Problems of the Peripheral Nervous System

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Problems of the Peripheral Nervous System
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Guillain-Barré Syndrome (GBS)

• Acute inflammatory process
• Varying degrees of motor weakness and paralysis
• Segmental demylination (destruction of myelin
  between the nodes of Ranvier
• Saltatory conduction is impaired
• Stages
• Initial (1-3 weeks)
• Plateau (several days to 2 weeks)
• Recovery (4-6 months)
• Chronic Inflammatory Demyelinating Polyneuropathy
  (CIDP)

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GBS Etiology

• Immunologic reaction
• T lymphocytes (cell-mediated reaction)
• B lymphocytes (humoral reaction)
• History of
• Acute illness/trauma/surgery/immunization
• Upper respiratory infection/GI illness
• Positive antibodies to CMV/EBV
• Limited malfunction of immune system
• Key features Chart 44-1, p. 954

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GBS Assessment

• Ascending GBS
• Most common
• Weakness/paresthesia begins in lower extremities
  and progresses ?
• Evolves over a period of 1-10 days
• Mild paresis to total quadriplegia
• 50 develop respiratory compromise
• Pure motor GBS
• Identical to ascending GBS but without sensory
  signs and symptoms

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GBS Assessment

• Descending GBS
• Weakness initially begins at head and shoulders
  and progresses ?
• Affects respiratory function
• Visual disturbances
• Deep tendon reflexes ? or absent
• Miller Fisher variant
• Cranial nerve involvement
• Autonomic dysfunction

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GBS Nursing Diagnosis

• Ineffective breathing pattern
• Ineffective airway clearance
• Impaired gas exchange
• Impaired physical mobility
• Acute pain
• Impaired verbal communication
• Powerlessness

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GBS Interventions

• Respiratory management
• Drug therapy
• Immunoglobulin therapy
• Plasmapheresis
• Improve physical mobility
• Prevent immobility consequences

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Myasthenia Gravis (MG)

• Chronic neuromuscular autoimmune disease
• Weakness of voluntary or striated muscles
• Remissions and exacerbations
• Nerve impulses not transmitted to skeletal
  muscles at neuromuscular junction
• Development of specific antibodies to one or more
  ACh receptor sites
• Degeneration of ACh receptors
• Thymus gland often abnormal

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Myasthenia Gravis Assessment

• Rapid onset of fatigue
• Complaints of muscle weakness
• Progressive paresis of affected muscles
• Ptosis
• Diplopia
• Difficulty swallowing/chewing
• Respiratory difficulty
• Weakness of the voice

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Myasthenia Gravis Interventions

• Treatment of symptoms
• Anticholinesterases
• Cholinergic drugs
• Inducing remission
• Immunosuppressive drugs
• Corticosteroids
• Plasmapheresis
• Thymectomy

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Myasthenia Gravis Interventions

• Assistance with activities
• Respiratory support
• Assistance with communication
• Nutritional support
• Eye protection
• Surgical management
• Psychosocial support

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Myasthenia Gravis Crisis

• Myasthenia crisis
• Exacerbation of myasthenic symptoms
• Undermedication with anticholinesterase drugs
• Cholinergic crisis
• Acute exacerbation of muscle weakness
• Overmedication with cholinergic drugs
• Often preceded by infection
• Mixed crisis
• Maintenance of adequate respiratory function

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Polyneuritis/Polyneuropathy

• Muscle weakness with or without atrophy
• Pains and paresthesia
• Loss of sensation
• Impaired reflexes
• Autonomic manifestations
• Combination of symptoms