Potential Complications
Pathophysiology
Assessment
Nursing Management
Diet
100
In patients with GBS malnutrition places them at risk for this particular skin issue especially since they are immobile
What is pressure ulcers
100
GBS is an acute inflammation demyelination polyneuropathy (AIDP) that effects what nervous system
What is the Peripheral Nervous System?
100
Most people with GBS report sudden onset of
What is muscle weakness and pain?
100
This should be kept by the bedside of a patient with GBS in case of respiratory emergency
What is an endotracheal tube?
100
What can cause malnutrition in a patient with GBS?
What is gastric motility, dysphagia and depression
200
The patient with GBS will sometimes need suctioned which places them at high risk for vagal nerve stimulation that could lead to these cardiac issues
What is bradycardia and cardiac arrest?
200
Destruction of the myelin sheath of the PNS leads to progressive motor weakness and sensory abnormalities. Symptoms usually begin in the legs and spread to the arms and upper body. What is the condition referred to?
What is ascending paralysis?
200
Assessment of cranial nerve VII (facial nerve) involves?
What is patient's ability to smile, frown, whistle or drink from a straw?
200
This should be done every 2 hrs to prevent skin breakdown in the immobilized patient with GBS
What is reposition?
200
Malnutrition places patient's with GBS at risk for what
What is pressure ulcers?
300
Patient with GBS are immobile for long periods which places them at high risk for these two common issues with immobility
What is DVT and pulmonary emboli?
300
The immune system starts to destroy the myelin sheath or the axon themselves, the destruction of the myelin between the nodes of Ranvier is?
What is Segmental demyelination?
300
The nurse knows that the patients inability to cough, gag or swallow results from involvement of which cranial nerves?
What is IX and X?
300
This will be placed to obtain enteral nutrition if a patient with GBS cannot safely swallow food or liquids
What is feeding tube?
300
If a patient cannot swallow food or liquids what is prescribed
What is Enteral nutrition via feeding tube?
400
This is common complication of GBS will be treated with a beta-blocker or nitroprusside (Nitropress).
What is hypertension?
400
The Acute period (1-4 weeks), the Platue period (several days to 2 weeks), the recovery period (gradual over 4-6 months up to 2 years) Some patients may have permanent neurological deficits -- this is referred to as chronic GBS.
What is the acute stages of GBS?
400
The patient with GBS should be monitored closely for what?
What is varying BP, bradycardia, heart block and possible asystole?
400
These are given subcutaneously to prevent pulmonary emboli and DVT due to immobility in a patient with GBS
What is Heparin and Lovenox?
400
What is an important nursing intervention to help determine malnutrition in patient with GBS?
What is weigh the patient 3 times a week and monitor serum prealbumin each week?
500
This is one of the most serious complications with GBS that requires equipment for an endotracheal intubation be placed at the patient's bedside
What is respiratory distress?
500
Acute illness, trauma, surgery, immunization, upper respiratory tract infection, GI illness and positive antibodies to cytomegalovirus or Epstine-Barr virus (EBV)
What could the related causes of GBS? (Although the exact cause of GBS remains unclear, patients often relate a history of the above factors before the onset of neurologic manifestations)
500
The nurse knows to expect which tests will be ordered for dx of BGS
What is Electrophysiologic studies (EMS), electromyographic studies (EMG) and nerve conduction velocity testing (NVC). (note NVC is performed with EMG)
500
This should be done to remove secretions and promote airway patency and gas exchange in patient with GBS
What is suctioning?
500
An intervention for GBS is, plasmapheresis which can cause temporary circumoral and distal extremity parathesias, muscle twitching, N/V. What would you do as the nurse?
What is add calcium gluconate or calcium chloride to exchange fluids as prescribed?