PATHOPHYSIOLOGY
Infectious organism
Epstein-Barr virus (EBV) Cytomegalovirus Campylobacter jejuni
Infectious organism contains amino acid that mimics the peripheral nerve myelin protein
Schwann cell deposit myelin around axons with interruption at intervals by the nodes of Ranvier
Clinical Manifestations
1. Initial Phase
Ascending weakness from the lower extremities and spreading to the upper trunk, upper extremities and face evolves over hours to days with maximal deficit by 4 weeks Deep tendon reflex are lost Paresthesias in the limbs
2. Plateau phase
Disease does not progress Deep, aching muscle in the shoulder and thigh Respiratory muscle weakness Autonomic neuropathy w/c involves sympathetic and parasympathetic systems
3. Recovery Phase
Improvement and recovery occur with remyelination Remyelination occurs in a descending pattern. The last function that was lost are the first to be regained Usually maximal at 6 mos. up to 2 years
The principle Ones neurons die, they don t regenerate is not applicable because the neurons here did not die. Only the myelin sheath is demyelinated. And so, once remyelination begins functions will be back.
Nursing Management
Ineffective breathing pattern related to neuromascular weakness or paralysis of the facial, throat and respiratory
Monitor patients ability to take fluids orally. Assess for cough reflex, gag reflex, and difficulty in swallowing Monitor RR, rhythm and depth Observe changes in mental status, LOC and orientation coughing and deep breathing