Guillain-Barré Syndrome: Symptoms (Nursing)

00:01 Okay. So we know these symptoms. We've talked about them, kind of talked around them.

00:05 Let's get a little more specific. Now, I just said we're gonna get more specific.

00:09 And then I say, the first symptom is, unexplained sensations. These are what occur first.

00:15 So, there's a wide range in these too.

00:18 But it could be a tingling in the feet or the hands, maybe even pain.

00:23 Especially if a child develops GBS, they might have pain.

00:26 And it might often start in the legs or in the back.

00:30 Now children showing these symptoms, and they may show you just by -- they have a hard time walking or they must -- they may just refuse to walk.

00:38 They wanna be carried. They'll tell you, "Hold me. Hold me." They don't necessarily wanna walk because they can't communicate to you what's going on that they have this tingling or this weirdness or this pain, so they'll just refuse to start walking.

00:53 So these sensations tend to disappear before the major long-term symptoms appear.

01:00 That is what happened to my patient who was a lawyer.

01:04 She had that issue with just kind of her feet and with her hands and she just kind of brushed it off to stress or being overworked or really tired.

01:12 But weakness on both sides of the body is the major symptom that prompts most people to seek medical attention.

01:20 So, you know in a stroke, people usually just have one sided weakness or issues.

01:24 In Guillain-Barre, they have weakness on both sides of the body and that's usually when we first meet the patient.

01:31 That's what causes them to come in and seek medical attention.

01:34 Now we talked about the weakness may first appear as difficulty climbing stairs or with walking.

01:40 You like to think of the normal progression, Guillain-Barre is the letters G and B.

01:46 So I always try to remember this as ground to brain paralysis.

01:52 Because the typical course is it will start in the lower extremities near the ground and move upwards toward the brain.

02:00 So think of it as ground to brain paralysis.

02:05 Now initially it's just weakness and they might find themselves having a hard time with the motions to climb stairs or with walking.

02:12 That's exactly what my lawyer friend did.

02:15 And then as the syndrome progresses, the difficulty spreads upwards through the body; ground to brain; GBS.

02:26 Now sometimes the symptoms do start in the upper body and they can move down towards the leg and feet.

02:32 That's kind of an unusual course but it is possible.

02:36 So normally, its ground to brain but it could in some cases start upper body and move down to the feet.

02:43 Now here's some of the other craziness that happens with Guillain-Barre syndrome.

02:48 In addition to the muscle weakness, they might also have problems with their eye muscles and vision, might have a hard time swallowing, speaking or chewing.

02:58 Now they have this prickling or pins and needles sensation in their hands and feet.

03:03 They might have pain that could be severe and it sometimes gets worst at night.

03:08 They could have coordination problems and they're kind of unsteady that was my lawyer symptom.

03:14 Abnormal heart rate even or blood pressure.

03:18 Now, I have not experienced it in the patients I've dealt with, but it is a possibility with Guillain-Barre.

03:23 So, they might also -- lastly we're talking about digestion or bladder control.

03:29 Okay. This is a bizarre list, right? Sometimes, patients will kind of put the symptoms off because it just doesn't seem to make sense to them.

03:41 But I want you to take a minute and as we're going through this, just kinda look at these symptoms.

03:45 How would you chunk them together? What makes sense to you? Do you wanna put them in order from toe to brain? Do you wanna put them in order by system? Whatever makes sense to you to just kinda get a feel for? There's a wide variety in symptoms and these are some examples that we've had reported by patients who suffer from GBS.

04:06 Now, this can develop and they can increase in intensity over just a few hours, days or weeks.

04:14 I worked in the intensive care unit when I met this patient and so she had progressed.

04:19 It had been over a number of days but then it seemed to accelerate over a period of hours before we had to intubate her.

04:25 So, what happens is, they start of as mild, and then it gets to the point where certain muscles can't be used at all.

04:34 The worst-case scenario is when the diaphragm can't be used, it's paralyzed and they're gonna need respiratory support.

04:41 So the prognosis can be everything from minor, and they recover relatively quickly.

04:48 Or it can progress to life-threatening with respiratory involvement.

04:52 So when we're thinking about a GBS patient, I want you to think, "Wow, it just depends on how the symptoms go." They could be kind of vague symptoms but they're definitely abnormal, not with the patient we normally experience, and it may progress quickly or it may just kind of stall out.

05:10 This can happen over a period of hours to weeks, so that's another wide range when the patient will walk through that.

05:18 Okay. Now, at about two weeks, sometimes it's 2 to 3 weeks, patients have their greatest stage of weakness.

05:26 So this is a key factor.

05:28 We say about two weeks cuz -- and by three weeks, 90% of people have reached their highest level of weakness.

05:35 But it's about a 2 to 3 week range with the majority of them hitting that highest point of weakness at about two weeks.

05:43 So it develops over hours and weeks. Most people -- remember, this is a wide range, but most people at about two weeks have their greatest stage of weakness.

05:54 90% of patients will hit their greatest stage of weakness at three weeks after the onset of their initial symptoms.

06:03 So these are the things you wanna watch for.

06:06 These are things that as a nurse you could be aware of.

06:09 The patient tells you they have abnormal sensations, like pain, numbness, tingling that occur and they have them before the weakness will really kick in.

06:19 Here's the problem with that. Pain could be anything, as could the numbing and tingling in their feet.

06:27 So, we go through a lot of different differential diagnosis before you land on this one.

06:33 So always follow a way in your brain, "This is a possibility.

06:37 If a patient expresses these symptoms, not the most common one, but it is always a possibility." Now if you look at their deep tendon reflexes, if the limbs that they're saying feel weak, you check their reflexes, they won't be normal.

06:56 So that's another clue that you put together.

06:58 So just not one of these symptoms you can say, "Yup, that's Guillain-Barre." No, it takes a whole package of looking at this patient's whole story and their assessment data.

07:10 So, ask some if they've had a recent viral infection or maybe diarrhea which could be a sign of a viral infection.

07:16 These are some of the clues that we'll put together so when we meet with the healthcare team, we have a lot of key information to share with them.