Guillain-Barre’ syndrome
Causes
Unknown. Body’s immune system attacks your nerves. Weakness and tingling in extremities are usually the first symptoms. No cure. Can occur after viral or bacterial infection.
Opposite of MS, demyelination
Cause and Symptoms
Cause: Degeneration of substantia nigari, resulting in too little dopamine and to much acetylcholine.
Symptoms: Tremor, muscle rigidity, slow/shuffling gait, bradykinesia (slow movement), mask like expression, drooling, difficulty swallowing
Pathophysiology
•Changes in brain structure and function
Amyloid plaques
Neurofibrillary tangles
Loss of connections between neurons
Neuron death
Drug Therapy
•Memantine (Namenda) protects nerve cells against excess amounts of glutamate
Glutamate is released in large amounts by cells damaged by AD
Etiology
•Deficiency of Acetylcholine and GABA leading to too much Dopamine.
•This is the opposite of Parkinson’s disease
•Genetic
•Onset: 30-50 y/o
Three States
Initial (1-3 weeks)
Plateau (several days to 2 weeks)
Recovery (4-6 months)
Coincides with remyelinating and axonal regeneration
Nursing Care
Monitor swallowing/food intake, thicken liquid, high fowlers, suction, encourage ROM and exercise, assist w/ ADL’s
Clinical Manifestations - as disease progresses
•As the disease progresses
↓ Personal hygiene
↓ Concentration and attention
Unpredictable behavior
Delusions and hallucinations
•Changes are not under control of patient
•As AD progresses, personal hygiene deteriorates, as does the ability to concentrate and maintain attention.
•Ongoing loss of neurons in AD can cause a person to act in altered or unpredictable ways.
•Behavioral manifestations of AD (e.g., agitation, aggression) result from changes that take place within the brain.
•They are neither intentional nor controllable by the individual with the disease.
•Some patients develop delusions and hallucinations.
Assessment - Behavioral
•Extremes in temperature or excessive noise may lead to behavior changes.
•Check the patient for changes in vital signs, urinary and bowel patterns, and pain that could account for behavioral problems.
•Then assess the environment to identify factors that may trigger behavior disruptions.
•Do not ask the confused or agitated patient challenging “why” questions. The person with AD cannot think logically.
•If the patient cannot verbalize distress, validate his or her mood.
•Rephrase the patient's statement to validate its meaning.
Assessment
•jerky involuntary movements
•hesitant or explosive speech
•dysphagia
•bowel and bladder incontinence
•poor judgment, memory loss,
• personality changes,
• dementia
Symptoms
Pins and needles, weakness in legs, unsteady walking or climb stairs, difficulty with eye or facial movements including speaking or chewing or swallowing, rapid HR, low or high BP, dyspnea
Medications
Levodopa/carbidopa (increase dopamine level), benztropine (decreases acetylcholine level)
Levodopa: cross blood brain barrier
Carbidopa: Dopamine
Clinical Manifestations - cognitive impairments
•dysphasia (difficulty comprehending language and oral communication)
•apraxia (inability to manipulate objects or perform purposeful acts)
•visual agnosia (inability to recognize objects by sight)
•dysgraphia (difficulty communicating via writing)
•Eventually long-term memories cannot be recalled, and patients lose the ability to recognize family members and friends.
•Other problems include aggression and a tendency to wander.
Care - Safety
•Pain should be recognized and treated promptly
Monitor patient’s responses
Patients can have difficulty communicating complaints
May exhibit changes in behavior
Nursing Care/Interprofessional Care
•No cure
•Palliative Care
•Anticonvulsants, antidepressants
•Genetic Counseling
Diagnostic test: Spinal tap, electromyography, nerve conduction studies
Treatment:
Plasmapheresis (Plasma exchange), immunoglobulin therapy, heparin, oxygen, IV fluids
Airway management, positioning, pain management
Clinical Manifestations - late stages
Unable to communicate
Cannot perform activities of daily living (ADLs)
Patient becomes unresponsive and incontinent
Total care is required
Nursing Care - Interventions
•Promote independence in ADLs
•Ensure safety
•Promote bowel and bladder continence.
•Teach family members
Diagnostics
•No definitive diagnostic test exists for AD
Diagnosed by exclusion
Made once all other possible conditions causing cognitive impairment have been ruled out
Definitive diagnosis of AD usually requires an autopsy