A female client with Guillain-Barré syndrome has paralysis affecting the respiratory muscles and requires mechanical ventilation. When the client asks the nurse about the paralysis, how should the nurse respond?
A. “You may have difficulty believing this, but the paralysis caused by this disease is temporary.”
B. “You’ll have to accept the fact that you’re permanently paralyzed. However, you won’t have any sensory loss.”
C. “It must be hard to accept the permanency of your paralysis.”
D. “You’ll first regain use of your legs and then your arms.”
Correct Answer: A. “You may have difficulty believing this, but the paralysis caused by this disease is temporary.”
The nurse should inform the client that the paralysis that accompanies Guillain-Barré syndrome is only temporary. Return of motor function begins proximally and extends distally in the legs. Guillain-Barre syndrome (GBS) patients describe a fulminant course of symptoms that usually include ascending weakness and non-length dependent sensory symptoms. By definition, the nadir is usually reached within 4 weeks. Symmetric involvement is a key feature of GBS.
Option B: GBS is usually considered monophasic; therefore, a relapsing or remitting course at presentation would be considered atypical. Additionally, a prior GBS event (recurrent GBS) is also unusual, occurring in < 10% of all patients. If the patient reports progression beyond 8 weeks, other diagnoses should be considered.
Option C: After the acute phase of illness, Guillain-Barre syndrome (GBS) patients tend to do well. More than 80% achieve independent ambulation after 6 months. Mortality during the acute phase of the illness is less than 5%.
Option D: Classically, patients with GBS will have a pattern of proximal and distal weakness, which is flaccid and often profound if hospitalized. Significant neck flexion weakness may be present and can portend the need for intubation. Areflexia or hyporeflexia is usually present.
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