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Guillain-Barré syndrome

Guillain-Barré syndrome (GBS), is an acquired immune-mediated inflammatory disorder of the peripheral nervous system (i.e. not the brain or spinal cord). It is also called acute inflammatory demyelinating polyneuropathy, acute idiopathic polyradiculoneuritis, acute idiopathic polyneuritis, French Polio and Landry's ascending paralysis. more...

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Guillain-Barré syndrome


The pathologic hallmark of the disease is loss of myelin in peripheral nerves due to an acute and progressive inflammation of unknown cause. It is suggested that it is an autoimmune disease, in which the sufferer's immune system is triggered into damaging the nerve covering. There is some support for this in that half of all cases occur soon after a microbial infection or respiratory or gastrointestinal viral infection. Many cases developed in people who received the 1976 swine flu vaccine.

Peripheral nerves originate in the spinal cord and proceed to their target tissues (mainly muscle, skin and all internal organs). Their most proximal parts emerging from the spinal cord are called nerve roots and the inflammation in most (but not all) typical Guillain-Barré syndrome cases starts in these roots. Therefore, this condition is also referred to as acute polyradiculoneuritis.

Recent studies on the disease have demonstrated that approximately 80% of the patients have myelin loss, whereas, in the remaining 20%, the pathologic hallmark of the disease is indeed axon loss. The cases indicating the demyelinating form (AIDP) are called "acute motor and sensory axonal neuropathy" (AMSAN); the cases showing only motor symptoms (diffuse weakness) are called "acute motor axonal neuropathy" (AMAN). In a different and infrequent variant called Miller Fisher syndrome, patients develop ataxia, loss of tendon reflexes, and difficulty moving eye muscles but not weakness or sensory loss. All variants of Guillain-Barré syndrome are now supposed to be an autoimmune disease caused by antibodies against a variety of gangliosides found in abundant amounts in the peripheral nerve tissue.


GBS is a rare disease affecting about 1 to 2 people in every 100,000 annually. It does not discriminate with regard to the age or sex of sufferers. When diagnosed in young teenagers, it generally does not recur for many years, although when it does, it often does so in the fourth or fifth decade of life, long after the patients may have forgotten the details of the original episode.


About one half of patients have a history of preceding viral infection within two to four weeks prior to exhibiting the onset of Guillain-Barré syndrome. Guillain-Barré syndrome may also be associated with immunizations, recent surgery or trauma, pregnancy, Hodgkin's disease, chemo-therapy, and connective tissue diseases. The most frequently associated viral agents are cytomegalovirus (CMV), HIV, measles and herpes simplex virus. A bacterium called Campylobacter jejuni has recently been shown to be closely related with certain subtypes of the disease.


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Preventing heel pressure ulcers
From Nursing, 11/1/04 by Black, Joyce

BECAUSE OF ITS THIN LAYER of subcutaneous tissue between the skin and bone, the heel is the second most common site for pressure ulcer development (after the sacrum). Heel ulcers are costly and, if not treated promptly and properly, may lead to osteomyelitis and even limb amputation. In this article, I'll describe how to assess patients for risk and take preventive measures. In a future article, I'll describe how to manage ulcers if they develop.

Who's at risk?

Focus your preventive interventions on the Braden scale categories in which the patient has a low score (the lower the score, the higher the risk). Keep in mind, however, that even patients whose total score indicates low risk of pressure ulcer development can develop heel pressure ulcers.

Three groups of patients are at greatest risk for heel pressure ulcers:

* Patients with immobile legs due to health care problems such as fractured hips, joint replacement surgery, spinal cord injury, Guillain-Barré syndrome, or stroke don't move their legs because of paralysis, weakness, or pain. If the foot of the bed is elevated to reduce edema, remember to elevate the patient's knee too, or his leg will be suspended by the heel. Bending the knee provides a level plane of leg elevation, prevents hyperextension of the knee, and relieves pressure on the heels.

* Patients with diabetes may have peripheral neuropathy, which prevents them from feeling pressure or injuries to the feet. Immobile patients with diabetes also may have trouble moving their legs. Carefully monitor these patients and assess their heels twice daily.

* Patients with leg spasms, those in pain, and those who are confused may rub their heels on the bed and abrade the heel. Patients may also dig their heels into the mattress to keep from sliding down in bed, causing further pressure injury.

Heels are difficult to see in supine or chair-bound patients, but inspect them every shift anyway; don't rely on the patient to report heel pain. Lift the leg or use a mirror to see the heels. Teach nursing assistants to inspect heels when dressing or bathing a patient and tell them to report redness, blisters, or bruises. If your patient is wearing compression stockings, remove them at least once a day so you can assess his heels.

Preventive strategies

The best way to treat heel ulcers is to prevent them. Elevate the patient's calf on a pillow, small towel, or folded bath blanket to suspend the heel off the bed. Make sure you place it under the calf and not under the Achilles tendon. You should be able to place your open hand on the bed under the patient's heel and not feel the skin. Avoid hyperextending the knee and don't use a rolled towel under the Achilles tendon to lift the leg for more than a day or two; you may injure the Achilles tendon.

Devices that elevate the legs work best on patients with immobile legs, such as those recovering from hip and knee surgery or stroke. If your patient is at risk for moving his leg off the device, or if you need to elevate his leg longer than a few days, use a product that stays on the foot during movement.

The best heel pressurereducing products reduce pressure, friction, and shear; separate and protect the ankles; maintain heel suspension; and prevent footdrop. They should also be comfortable for the patient, easy for you to use, and permit repositioning without increasing pressure in other areas. Remove boots or braces every shift and inspect the patient's skin for redness from the device.

Prevent heel ulcers from abrasion with moisturizers, socks, dressings (such as films or hydrocolloids), or heel protectors. These nursing interventions reduce friction from shearing and rubbing.


Brenza, D., et al: "Sealing, Positioning, and Support Surfaces," in Wound Care Essentials: Practice Principles, S. Baranoski and E. Ayello, Springhouse, Pa., Lippincott Williams & Wilkins, 2004.

National Pressure Ulcer Advisory Panel: "Pressure Ulcers in America: Prevalence, Incidence, and Implications for the Future. An Executive Summary of the National Pressure Ulcer Advisory Panel Monograph," Advances in Skin & Wound Care. 14(4):208-215, July/August 2001.

Wound, Ostomy, and Continence Nurses Society: Guideline for Prevention and Management of Pressure Ulcers. Glenview, Ill., Wound, Ostomy, and Continence Nurses Society, 2003.


Joyce Black is an associate professor of nursing at the University of Nebraska Medical Center in Omaha. Wound and Skin Care is coordinated by Sharon Baranoski, RN, APN, CWOCN, MSN, FAAN, DAPWCA, administrative director of clinical programs and development and administrator of home health care at Silver Cross Hospital in Joliet, Ill., and Elizabeth A. Ayello, RN, APRN,BC, CWOCN, PhD, FAAN, FAPWCA, faculty member at Excelsior College School of Nursing in Albany, N.Y., and senior adviser for The John A. Hartford Institute for Geriatric Nursing in New York, N.Y.

Copyright Springhouse Corporation Nov 2004
Provided by ProQuest Information and Learning Company. All rights Reserved

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