(^230) Medical-Surgical Nursing Demystified
Guillain-Barré Syndrome
WHAT WENT WRONG?
This is an acute, progressive autoimmune condition that affects the peripheral
nerves. Symptoms occur as the myelin surrounding the axon on the peripheral nerves
is damaged from the autoimmune effect. The disease typically follows a viral in-
fection, surgery, other acute illness or immunization by a couple of weeks. Ascending
Guillain-Barré exhibits muscle weakness and/or paralysis that begins in the distal
lower extremities and travels upwards. The patient may also experience altered
sensory perception in the same areas, such as the sensation of crawling, tingling,
burning, or pain. The progression of symptoms may take hours or days. Descending
Guillain-Barré begins with muscles in the face, jaw, or throat and travels down-
ward. Respiratory compromise is a concern as the paralysis reaches the level of the
intercostal muscles and diaphragm. Breathing can become compromised more
quickly in patients with descending disease. Level of consciousness, mental status,
personality, and pupil size are not affected.PROGNOSIS
Patient support and monitoring are important during symptom progression.
Involvement of respiratory muscles may result in respiratory compromise or fail-
ure. Involvement of ocular areas may cause blindness. If the nerve cell body is
damaged during the acute phase, there may be permanent deficits for the patient
in the involved area. Otherwise, the axons of the nerves may be able to repair the
damage over several months.HALLMARK SIGNS AND SYMPTOMS
- Burning or tickling feeling due to demyelination of the nerve axons
- Symmetrical weakness or flaccid paralysis, typically ascending in pattern
- Absence of deep tendon reflexes due to changes within the nerves—reflexes
are a sensory-motor response that happens at the spinal level, not the brain - Recent infection or other acute illness
- Facial weakness, dysphagia, visual changes in descending disease
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