PMH
*
*
Stomach flu 2 weeks ago

*
*
Appendicitis 3 years ago, appendix was removed.


VOCAB/ACRONYMS
*
*
A & O x 3- alert and oriented times 3

*
*
Tachypneic- rapid breathing


OBSERVATIONS

· Vision and hearing is normal.
· Temperature 98.7
· BP 123/74
· HR 77
· RR 11
· Light touch sensation in his arms c5, c6, c7 dermatomes
· Legs L3, L4, L5 dermatomes
· Cranial nerve reflexes are normal.
· Weakness in biceps, triceps, and deltoids (1/5) decrease. (3/5 for muscles)
· Weakness in both ankles DF (3/5)
· knee extension (3+/5)
· Patellar/ Achilles tendon reflexes decreased (1/5)
· Babinski test is negative
3 days later
· Temperature 98.6, BP 152/90, HR 96, and RR 22.


TESTS ORDERED AND RESULTS




Nerve conduction test- shows sensory and motor peripheral neuropathy, PNS problem.
Spinal Tap- shows elevated proteins consistent with GBS





SYMPTOMS/COMPLAINTS
· Weakness in biceps, triceps, and deltoids (1/5) decrease. (3/5 for muscles)
· Weakness in both ankles DF (3/5)
· Light touch sensation in his arms c5, c6, c7 dermatomes
· Legs L3, L4, L5 dermatomes
· Weakness in both arms/hands.






















DIAGNOSIS

Guillain-Barre Syndrome

RATIONALE FOR DIAGNOSIS
- Usually caused by infections
-He had stomach flu two weeks ago.
-Weakness in both hands and arms
-Also in biceps, triceps, and deltoids
-Bicep reflex decreased
-Weakness in both ankles and knee extensions
-Patellar/Achilles tendon reflexes decreased
-Babinski test is negative.

Complete the following for the disease you diagnosed

NAME OF DISEASE
Guillain-Barre Syndrome

WHAT IT DOES
Guillain-Barre Syndrome is an autoimmune disease usually caused by an infection. The immune system attacks peripheral nerves and damages the myelin sheath covering the nerves, causing nerves to misfire. This causes the loss sensation and paralysis.

SIGNS AND SYMPTOMS OF DISEASE
  • Numbness or tingling in hands and feet and sometimes around the mouth and lips
  • Muscle weakness in your legs and arms and the sides of your face
  • Trouble speaking, chewing, and swallowing
  • Not being able to move your eyes
  • Back or neck pain
  • Unsteady walking or inability to walk
Symptoms usually start with numbness or tingling in the fingers and toes. Over days to weeks, muscle weakness in the legs and arms develops. Muscle weakness is usually described as ascending, starting in the legs and spreading to the arms, but cases vary and can spread from the arms to the legs, as in Neil’s case.

HOW DISEASE IS DIAGNOSED (WHAT DIAGNOSTIC TESTS AND WHAT THEY WOULD SHOW)

· Nerve conduction velocity test
· Spinal Tap shows elevated proteins consistent with GBS

TREATMENT

GBS usually is treated in the hospital. The hospital staff will watch carefully to make sure it doesn’t get worse and makes sure the patient doesn’t get an infection. Infections can retrigger the autoimmune response and cause GBS to progress and get worse. Breathing, heart rate, and blood pressure are carefully tracked. Some people need a ventilator to help them breathe.
In the hospital, you may get a plasma exchange or intravenous immune globulin (IVIG).
  • In a plasma exchange, blood is taken out of your body. The harmful antibodies are removed from the blood, and then the blood is returned to your body.
  • In IVIG, helpful antibodies are added to your blood.
These treatments may help your body fight the disease and may speed recovery.
You may need 3 to 6 months or longer to recover from GBS. Sometimes GBS can come back.
If you had severe muscle weakness, you may need physical or occupational therapy. You will also need exercise to help you regain muscle strength and movement. Patients can go to therapy for months or years before they regain normal muscle functions.
PROGNOSIS AND COURSE OF DISEASE

Recovery can take weeks or years. Most people survive and recover completely. Some patients still have weaknesses after 3 years. A patient's outcome is most likely to be very good when the symptoms go away within 3 weeks after they first started. People may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack. Most patients, however, recover from even the most severe cases of Guillain-Barre syndrome, although some continue to have minor problems. Deaths due to GBS are usually caused by fluctuations in heart rate and blood pressure as well as breathing issues.

WHAT IT’S LIKE TO LIVE WITH IT (FIND PICTURES AND VIDEOS FOR YOUR WIKI PAGE)

http://www.youtube.com/watch?v=SZz4DfOS5bM&feature=related

http://www.youtube.com/watch?v=kDspLPFhkS4&feature=related



Patients usually reach the point of greatest weakness or paralysis days or weeks after the first symptoms occur. The recovery period can be as short as a few weeks, or as long as a few years. About 30 percent of those with Guillain-Barré still have remaining weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations years after their original treatment for Guillain-Barre Syndrome.