Paralyzed and Painfully Aware:

A Discussion on
Guillain-Barr Syndrome
Libby Cyran BSN, RN, CNRN
St. Vincent Hospital
Indianapolis, IN

Objectives
Define Guillain-Barr Syndrome and its
classifications
Explain how GBS is diagnosed and treated
Consider potential complications and
nursing management
Discuss recovery and prognosis for GBS
patients
Explore a case study of a GBS survivor

Guillain-Barr Syndrome Defined

Acute inflammatory polyneuropathy
Autoimmune
Ascending weakness and sensation changes
progressing to possible paralysis
Rare; Affecting 1-2/100,000 each year
Mortality rate = 5%

Pathophysiology
Myelin sheath on
peripheral nerves
degenerates as it is
attacked by the immune
system
Delays and impairs
impulse along the dorsal
and ventral nerve roots
Muscles weaken and
possible paralysis can
result

Causes
Unknown
Post-infectious immune-mediated-Respiratory or GI
illness 1-3 weeks prior to onset
Campylobacter jejuni
Post-surgical
Vaccination
Significant elevation of GBS in1976-77 Swine Flu
vaccination season

GBS Defined
3 Phases
1. Acute-rapidly progressive and potentially fatal (1-3
weeks)
2. Plateau-symptoms stabilize (several days-2 weeks)
3. Recovery-remyelination of nerves (4 months-3 years),
sometimes recovery is not complete

Diagnostic Evaluation
History
2/3 of patients have experienced a GI or Respiratory
illness in the 3 weeks prior to onset of symptoms
Paresthesia in the legs
Stiffness or pain in legs and back
Dyspnea on exertion
Physical
Ascending weakness of the limbs (symmetrical)
Muscle weakness
Decreased/absent tendon reflexes (knee jerks)

Diagnostic Evaluation
Lumbar Puncture
Low blood cell count
Elevated protein

Nerve Conduction
Velocity
Decreased conduction
velocity to peripheral
nerves

Treatment
No known cure
Plasmapheresis-temporarily reduces circulating
antibodies
Daily exchanges for 3-5 days
High-Dose Immune Globulin therapy-acts as a
blocking receptor on the macrophages to prevent
antibody attack on the myelin
Daily infusions for 5 consecutive days
Corticosteroids-thought to affect the inflammatory
process, given in combination with another therapy.
Some studies indicate not an effective treatment..

Complications
1.
2.
3.
4.
5.
6.

Weakness/Immobility
Respiratory Distress
Autonomic Dysfunction
Nutrition
Psychosocial
Pain

Weakness/Immobility
Effects

Weakness, depending on
severity, leads to limited
mobility to complete bedrest
Skin breakdown, constipation,
Deep Vein Thrombosis (DVT)
and Pulmonary Emboli (PE)

Interventions

Teach safety precautions

Frequently turn/reposition
Provide ROM exercises
Recommend physical
therapy referral
Assess for contractures,
edema in LE and
constipation
Provide assistive devices
Apply antiembolism
stockings

Respiratory Distress
Effects

Decreased vital capacity and

depth of respirations due to
accessory muscle weakness
Ineffective cough

Interventions

Encourage cough/deep
breathing
Elevate HOB
Monitor breath sounds,
depth of respirations and
O2 saturation
Administer oxygen
Avoid opioids and
sedatives, if possible
Intubation

Autonomic Dysfunction
Effects

Tachycardia and
arrhythmias
Postural hypotension
Temperature instability
Urinary retention

Interventions

Monitor telemetry
Obtain vital signs frequently
Insert NG tube if paralytic ileus
occurs
Perform In and Out
catheterization to relieve
urinary retention
Monitor fluid and electrolytes

Nutrition
Effects

Rapid weight loss and

muscle atrophy
Dysphagia due to cranial
nerve involvement

Interventions

Auscultate for bowel sounds;

hold enteral feedings if BS are
absent
Assess chewing and
swallowing ability
During rehab, encourage
small, frequent meals
Referral to dietician for
evaluation

Psychosocial
Effects

Anxiety and depression are

very common
Inability to communicate
increases anxiety

Interventions

Build a trusting relationship

Develop a communication
system
Provide explanation and
reassurance
Provide patient call system
Recommend referral to speech
therapy
Refer to social work,
counselor, psychologist

Pain
Effects

Described as severe
charley horse
Often in the extremities and
low back
Worse at night, causing
sleep dysfunction
1/3 have pain after 2 years

Interventions

Assess pain frequently

Administer analgesics as
required (Narcotic agents
sometimes effective)
Turn the patient frequently
Provide multiple pain relieving
techniques (massage,
distraction, etc.)

Recovery

After the patient reaches

plateau, an aggressive rehab
program is needed for optimal
recovery
Outcome can be predicted by
age and severity of illness
15-25% experience residual
weakness
1/3 of patient have pain after 2
years

Case Study-Part 1
From Guillain-Barre
Syndrome to Happily
Every After

26 year old, previously healthy

female
January 26, 2011-delivered infant
by c-section
Early February-suffered from the
flu
3 weeks postpartum- tingling
finger, pain in neck and weakness
in lower extremities, bilaterally
Late February-diagnosed with
GBS and intubated within 24 hours
of admission

Case Study-Part 2
One IVIG dose given
and patient continued
to decline
Plasmapheresis
Tracheotomy
PEG Tube

From Guillain-Barre
Syndrome to Happily
Ever After

May is Guillain-Barr Awareness Month

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