Case Study Guillain Barre Scenario C.B. is a single, self-em
Case Study Guillain Barre Scenario C.B. is a single, self-employed… Case Study Guillain Barre ScenarioC.B. is a single, self-employed 54-year-old man. Three weeks ago, he saw his primary care provider because of symptoms of fatigue, myalgia, fever, and chills, which were accompanied by a hacking cough. He was diagnosed with viral influenza. Today he has weakness, numbness, and tingling of both lower extremities, which is progressing into his upper body. His brother brought him to the emergency department after recognizing the seriousness of his illness. The attending physician immediately suspects Guillain-Barré syndrome (GBS).1. Describe the cause of GBS 2. What factors in C.B.’s history support a diagnosis of GBS? 3. Describe the clinical manifestations of GBS. 4. How is GBS diagnosed, and what tests would you expect to be performed? 5. What is your immediate concern for C.B. and why? 6. What assessment findings would tell you this is occurring? 7. Which set of arterial blood gases would be consistent with the presence of this complication? pH 7.50, Pco2 52 mm Hg pH 7.35, Pco2 40 mm Hg pH 7.25, Pco2 60 mm Hg pH 7.51, Pco2 31 mm Hg8. Which assessment finding, if present, would require your immediate intervention? Diaphoresis Slurred speech Facial flushing Urinary retentionCASE STUDY PROGRESSShortly after arrival, C.B. becomes completely paralyzed and requires endotracheal intubation and mechanical ventilation. He is transferred to the neurologic ICU for further support.9. What are the goals of medical management in GBS? 10. Describe the collaborative care patients generally receive in the ICU for GBS11. What are the overall goals of nursing care for C.B. at this time? 12. The attending physician states C.B. will begin either IV immune globulin or plasmapheresis. What is plasmapheresis? 13. You are concerned about the possibility of disuse syndrome related to C.B.’s paralysis. Describe an outcome of nursing care for C.B., and 4 independent nursing interventions you would implement to meet that outcome? 14. How would performing passive ROM exercises benefit C.B. from a cardiovascular perspective? ROM will help prevent C.B. from developing contractures. Keeping his muscles active will assist in maintaining muscle tone. ROM is an effective way to help prevent VTE. The stretching motion accompanying ROM will decrease C.B.’s pain.15. Name 5 interventions you would implement to meet the expected outcome of maintaining skin integrity. 16. What is foot drop? How can it be prevented? 17. How would C.B.’s nutritional needs be met (list 5). 18. What evaluative parameters would you use to determine whether C.B.’s nutritional needs were being met? 19. What interventions can you implement to help decrease C.B.’s fear and anxiety? Select all that apply. Speak calmly to him when providing care. Administer continuous intravenous sedation. Limit visitors only to immediate family members. Continually reassure him that his needs are being met. Use a communication system that allows C.B. to let his needs be known.20. C.B.’s brother asks how long C.B. will be paralyzed. How should you respond? CASE STUDY OUTCOMEAfter staying in the ICU for 8 days, C.B. is transferred to a special ventilator unit of an extended care facility because he shows no signs of improvement in respiratory muscle strength. After several weeks, he progressively regains neurologic function and is weaned from the ventilator. He is able to go home with his brother 5 months after the initial admission Health Science Science Nursing NURSING 121
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