Question

A 33-year-old male construction worker has been in good health except for a recent bout of gastroenteritis. Initially he noted some paresthesia in his feet and less so in his fingers. The following day he noted difficulty climbing a ladder. He presented to the Emergency Department and was noted to have hypoactive deep tendon reflexes, no sensory loss and was able to walk unassisted. A diagnosis of "flu" was given and he was given symptomatic treatment. He spent the remainder of the day resting in bed. The following morning, he fell while attempting to walk to his bathroom and at that time, was unable to stand without support. Re-evaluation, at the Emergency Department, revealed distal leg weakness and absent deep tendon reflexes. There was no objective sensory deficit. Other studies included normal EKG, CPK and troponin and normal chest x-ray. Neurology consultation was obtained. Nerve conduction/EMG studies revealed prolonged distal motor latencies and slowed nerve conduction velocities. CSF was obtained and showed a protein level of 80 mg/dl with no cells and normal glucose. Treatment was started. The following day the patient noted difficulty grasping and elevating his arms but then stabilized. After one week of treatment strength started to return in the upper, then lower extremities. Patient is diagnosed with an acute inflammatory demyelinating polyradiculoneuropathy (AIDP) also known as Guillain-Barre syndrome.

• Define the disorder identified

• In your own words explain the pathophysiology of the disorder identified

• Identify the common signs and symptoms highlighted in the case

• Diagnostic tests for this patient

• List the common pharmacology interventions for the disorder please state the category the drug belongs as well as the actions and side effects

• Please complete a nursing care plan listing two actual and one potential nursing diagnosis for the CASE you identified.

• Please remember to maintain APA formatting throughout your submission TURN IT IN for assignments must be less than 20%

Answer 1

*Guillain-Barre Syndrome-It is a rare but serious autoimmune disorder in which the immune system attacks healthy nerve cells in peripheral nervous system (PNS).This leads to weakness, numbness and tingling and can eventually cause paralysis.

*Pathophysiology-The pathophysiology of GBS is complex. GBS is considered to be an autoimmune disease triggered by a preceding bacterial or viral infection. Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus and Mycoplasma pneumoniae are commonly identified antecedent pathogens.

In the acute motor axonal neuropathy (AMAN) form of GBS, the infecting organisms probably share homologous epitopes to a component of the peripheral nerves (molecular mimicry) and, therefore, the immune responses cross-react with the nerves causing axonal degeneration; the target molecules in AMAN are likely to be gangliosides GM1, GM1b, GD1a and GalNAc-GD1a expressed on the motor axolemma.

In the acute inflammatory demyelinating polyneuropathy (AIDP) form, immune system reactions against target epitopes in Schwann cells or myelin result in demyelination.

*Signs and Symptoms-

1)distal paresthesia and pain precedes muscle weakness that ascends rapidly from lower to upper limbs and more marked proximally than distally.

2)Facial and bulbar weakness commonly develops.

3) Respiratory weakness

4)Diffuse weakness with loss of reflex on examination.

*Diagnostic Test-

1)CSF Protein-Raised

2) Electrophysiological changes may emerge after a week or so,with conduction block and multifocal motor slowing.

3) Antibodies to the gangliosides GM1 are found.

4)other causes of an acute neuromuscular paralysis should be excluded(e.g. poliomyelitis, botulism,diptheria,spinal cord syndrome or myesthenia)