NUR2755 Section BTP3 Multidimensional Care IV
Module 03 Overview and Activities
Readings
Activity Time : 1 hour, 30 minutes
. Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapter 44
.
Module 03 The Peripheral Nervous System
The Peripheral Nervous System
The Peripheral Nervous System is composed of the spinal nerves and cranial nerves. Take a
moment to review the anatomy and function of the peripheral nervous system.
Module 03 Diseases of the Peripheral Nervous System
. Diseases of the Peripheral Nervous System
Guillain-Barre Syndrome
Gullain-Barre Syndrome (GBS) is a result of overactive immunity. It is rare and affects
men more than women. The myelin sheath is attacked by circulating antibodies resulting
from an immune response. There are various triggers from bacterial to viral. The most
common presentation is a viral-like illness one to three weeks prior to GBS symptoms.
The result of the overactive immunity results in destruction of the myelin sheath which
slows the transmission of impulse from node-to-node. The slowing of impulses produces
the symptoms of GBS. The hallmark of the disease is ascending weakness.
Stages of GBS
. Acute Stage – Onset of symptoms
. Plateau – Symptoms remain for a few days to a few weeks
Recovery
. May take up to 2 years
Diagnostics
. Lumbar puncture to evaluate cerebral spinal fluid (CSF) for increase in protein--
results are non-conclusive
. Electrophysiologic studies (EPSs)--demonstrates demyelinating neuropathy
. Treatment Options
1
, NUR2755 Section BTP3 Multidimensional Care IV
. Plasmapheresis – Remove circulating antibodies
. Start within several days of onset of illness
. 3 to 4 treatments – 1-to-2 days apart
. Weigh the client before and after procedure
. IV immunoglobulin (IVIG)
. Is as effective as Plasmapheresis
. Infuse slowly observing for any side and adverse effects
Nursing Care
. Frequent monitoring of the respiratory and cardiovascular system
. Inability to maintain airway--potentially fatal with ascending paralysis
. Aspiration precautions
. Suction equipment at the bedside
. HOB elevated 45 degrees
. Change position every 2 hours
. Breathing exercises, cough and deep breathing
. Incentive spirometer
. Oxygen
. Report change in HR and BP to primary healthcare provider
. Interdisciplinary – Respiratory therapy
. Chest physiotherapy
. Managing airway if compromise occurs
. Oxygen
. During the recovering period involve other disciplines
. PT/OT
. Speech therapy
. Nutritionist
. Myasthenia Gravis
Myasthenia Gravis is a progressive-acquired autoimmune disease. It is a breakdown in
the relaying of signals from the nerves to the muscles. This breakdown in
communication at the synapses causes muscle weakness. The typical area where
symptoms are first noticed is visual disturbances. Other symptoms can include drooping
of the eyelids and difficulty swallowing. Death can result from a rapid development of
2
Module 03 Overview and Activities
Readings
Activity Time : 1 hour, 30 minutes
. Medical-Surgical Nursing: Patient-Centered Collaborative Care, Chapter 44
.
Module 03 The Peripheral Nervous System
The Peripheral Nervous System
The Peripheral Nervous System is composed of the spinal nerves and cranial nerves. Take a
moment to review the anatomy and function of the peripheral nervous system.
Module 03 Diseases of the Peripheral Nervous System
. Diseases of the Peripheral Nervous System
Guillain-Barre Syndrome
Gullain-Barre Syndrome (GBS) is a result of overactive immunity. It is rare and affects
men more than women. The myelin sheath is attacked by circulating antibodies resulting
from an immune response. There are various triggers from bacterial to viral. The most
common presentation is a viral-like illness one to three weeks prior to GBS symptoms.
The result of the overactive immunity results in destruction of the myelin sheath which
slows the transmission of impulse from node-to-node. The slowing of impulses produces
the symptoms of GBS. The hallmark of the disease is ascending weakness.
Stages of GBS
. Acute Stage – Onset of symptoms
. Plateau – Symptoms remain for a few days to a few weeks
Recovery
. May take up to 2 years
Diagnostics
. Lumbar puncture to evaluate cerebral spinal fluid (CSF) for increase in protein--
results are non-conclusive
. Electrophysiologic studies (EPSs)--demonstrates demyelinating neuropathy
. Treatment Options
1
, NUR2755 Section BTP3 Multidimensional Care IV
. Plasmapheresis – Remove circulating antibodies
. Start within several days of onset of illness
. 3 to 4 treatments – 1-to-2 days apart
. Weigh the client before and after procedure
. IV immunoglobulin (IVIG)
. Is as effective as Plasmapheresis
. Infuse slowly observing for any side and adverse effects
Nursing Care
. Frequent monitoring of the respiratory and cardiovascular system
. Inability to maintain airway--potentially fatal with ascending paralysis
. Aspiration precautions
. Suction equipment at the bedside
. HOB elevated 45 degrees
. Change position every 2 hours
. Breathing exercises, cough and deep breathing
. Incentive spirometer
. Oxygen
. Report change in HR and BP to primary healthcare provider
. Interdisciplinary – Respiratory therapy
. Chest physiotherapy
. Managing airway if compromise occurs
. Oxygen
. During the recovering period involve other disciplines
. PT/OT
. Speech therapy
. Nutritionist
. Myasthenia Gravis
Myasthenia Gravis is a progressive-acquired autoimmune disease. It is a breakdown in
the relaying of signals from the nerves to the muscles. This breakdown in
communication at the synapses causes muscle weakness. The typical area where
symptoms are first noticed is visual disturbances. Other symptoms can include drooping
of the eyelids and difficulty swallowing. Death can result from a rapid development of
2
