Etiology

The syndrome often follows an acute infection or vaccination. Antibodies react with antigens on the surface of peripheral myelinated nerves, causing demyelination.

Treatment

Treatment is aimed at supporting the patient until motor function returns and preventing complications. Approximately one third of patients need intubation and mechanical ventilation until they can breathe on their own. Total enteral or parenteral nutrition as necessary, physical therapy, cardiac monitoring, and close observation for infection are important to reduce complications. Plasmapheresis and use of intravenous immune globulin (IVIG) is most beneficial in treating patients with rapidly progressing paralysis.

Patient care

The patient is carefully assessed for evidence of impending respiratory failure, through the use of bedside spirometry. If the inspiratory force, vital capacity, or arterial blood gases deteriorate respiratory support is provided. Testing for thoracic sensation and monitoring and marking the level of diminished sensation as it ascends helps to predict impairment of intercostal muscle function.

Noninvasive interventions such as passive ROM exercises, massage, distraction, imagery, ice, heat, cutaneous stimulation, and transcutaneous electrical nerve stimulation should be offered and added to the patient's plan of care, depending upon his or her response. Range-of-motion exercises are provided three to four times daily within the patient's limits. As the patient's condition stabilizes, gentle stretching and active-assisted exercises are provided.

The GBS patient may be anxious, frightened, or depressed. Questions or misconceptions about the illness and the procedures used to address it should be answered thoughtfully and compassionately. Feelings of isolation and fear can be reduced by family visits, patient education, or the assistance of former GBS patients who can share feelings and offer hope and information on coping. Routine care of the paralyzed patient is implemented including range of motion exercises, turning and positioning every 2 hr, and scrupulous skin care.

Fluid and electrolyte balance is maintained. To prevent aspiration, the head of the bed is elevated and the gag reflex tested before oral intake. If the gag reflex is impaired, nasogastric enteral feedings are provided until the reflex returns. The nurse encourages adequate fluid intake (2000 ml/day) orally, enterally, or if necessary, parenterally unless contraindicated. The bladder should be palpated and percussed to assess for urine retention. Either urinal or bedpan is offered every 3 to 4 hr. Intermittent urinary catheterization is instituted if necessary. To prevent or relieve constipation, prune juice and a high-bulk diet, stool softeners and laxatives, glycerin or bisacodyl suppositories, or enemas (as prescribed) are provided daily or on alternate days.

If the patient has facial paralysis, the nurse provides oral hygiene and eye care every 4 hr, protecting the corneas with shields and isotonic eye drops. If the patient cannot vocalize, establishing alternative methods of communication, such as eye blink or letter boards, is essential to ensure that patient needs are met. If the patient cannot use the regular call light to signal for assistance, a pressure-sensitive cell device activated with minimal pressure is placed near the hand or head; or a sip-and-puff call system should be used. The patient's legs are inspected regularly for signs of thrombophlebitis, and antiembolism devices are applied and anticoagulants given if prescribed.

During recovery, patients require physical and occupational therapy to reach their fullest potential. Patient and family should also meet with a social worker or case manager to discuss financial concerns (insurance coverage, disability-related income losses) and to learn about available community resources.

Before discharge, the nurse assists the patient and family to develop an appropriate home care plan and makes appropriate referrals for home care as necessary. The patient and family are also taught the skills required for home care or are referred for instruction. Additional information is available from support and educational associations, such as the GBS/CIPD Foundation International (www.gbs-cidp.org/).