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| Guillain-Barré syndrome (GBS) |
Guillain-Barré Syndrome (GBS), also known as Acute Inflammatory Demyelinating Polyneuropathy (AIDP), is a rare but serious autoimmune disorder in which the body’s immune system mistakenly attacks the peripheral nervous system. This condition leads to progressive muscle weakness, sensory disturbances, and in severe cases, life-threatening respiratory complications. GBS may also be referred to as acute idiopathic polyneuritis, acute polyradiculoneuritis, French Polio, or Landry ascending paralysis.
GBS is one of the most common causes of acute paralysis worldwide and is frequently seen in both developed and developing countries. Although it can occur at any age, it is more common in adults and has a higher incidence among males. Many patients report having a mild respiratory or gastrointestinal infection 2–3 weeks before the onset of symptoms, especially those caused by viruses or bacteria such as Campylobacter jejuni, cytomegalovirus, or influenza.
Understanding Guillain-Barré Syndrome (GBS)
The pathophysiology of Guillain-Barré Syndrome involves the immune system attacking the myelin sheath of peripheral and cranial nerves. This demyelination slows or blocks nerve conduction, resulting in muscle weakness, paresthesia, and reduced reflexes. In more severe cases, axonal degeneration may also occur.
Early symptoms often include tingling sensations (paresthesia), numbness, weakness in the legs that spreads upward (ascending paralysis), and difficulty walking. Some patients may experience facial weakness, difficulty swallowing, or visual disturbances. Because symptoms can progress rapidly, early recognition and treatment are critical.
Common Early Signs and Symptoms
- Pins-and-needles sensation in feet or hands
- Weakness that begins in the legs and ascends upward
- Difficulty gripping objects or performing fine motor tasks
- Trouble walking or climbing stairs
- Decreased or absent reflexes
- Breathing difficulty in severe cases
Diagnosis is usually confirmed through clinical assessment, nerve conduction studies, and cerebrospinal fluid (CSF) examination, which typically shows elevated protein levels with normal white blood cell counts (albuminocytologic dissociation).
Nursing Care Goals for Clients With GBS
The primary objectives of nursing management include:
- Maintaining adequate respiratory function
- Preventing complications related to immobility
- Monitoring cardiovascular status
- Ensuring adequate nutrition and hydration
- Supporting psychological well-being of patients and families
Because GBS can progress rapidly, continuous monitoring is crucial. Complications such as acute respiratory failure, autonomic dysfunction, deep vein thrombosis, and cardiac arrhythmias must be recognized early.
5 Guillain-Barré Syndrome (GBS) Nursing Diagnosis
Below are five major nursing diagnoses commonly identified in clients with Guillain-Barré Syndrome, along with explanations, possible related factors, expected outcomes, and key nursing interventions.
1. Ineffective Breathing Pattern
Related to:
- Rapidly progressive weakness of respiratory muscles
- Threat of respiratory failure
- Demyelination of nerves innervating respiratory muscles
Evidence:
- Shortness of breath
- Use of accessory muscles
- Decreased breath sounds
- Low oxygen saturation
Nursing Interventions:
- Assess respiratory rate, depth, and effort frequently.
- Monitor arterial blood gases (ABG) and oxygen saturation.
- Encourage deep breathing exercises if tolerated.
- Prepare for possible mechanical ventilation in cases of respiratory decline.
- Position the patient in semi-Fowler’s or high-Fowler’s to enhance lung expansion.
Expected Outcome:
The patient maintains adequate ventilation and oxygenation, demonstrates improved breath sounds, and remains free from respiratory failure.
2. Risk for Decreased Cardiac Output
Related to:
- Autonomic nervous system dysfunction
- Changes in heart rate, rhythm, and electrical conduction
Evidence:
- Hypotension or hypertension
- Tachycardia or bradycardia
- Arrhythmias detected on ECG
Nursing Interventions:
- Monitor blood pressure and heart rhythm continuously.
- Assess for signs of decreased cardiac output such as cool extremities or weak pulses.
- Administer cardiac medications as ordered.
- Provide a calm environment to reduce autonomic fluctuations.
Expected Outcome:
The patient maintains stable vital signs and demonstrates adequate cardiac output without arrhythmic episodes.
3. Imbalanced Nutrition: Less Than Body Requirements
Related to:
- Difficulty chewing and swallowing (dysphagia)
- Weakness of facial and bulbar muscles
- Increased metabolic demands from illness
Evidence:
- Weight loss
- Fatigue
- Inadequate oral intake
- Laboratory indicators of malnutrition
Nursing Interventions:
- Assess swallowing ability before each meal.
- Provide soft or pureed diets when needed.
- Collaborate with a dietitian to determine nutritional needs.
- Insert a nasogastric tube (NGT) or consider enteral feeding if oral intake is inadequate.
- Monitor calorie intake and patient weight.
Expected Outcome:
The patient meets daily nutritional requirements and maintains stable weight and hydration status.
4. Impaired Physical Mobility
Related to:
- Neuromuscular damage
- Decreased muscle strength
- Paralysis or weakness
Evidence:
- Inability to move independently
- Reduced muscle strength (0–3/5)
- Joint stiffness or muscle atrophy
Nursing Interventions:
- Encourage range-of-motion (ROM) exercises to prevent contractures.
- Use assistive devices such as splints or mobility aids.
- Reposition the patient frequently to prevent pressure injuries.
- Collaborate with physical and occupational therapists.
Expected Outcome:
The patient demonstrates improved mobility, maintains joint flexibility, and remains free from complications associated with immobility.
5. Anxiety
Related to:
- Uncertainty about prognosis
- Severe illness and sudden loss of mobility
- Fear of long-term disability
Evidence:
- Restlessness
- Crying or verbal expressions of fear
- Physiological signs such as increased heart rate
Nursing Interventions:
- Provide accurate and timely information about the condition.
- Encourage verbalization of fears and concerns.
- Involve family members in care and education.
- Use relaxation techniques such as deep breathing or guided imagery.
- Refer to psychological counseling if needed.
Expected Outcome:
The patient reports reduced anxiety, demonstrates coping strategies, and shows increased emotional stability.
Conclusion
Guillain-Barré Syndrome is a serious neurological condition that requires rapid assessment, intensive monitoring, and comprehensive nursing care. Understanding the common nursing diagnoses—such as ineffective breathing pattern, risk for decreased cardiac output, imbalanced nutrition, impaired mobility, and anxiety—allows nurses to prioritize interventions and support recovery. With timely medical treatment, supportive care, and rehabilitation, many patients experience significant improvement and regain functional independence.
Sources
- Price, Sylvia A., & Wilson, Lorraine M. (1995). Pathophysiology: Clinical Concepts of Disease Processes.
- Smeltzer, Suzanne C., & Bare, Brenda G. (2002). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing.
- World Health Organization (WHO). Guillain-Barré Syndrome Fact Sheet.
- Centers for Disease Control and Prevention (CDC). GBS Information for Clinicians.
