervous system that
is outside the brain and spinal cord.
Physical therapy: A branch of rehabilitative health that uses specially designed
exercises and equipment to help patients regain or improve
their physical abilities. Physical therapists work with many
types of patients, from infants born with musculoskeletal
birth defects, to adults suffering from sciatica or the after-
effects of injury, to elderly post-stroke patients.
The liquid part of the blood and lymphatic fluid, which makes up about
Plasma:
half of its volume. Plasma is devoid of cells and, unlike serum, has not
clotted. Blood plasma contains antibodies and other proteins. It is
taken from donors and made into medications for a variety of blood-
related conditions. Some blood plasma is also used in non-medical
products.
Plasmapheresis: A procedure designed to deplete the body of blood plasma
(the liquid part of the blood) without depleting the body of
its blood cells. Whole blood is removed from the body, the
plasma is separated from the cells, the cells are suspended
in saline, a plasma substitute or donor plasma), and the
reconstituted solution may be returned to the patient. The
procedure is used to remove excess antibodies from the
blood in lupus, multiple sclerosis, multiple myeloma, etc.
Plasmapheresis carries with it the same risks as any
intravenous procedure. The risk of infection increases with
the use of donor plasma, which may carry viral particles
despite screening procedures. The procedure is done in a
clinic or hospital.
Protein: A large molecule composed of one or more chains of amino
acids in a specific order determined by the base sequence of
nucleotides in the DNA coding for the protein.
Proteins: Large molecules composed of one or more chains of amino acids
in a specific order determined by the base sequence of
nucleotides in the DNA coding for the protein.
The return of signs and symptoms of a disease after a patient
Relapse:
has enjoyed a remission . For example, after treatment a patient
with cancer of the colon went into remission with no sign or
symptom of the tumor, remained in remission for 4 years, but
then suffered a relapse and had to be treated once again for
colon cancer.
Residual: Something left behind. With residual disease, the disease has not
been eradicated.
Syndrome: A set of signs and symptoms that tend to occur together and
which reflect the presence of a particular disease or an
increased chance of developing a particular disease.
Trigger: Something that either sets off a disease in people who are
genetically predisposed to developing the disease, or that causes
a certain symptom to occur in a person who has a disease. For
example, sunlight can trigger rashes in people with lupus.
Viral:Of or pertaining to a virus. For example, "My daughter has a viral rash ."