Medical Surgical Guillain-Barre Syndrom GBS #1

Question

When the nurse enters the hospital room of a client diagnosed with Guillain-Barré Syndrome (GBS) the spouse asks, “Why is he drooling and having swallowing difficulty?” The best response by the nurse is to explain the cause as:

Answers

  1. “The blood is obstructed somewhere in the midbrain area.”
    • Rationale:

      This answer is not correct because decreased perfusion to the midbrain does not affect swallowing and gag reflex. The midbrain, or mesencephalon is responsible for motor control of the eyes and ears, autonomic functioning, sleep-wake cycles, and short-term memory.

  2. “There are certain B vitamin deficiencies that result and affect the nervous system.”
    • Rationale:

      This answer is not correct because although vitamin B deficiency affects the nervous system, it is usually found with Wernicke-Korsakoff or beriberi conditions, but not with Guillain-Barré. B vitamins play a key role in keeping the nervous system healthy; however, does not affect the glossopharyngeal or vagus nerve.

  3. “There is cranial nerve involvement that affects swallowing and the gag reflex.”
    • Rationale:

      This answer is correct because the two nerves affected by GBS are cranial nerve IX, or the glossopharyngeal nerve, and cranial nerve X, the vagus nerve. Cranial nerve IX controls motor and sensory functions of the tongue and pharynx. Cranial nerve X is responsible for motor functions of the larynx, pharynx, and esophagus. Demyelination of cranial nerves IX and X will affect swallowing and gag reflex. Priority should be placed on preventing aspiration, choking, and coughing during meals. Caregivers should be educated on assessing for aspiration, choking, and the use of suction. Advise family or caregivers to call 9-1-1 if a client has difficulty breathing and encourage caregivers to attend a CPR class. Unfortunately, GBS causes sudden respiratory muscle paralysis for many clients, which forces the need for hospitalization and ventilator support.

  4. “The drooling and swallowing is voluntary and if the client concentrates hard enough she will be able to control it.â€
    • Rationale:

      This answer is not correct because the gag reflex or pharyngeal reflex is involuntary. Also this answer is insensitive to the client’s condition.

Overview

Guillain-Barré Syndrome (GBS) is a neurological autoimmune disease which damages the peripheral nervous system causing muscle weakness and sometimes paralysis. This can cause drooling and swallowing difficulty.

Explanation

Learning Outcomes

Guillain-Barré Syndrome (GBS) is a neurological disease which damages the peripheral nervous system causing sudden muscle weakness and sometimes paralysis. The condition causes drooling and swallowing difficulty. Therapeutic interventions for impaired swallowing include having suction equipment at bedside, keeping clients in high Fowler’s position during mealtimes, providing rest periods before mealtime to prevent further fatigue, and providing oral care before and after feedings. It is important to consult speech pathology for further recommendations. Remember airway and breathing are priorities in clients with impaired swallowing. Unfortunately, the condition causes sudden respiratory muscle paralysis for many clients, which forces the need for ventilator support.

Test Taking Tip

The nurse is always an educator. Be sure to understand the disease process, clinical manifestations, and treatments so that clients and their family members can be educated. This is an emphasis of many nursing questions, so be ready to educate!

Video Rationale