Guillain-Barre Syndrome: Promoting Communication
*Collaborate w/Speech Pathologist
*Develop communication system(blink for yes or no; pad for writing requests)
(due to weakened muscles for speech production)
|What is a Herniated Disk?||
GUILLIAN-BARRE SYNDROME: LAB TESTS
*Lumbar Puncture: CSF
(increased CSF protein w/o an increase in cell count; lymphocyte count is normal)
*High protein levels occur after 1 to 2 weeks of illness, reaching peak at 4 to 6 weeks.
1.)Electrophysiologic Studies-EPS- show demyelinating neuropathy.(testing results do not always accurately correspond with level of neuropathy)
2.)MRI/CT used to rule out other causes.
|Guillain-Barre' Syndrome: Plasmapharesis||
*Start PE for nonambulatory adult pt. who seek treatment w/in 4wks of onset of symptoms AND for ambulatory pts seen w/in 2 weeks of onset of symptoms.
Treatment: Pt usually receives 3-4 tx, 1 to 2 days apart.
Check for shunt patency, assess for bruits q2-4h, Keeping double bulldog clamps at bedside, observing puncture site for bleeding or ecchymosis. To treat paresthesias, add calcium gluconate or chloride to exchange fluids as ordered.
*Give ATROPINE in case of bradycardia
|Medication treatment for Trigeminal Neuralgia?||
Anticonvulsants to reduce pain: Dilantin, tegretol, trileptal.
Baclofen- with anticonvulsants.
Proper dental care.
|Types of closed Spinal Cord Injuries? (3)||
|What is another name for Spinal Shock?||
|Causes of Multiple Sclerosis (MS)?||
Cause is unknown.
Genetic tendency, but not inherited.
Possibly viral, but not infectious.
|Diagnosing Trigeminal Neuralgia?||
Dental exam to r/o tooth problems.
MRI, CT to r/o other disorders.
|How long does Spinal Shock (areflexia) last?||
Guillain-Barre' Syndrome: Drug Therapy
Drug Therapy for Guillain-Barre Syndrome
*Plasmapharesis or immunoglobulin(IVIG)-do not combine.
Why? PE removes circulating antibodies thought to be responsible for GBS.
*DO NOT USE CORTICOSTEROIDS unless necessary to treat other conditions.
GUILLAIN-BARRE' SYNDROME: Mgmt of Respiratory Status/Airway
*PRIORITY INTERVENTION FOR GBS PATIENTS*
Respiratory Status/Airway Mgmt: GBS
*Elevate HOB to 45 deg or higher depending on patient needs.
*Place patient on side, to prevent aspiration, log roll of cervical aspiration suspected.
*Monitor for signs of respiratory distress(dyspnea, lack/diminished breath sounds, air hunger, adventitious breath sounds, dec. O2 sat, cyanosis.
*Monitor patient's ability to cough and swallow
*Assess cognitive status, esp. elderly, a decline indicates hypoxia.
*Chest phys by RT
*Frequent position changes w/ breathing exercises(cough/deep breathe) to prevent atelectasis /pneumonia
*Keep ET kit at bedside
|Treating Multiple Sclerosis (MS)?||
Treatment is symptomatic & supportive.
Meds: Acute exacerbations- Steroids (IV then PO)
|Clinical manifestations of Trigeminal Neuralgia?||
Pain- mild to excruciating:
Sudden, burning, electrical shock-like, jolting, piercing, lightning-like, shooting, jabbing, like having wires in your face.
Usually comes & goes but may be persistant.
Usually leaves as quickly as it begins.
Usually one side of face (both sides possible).
Facial twitching and tearing.
|Diagnosing Multiple Sclerosis (MS)?||
History & physical exam
No specific test: Tests done to r/o other diseases. Or to collect bits & pieces to confirm.
EMG to evaluate neuromuscular function.
CT, MRI visualizes plaques.
EEG may be slow.
LP: Increased IGG, protein & WBC.
|Diagnosing Bell's Palsy?||
Based on history & physical exam.
CT, MRI, to r/o CVA, tumor.
EMG to determine extent & severity of damage.
What are vertebrae disks?
Disks that form cushion between vertebrae bodies.
Tough, fiberous material within a capsule.
|Guillain-Barre' Syndrome: Pain Mgmt||
*Pain is often worse at night
(paresthesias, hyperperesthesia, deep muscle aches, and muscle stiffness)
*Opiates effective for pain mgmt.
*PCA pump or continuous IV drip will be used.
*Also Gabapentin or tricyclic antidepressants
(Older patients due not get tricyclic antidep. cause urinary retention/blurred vision)
*Use nonpharm methods as well(massage, ice, imagery, hypnosis)
|What is Bell's Palsy?||
A temporary weakness or paralysis of the muscles that control expression on one side of the face.
Results from damage to the facial nerve (7th).
|First priority with a Spinal Cord injury?||
Immobilization of the spine.
|Diagnosing a Spinal Cord Injury?||
History and physical exam.
X-ray of spine.
|Clinical manifestation of Herniated Disk?||
Vary depending on level of injury.
Pain, weakness, paralysis, numbness, tingling radiating down arm or leg over distribution of nerve root.
Pain increases with straining, coughing & lifting because disk bulges more r/t increased CSF pressure in spinal column.
Eventually walking & sitting becomes difficult.
Loss of bowel & bladder control.
Guillain-Barre' Syndrome: Symptoms
*ASCENDING symmetric muscle weakness--flaccid paralysis
*Decreased or absent DTRs
*Loss of bowel sounds
GBS is self limiting and paralysis is temporary!!!
|How does Multiple Sclerosis affect nerve function?||
Demyelination of nerves results in scarring & plaque formation, which causes poor nerve transmission.
|Visual changes r/t Multiple Sclerosis (MS)?||
Due to lesions on occipital lobe.
Nystagmus (involuntary movement of eyeball)
Diplopia (double vision)
|Herniated disks usually occur where?||
Usually affects the cervical or lumbar disks.
|Injury involved in a Subluxation Spinal Cord Injury?||
Partial or incomplete dislocation of one vertebrae over another.
Spinal cord injury may or may not occur.
|What is Autonomic Dysreflexia (hyperreflexia)?||
Occurs with injury above T6 after spinal shock phase is over.
Stimuli --> massive sympathetic reflexive discharge from autonomic system --> catecholamine released --> vasoconstriction.
|Clinical manifestations of Multiple Sclerosis (MS)?||
Many & varied according to site of lesions- lesions scattered thoughout entire CNS
Repeated exacerbations result in increased scarring, therefore increased severity of s/s & increased residual deficits.
|Biological response modifiers for Multiple Sclerosis (MS)?||
Used to reduce severity & frequency of exacerbations.
ABC's of MS- use one:
|Changes to hearing & speech r/t Multiple Sclerosis (MS)?||
Decreased hearing & tinnitus r/t lesions in temporal lobe.
Speech is slurred & hesitant r/t muscle weakness & frontal lobe lesion.
|Goals of treatment for Herniated Disk?||
Rest & immobilization of spine to allow soft tissues time to heal.
Decrease inflammation of soft tissue & nerve roots.
|Who is more prone to Trigeminal Neuralgia?||
Females > Males
Usually after 50 yrs old.
|How does a Compression Spinal Cord Injury occur?||
Axial loading: Fall from a height- landing on feet, buttocks or top of head- vertebrae explode or burst.
|How does a Hyperextension Spinal Cord Injury usually occur?||
Whiplash- mild form without injury to vertebrae or spinal cord from a rear end collision.
Fall and hit chin (ie falling on a slip and slide).