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Surigao Education Center

Km.2, Surigao City

Of

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PRESENTORS:

• ALBERCA, Michelle J.

• BAROTAC, Razil L.

• COMPRA, Anne rose J.

• EUSALA, Keene E.

• LIONG, Kris Madeline E.

• LLAMERA, Joackimm A.

• MINARDO, Sheny G.

• PACHANO. Ana Mae O.

• PAREDES, Riza Mae M.

• SINCO, Mark Kevin G.

Table of Contents

I. Dedication i
II. Acknowledgement ii

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III. Introduction 1
IV. Review of Related Literature 2
V. Anatomy and Physiology 13
VI. Patient’s Health History 24
A. Biographic Data 25
B. History of Present Illness 26
C. Past Health History 27
a. Childhood Illness 27
b. Immunization 27
c. History of Hospitalization 27
d. Surgical History 27
e. Accidents and Injuries 27
f. Allergic and Type of Reaction 27
g. Family Health History 27
h. Personal Health History 28
1. Lifestyle 28
1.1 Personal habits 28
1.2 Diet 28
1.3 Sleep and rest-pattern 29
1.4 Elimination Pattern 29
1.5 Activities of Daily Living (ADL) 29
1.6 Recreation and Hobbies 30

i. Social Data 30
1. Occupational Data 30
j. Environmental Data 30
k. Psychological Data 30
l. Patterns of Health Care 30

VII. Review of System 31


a. Integumentary System 31
b. Head, Eyes, Ears, Nose, Throat( HEENT) 31
c. Neck 31
d. Breast and Axillae 31
e. Thorax and Lungs 31
f. Cardiovascular System 31
g. Gastrointestinal System 31
h. Musculoskeletal System 31
i. Neurologic System 32
j. Urinary System 32
k. Reproductive System 32
l. Hematologic 32
m. Endocrine 32
n. Psychiatric 32

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VIII. Physical Assessments 33
a. General Survey 33
b. Vital signs 33
c. Integumentary System 33
d. Hair 33
e. Nails 33
f. Head 34
g. Eyes and vision 34
h. Ears and hearing 34
i. Nose and sinusitis 34
j. Oropharynx (mouth and throat) 34
k. Neck 35
l. Thorax and lungs 35
m. Breast and Axillae 35
n. Abdomen 35
o. Musculoskeletal system 35
p. Cardiovascular system 36
q. Urinary system 36
r. Gastrointestinal system 36
s. Neurologic system 36
a. Cranial nerves I- XII 37
b. Glass Coma Scale 39
c. Muscle Strength 41

IX. Doctor’s Order (detailed) 42


X. Laboratory Data 44
t. Urinalysis 44
u. Hematology 44
XI. Drug Study 45
XII. Pathology and Physiology of GBS 50
XIII. Nursing Care Plan (NCP) 52
XIV. Discharge Plan (detailed) 66
XV. Appendix 68
a. IV Record 68
b. Genogram 69
XVI. Definition of Terms 70
XVII. References 76

Introduction

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We have nerves that live outside the central nervous system (the brain and
spinal cord), and deal with our body's senses and movements. These are called our
peripheral nerves.

Guillain-Barre syndrome (also known as acute inflammatory or post-infective


polyradiculoneuropathy) is a rare but serious disease of the peripheral nervous system.
It makes the bodys own immune system attack the nerves, causing widespread
inflammation that leads to a tingly, numbing sensation in the arms and legs. This can
eventually result in a short-term loss of feeling and movement (temporary paralysis).It is
slightly more common in men than women, and can affect people of any age, even
children. What exactly causes the condition is unclear and there is no way to pinpoint
who may be most at risk. However, in most cases of Guillain-Barre syndrome the
person had a virus or bacterial infection in the last four weeks.

Most people will make a full recovery within a few weeks or months, with no
further trouble. Some cases take longer to recover from and there is a possibility of
permanent nerve damage.

Patient R is a 16 years old male, single who resides at Esperanza, Loreto,


Dinagat Island is an embodiment of rare people who have GBS. He was admitted at
Caraga Regional Hospital last September 25, 2009 with the chief complaint of sudden
onset of weakness of left lower extremities then after the right extremities for almost 3
weeks under the care of Dr. Asodisen.

We chose patient R’s case for our case study because we think it is interesting
though it’s rarely seen .It is a culprit condition that can cause temporary paralysis and
can affect our activities of daily living since in GBS we can feel weakness and
numbness in our body that’s why patient couldn’t walk and have limited range of motion.
It’s not so depressing though there is a glint hope with the proper medical attention, the
syndrome may be reversed. We are hoping that through this case study we can impart
knowledge and better understanding of GBS to the community for them to be aware of
the said syndrome.

Review of Related Literature

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What is Guillain Barre’ Syndrome?

Guillain-Barre syndrome is a serious disorder that occurs when the body's


defense (immune) system mistakenly attacks part of the nervous system. This leads to
nerve inflammation that causes muscle weakness.

Guillain-Barré syndrome is an acute, usually rapidly progressive inflammatory


polyneuropathy characterized by muscular weakness and mild distal sensory loss.
Cause is thought to be autoimmune.

Guillain-Barré syndrome is the most common acquired inflammatory neuropathy.


Although the cause is not fully understood, it is thought to be autoimmune. There are
several variants. In some, demyelination predominates; others affect the axon.

In about 2⁄3 of patients, the syndrome begins 5 days to 3 wk after a bacterial


infectious disorder, surgery, or vaccination. Infection is the trigger in > 50% of patients;
common pathogens include Campylobacter jejuni, enteric viruses, herpes viruses
(including cytomegalovirus and Epstein-Barr virus), and Mycoplasma sp. A cluster of
cases followed the swine flu vaccination program in 1975.

What are the causes?

Guillain-Barre syndrome is an autoimmune disorder (the body's immune system


attacks itself). Exactly what triggers Guillain-Barre syndrome is unknown. The syndrome
may occur at any age, but is most common in people of both sexes between ages 30
and 50.

It often follows a minor infection, usually a lung infection or gastrointestinal


infection. Usually, signs of the original infection have disappeared before the symptoms
of Guillain-Barre begin.

Guillain-Barre syndrome causes inflammation that damages parts of nerves. This


nerve damage causes tingling, muscle weakness, and paralysis. The inflammation
usually affects the nerve's covering (myelin sheath). Such damage is called
demyelination. Demyelination slows nerve signaling. Damage to other parts of the nerve
can cause the nerve to stop working.

Guillain-Barre syndrome may occur along with viral infections such as:

• AIDS

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• Herpes simplex
• Mononucleosis

It may also occur with other medical conditions such as systemic lupus
erythematosus or Hodgkin's disease.Some people may get Guillain-Barre syndrome
after a bacterial infection or certain vaccinations (such as rabies and swine flu). A
similar syndrome may occur after surgery, or when critically ill.

What are the risk factors?

Guillain-Barre syndrome can affect all age groups, but you're at greater risk if:

• You're a young adult


• You're an older adult

Guillain-Barre may be triggered by:

• Most commonly, infection with campylobacter, a type of bacteria often found in


undercooked food, especially poultry.
• Surgery
• Epstein-Barr virus
• Hodgkin's disease
• Mononucleosis
• HIV, the virus that causes AIDS
• Rarely, rabies or influenza immunizations

What are the symptoms?

Symptoms of Guillain-Barre can get worse very quickly. It may take only a few
hours to reach the most severe symptoms, but weakness increasing over several days
is also common.

Muscle weakness or the loss of muscle function (paralysis) affects both sides of
the body. In most cases, the muscle weakness starts in the legs and then spreads to
the arms. This is called ascending paralysis.

Patients may notice tingling, foot or hand pain, and clumsiness. If the
inflammation affects the nerves to the diaphragm, and there is weakness in those
muscles, the person may need breathing assistance.

Typical symptoms include:

• Loss of reflexes in the arms and legs

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• Muscle weakness or loss of muscle function (paralysis)
o In mild cases, there may be no weakness or paralysis
o May begin in the arms and legs at the same time
o May get worse over 24 to 72 hours
o May occur in the nerves of the head only
o May start in the arms and move downward
o May start in the feet and legs and move up to the arms and head
• Numbness, decreased sensation
• Sensation changes
• Tenderness or muscle pain (may be a cramp-like pain)
• Uncoordinated movement

Additional symptoms may include:

• Blurred vision
• Clumsiness and falling
• Difficulty moving face muscles
• Muscle contractions
• Palpitations (sensation of feeling heartbeat)

Emergency symptoms (seek immediate medical help):

• Breathing temporarily stops


• Can't take a deep breath
• Difficulty breathing
• Difficulty swallowing
• Drooling
• Fainting
• Feeling light-headed when standing

Flaccid weakness predominates in most patients; it is always more prominent than


sensory abnormalities and may be most prominent proximally. Relatively symmetric
weakness with paresthesias usually begins in the legs and progresses to the arms, but
it occasionally begins in the arms or head. In 90% of patients, weakness is maximal at 3
wk. Deep tendon reflexes are lost. Sphincters are usually spared. Facial and
oropharyngeal muscles are weak in > 50% of patients with severe disease. Dehydration
and undernutrition may result. Respiratory paralysis severe enough to require
endotracheal intubation and mechanical ventilation occurs in 5 to 10%.

A few patients (possibly with a variant form) have significant, life-threatening


autonomic dysfunction causing BP fluctuations, inappropriate ADH secretion, cardiac
arrhythmias, GI stasis, urinary retention, and pupillary changes. An unusual variant
(Fisher variant) may cause only ophthalmoparesis, ataxia, and areflexia.

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How to cope with Guillain Barre Syndrome?

The emotional impact of Guillain-Barre syndrome can be devastating. In severe


cases, Guillain-Barre syndrome can transform you from healthy and independent to
critically ill and physically helpless — suddenly, and without warning.

Although most people eventually recover fully, a diagnosis of Guillain-Barre


syndrome means confronting the possibility of long-term disability or paralysis. And
those who do develop these complications must adjust to lasting, limited mobility and a
dependence on others to help manage daily activities.

Talking with a mental health provider can play a critically important role in helping
you cope with the mental and emotional strain of this illness. In some cases, your
therapist may recommend family counseling to help you and your loved ones adjust to
the changes caused by Guillain-Barre syndrome.

You may also benefit from talking with others who have experienced this illness.
Ask your doctor or mental health provider to recommend a support group for people and
families coping with Guillain-Barre syndrome.

When to Contact a Medical Professional?

Seek immediate medical help if you have any of the following symptoms:

• Can't take a deep breath


• Decreased feeling (sensation)
o Difficulty breathing
o Difficulty swallowing
o Fainting
o Loss of movement

• Tingling that started in your feet or toes and is now ascending upward through
your body
• Tingling or weakness that's spreading rapidly
• Tingling that involves both your hands and feet
• Difficulty catching your breath
• Choking on saliva

Guillain-Barre syndrome is a serious disease that requires immediate hospitalization


because of the rapid rate at which it worsens. The sooner appropriate treatment is
started, the better the chance of a good outcome.

Alternative Names

Landry-Guillain-Barre syndrome; GBS; Acute idiopathic polyneuritis; Infectious


polyneuritis; Acute inflammatory polyneuropathy

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What is the prevention?

Because so little is known about what causes GBS to develop, there are no known
methods of prevention.

What is a 'syndrome'?
A syndrome is a medical condition, characterized by a collection of symptoms
(that the patient feels) and signs (that a doctor can observe or measure), rather than by
a specific organism that causes the disease.

No one knows what causes GBS. Symptoms and signs can vary a great deal in
GBS patients, sometimes making it difficult to diagnose, especially in the early stages.

Diagnosis

Guillain-Barre syndrome can be difficult to diagnose in its earliest stages. Its


signs and symptoms are similar to those of other neurological disorders and may vary
from person to person.

The first step in diagnosing Guillain-Barre syndrome is for your doctor to take a
careful medical history to fully understand the cluster of signs and symptoms you're
experiencing.

A spinal tap (lumbar puncture) and nerve function tests are commonly used to
help confirm a diagnosis of Guillain-Barre syndrome.

Spinal tap (lumbar puncture)


This procedure involves withdrawing a small amount of fluid from your spinal
canal at your low back (lumbar) level. This cerebrospinal fluid is then tested for a
specific type of change that commonly occurs in people who have Guillain-Barre
syndrome.

Nerve function tests


Your doctor may want information from two types of nerve function tests —
electromyography and nerve conduction velocity:

Electromyography reads electrical activity in your muscle to determine if your


weakness is caused by muscle damage or nerve damage.

• Nerve conduction studies assess how your nerves and muscles respond to
small electrical stimuli.

Diagnosis is primarily clinical. Similar acute weakness can result from


myasthenia gravis, botulism, poliomyelitis (mainly outside the US), tick paralysis, West

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Nile virus infection, and metabolic neuropathies, but these disorders can usually be
distinguished as follows:

• Myasthenia gravis is intermittent and worsened by exertion.


• Botulism may cause fixed dilated pupils (in 50%) and prominent cranial nerve
dysfunction with normal sensation.
• Poliomyelitis usually occurs in epidemics.
• Tick paralysis causes ascending paralysis but spares sensation.
• West Nile virus causes headache, fever, and asymmetric flaccid paralysis but
spares sensation.
• Metabolic neuropathies occur with a chronic metabolic disorder.
Tests for infectious disorders and immune dysfunction, including tests for hepatitis and
HIV and serum protein electrophoresis, are done.

If Guillain-Barré syndrome is suspected, patients should be admitted to a hospital


for electrodiagnostic testing, CSF analysis, and monitoring by measuring forced vital
capacity every 6 to 8 h. Initial electrodiagnostic testing detects slow nerve conduction
velocities and evidence of segmental demyelination in 2/3 of patients; however, normal
results do not exclude the diagnosis and should not delay treatment.

CSF analysis may detect albuminocytologic dissociation (increased protein but


normal WBC count), but it may not appear for up to 1 wk and does not develop in 10%
of patients.

Prognosis

Although some people can take months and even years to recover, most cases of
Guillain-Barre syndrome follow this general timeline:

• Following the first symptoms, the condition tends to progressively worsen for
about two weeks.
• Symptoms reach a plateau and remain steady for two to four weeks.
• Recovery begins, usually lasting six to 12 months.

This syndrome is fatal in < 2%. Most patients improve considerably over a period of
months, but about 30% of adults and even more children have some residual weakness
at 3 yr. Patients with residual defects may require retraining, orthopedic appliances, or
surgery.

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After initial improvement, 3 to 10% of patients develop chronic inflammatory
demyelinating polyneuropathy (CIDP—see below).

Recovery can take weeks or years. Most people survive and recover completely.
According to the National Institute of Neurological Disorders and Stroke, about 30% of
patients still have some weakness after 3 years. Mild weakness may persist for some
people.

A patient's outcome is most likely to be very good when the symptoms go away
within 3 weeks after they first started.

Complications of Guillan-Barre syndrome can include:

• Breathing difficulties. A potentially deadly complication of Guillain-Barre


syndrome is that the weakness or paralysis can spread to the muscles that
control your breathing. You may need temporary help from a machine to breathe
when you're hospitalized for treatment.
• Residual numbness or other sensations. Most people with Guillain-Barre
syndrome recover completely or have only minor, residual weakness or abnormal
sensations, such as numbness or tingling. However, full recovery may be slow,
often taking a year or longer.
• Breathing difficulty (respiratory failure)
• Contractures of joints or other deformity
• Deep vein thrombosis (blood clots that form when someone is inactive or
confined to bed)
• Increased risk of infections
• Low or unstable blood pressure
• Permanent loss of movement of an area
• Pneumonia
• Sucking food or fluids into the lungs (aspiration)

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Treatment

There's no cure for Guillain-Barre syndrome. But two types of treatments speed
recovery and reduce the severity of Guillain-Barre syndrome: When symptoms are
severe, the patient will need to go to the hospital for breathing help, treatment, and
physical therapy.

Plasmapheresis. A method called plasmapheresis is used to remove proteins,


called antibodies, from the blood. The process involves taking blood from the body,
usually from the arm, pumping it into a machine that removes the antibodies, then
sending it back into the body.

This treatment — also known as plasma exchange — is a type of "blood


cleansing" in which damaging antibodies are removed from your blood. Plasmapheresis
consists of removing the liquid portion of your blood (plasma) and separating it from the
actual blood cells. The blood cells are then put back into your body, which manufactures
more plasma to make up for what was removed. It's not clear why this treatment works,
but scientists believe that plasmapheresis rids plasma of certain antibodies that
contribute to the immune system attack on the peripheral nerves. Plasmapheresis (see
Transfusion Medicine: Plasmapheresis) helps when done early in the syndrome; it is
used if γ-globulin is ineffective. Plasmapheresis is relatively safe, shortens the disease
course and hospital stay, and reduces mortality risk and incidence of permanent
paralysis. Plasmapheresis removes any previously administered γ-globulin, negating its
benefits.

Intravenous immunoglobulin. Immunoglobulin contains healthy antibodies from


blood donors. High doses of immunoglobulin can block the damaging antibodies that
may contribute to Guillain-Barre syndrome.

High-dose immunoglobulin therapy (IVIg) is another treatment used to reduce the


severity and length of Guillain-Barre symptoms. In this case, the immunoglobulins are
added to the blood in large quantity, blocking the antibodies that cause inflammation.

Other treatments are directed at preventing complications.

• Blood thinners may be used to prevent blood clots.


• If the diaphragm is week, breathing support or even a breathing tube and
ventilator may be needed.
• Pain is treated aggressively with anti-inflammatory medicines and narcotics, if
needed.
• Proper body positioning or a feeding tube may be used to prevent choking during
feeding if the muscles for swallowing are weak.
• Intensive supportive care

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• Plasmapheresis or IV immune globulin
.

Each of these treatments is equally effective. Mixing the treatments or


administering one after the other is no more effective than using either method alone.

Often before recovery begins, caregivers may need to manually move your arms
and legs to help keep your muscles flexible and strong. After recovery has begun, you'll
likely need physical therapy to help regain strength and proper movement so that you'll
be able to function on your own. You may need training with adaptive devices, such as
a wheelchair or braces, to give you mobility and self-care skills.

Lifestyle Measures

How to Live with Guillain Barre Syndrome?

Instructions

Step 1

Find a good physical therapy program from which you can learn specific
isometric, isotonic and resistance exercises to rebuild weakened muscles. You
may do these exercises on an outpatient basis and continue them at home.
Remember to pace yourself and get adequate rest, as fatigue is to be expected
with Guillain-Barre Syndrome.

Step 2

Explore occupational therapy options. Changes in your home environment can


aid in your recovery by making it easier for you to bathe, dress and prepare
meals while your muscles return to normal levels of strength.

Step 3

Manage residual pain in the back, legs and feet with medication as needed.
Gabapentin and carbamazepine are often prescribed to relieve Guillain-Barre
Syndrome related pain. Both of these medications are anticonvulsants and may
cause fatigue and dizziness in some people.

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Step 4

Wear comfortable shoes and socks to help soothe pain and burning from
neuropathy in the feet. Inspect your feet often to be sure there are no cuts or
blisters that you may not have noticed.

Step 5

Follow a healthy eating plan with fresh, seasonal fruits and vegetables , lean
meat and fish, whole grains and plenty of colorful salads. Eating well may help
you to sustain your energy and can boost your mood.

Step 6

Seek emotional support to cope with feelings of depression and anxiety that are
part of living with Guillain-Barre Syndrome. Discuss antidepressant medication
with your doctor if you are having trouble with activities necessary for daily living.

Step 7

Connect with others who are learning to live with Guillain-Barre Syndrome in
forums online. See the Resources section below for links.

How to Recognize the Symptoms of Guillain-Barre Syndrome?

Instructions

Step 1

Watch for early symptoms like tingling or rubbery sensations in your feet and
legs. In many cases, Guillain-Barre Syndrome comes on rapidly, beginning in the
lower part of the body and climbing to the arms and upper torso within hours.
Tingling around the mouth is common as the symptoms ascend.

Step 2

Note any difficulty with facial muscles or movement, such as trouble moving your
eyes, slow speech and problems chewing or swallowing.

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Step 3

Assess both sides of your body. Guillain-Barre Syndrome affects both sides,
unlike a stroke. Strokes generally paralyze only one side.

Step 4

Test your reflexes. Guillain-Barre Syndrome diminishes the reflex response in the
legs first. Some people also lose feeling in their extremities.

Step 5

Check your heart rate and blood pressure . Both may drop with Guillain-Barre
Syndrome.

Step 6

Evaluate and report any changes in bladder or bowel function. Guillain-Barre


Syndrome impacts the muscles that control bladder and intestinal function.

Step 7

Monitor your breathing, and get help at once if breathing seems shallow. Guillain-
Barre Syndrome can worsen very rapidly and spread to the muscles that control
your breathing. Many people with the syndrome are temporarily placed on
ventilators in order to breathe.

Step 8

Review your recent medical history. Although scientists haven’t discovered a


single cause for Guillaine-Barre Syndrome, many cases are linked with recent
bacterial or viral infections , vaccinations or surgeries. Infection with
campylobacter, a bacteria found in undercooked food, especially poultry, may
trigger Guillaine-Barre Syndrome.

Step 9

Pay attention to unusual or severe lower back pain, which can signal Guillain-
Barre Syndrome.

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ANATOMY AND PHYSIOLOGY

THE NERVOUS SYSTEM


A nerve cell (neuron) consists of a large cell body
and nerve fibers—one elongated extension (axon)
Typical Structure of a for sending impulses and usually many branches
Nerve Cell (dendrites) for receiving impulses. Each large axon
is surrounded by oligodendrocytes in the brain and
spinal cord and by Schwann cells in the peripheral
nervous system. The membranes of these cells
consist of a fat (lipoprotein) called myelin. The
membranes are wrapped tightly around the axon,
forming a multilayered sheath. This myelin sheath
resembles insulation, such as that around an
electrical wire. Nerve impulses travel much faster in
nerves with a myelin sheath than in those without
one. If the myelin sheath of a nerve is damaged,
nerve transmission slows or stops

The nervous system is divided into the:

• peripheral nervous system (PNS)


• central nervous system (CNS)

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The PNS consists of

• sensory neurons running from stimulus receptors that inform the CNS of the
stimuli
• motor neurons running from the CNS to the muscles and glands - called
effectors - that take action.

The CNS consists of the

• spinal cord and the


• brain

THE PERIPHERAL NERVOUS SYSTEM IN FOCUS

In the peripheral nervous system, neurons can be functionally divided in three ways:

1. Sensory (afferent) - carry information INTO the central nervous system


from sense organs or motor (efferent) - carry information away from the
central nervous system (for muscle control).
2. Cranial - connects the brain with the periphery or spinal - connects the
spinal cord with the periphery.
3. Somatic - connects the skin or muscle with the central nervous system or
visceral - connects the internal organs with the central nervous system

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The peripheral nervous system is subdivided into the

• sensory-somatic nervous system and the


• autonomic nervous system

The Sensory-Somatic Nervous System

The sensory-somatic system consists of:

• 12 pairs of cranial nerves and


• 31 pairs of spinal nerves.

The Cranial Nerves


Nerves Type Function
I
sensory olfaction (smell)
Olfactory
II vision
sensory
Optic (Contain 38% of all the axons connecting to the brain.)
III
motor* eyelid and eyeball muscles
Oculomotor
IV eyeball muscles
motor*
Trochlear
V Sensory: facial and mouth sensation
mixed
Trigeminal Motor: chewing
VI
motor* eyeball movement
Abducens
Sensory: taste
VII
mixed Motor: facial muscles and
Facial
salivary glands
VIII
sensory hearing and balance
Auditory
IX Sensory: taste
mixed
Glossopharyngeal Motor: swallowing
X main nerve of the
mixed
Vagus parasympathetic nervous system (PNS)
XI
motor swallowing; moving head and shoulder
Accessory
XII
motor* tongue muscles
Hypoglossal

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*Note: These do contain a few sensory neurons that bring back signals from the muscle
spindles in the muscles they control.

The Spinal Nerves


All of the spinal nerves are "mixed"; that is, they contain both sensory and
motor neurons.

All our conscious awareness of the external environment and all our motor
activity to cope with it operate through the sensory-somatic division of the PNS.

The Autonomic Nervous System

The autonomic nervous system consists of sensory neurons and motor neurons that
run between the central nervous system (especially the hypothalamus and medulla
oblongata) and various internal organs such as the:

• heart
• lungs
• viscera
• glands (both exocrine and endocrine)

It is responsible for monitoring conditions in the internal environment and bringing


about appropriate changes in them. The contraction of both smooth muscle and cardiac
muscle is controlled by motor neurons of the autonomic system.

The actions of the autonomic nervous system are largely involuntary (in contrast to
those of the sensory-somatic system). It also differs from the sensory-somatic system is
using two groups of motor neurons to stimulate the effectors instead of one.

• The first, the preganglionic neurons, arise in the CNS and run to a ganglion in the
body. Here they synapse with
• postganglionic neurons, which run to the effector organ (cardiac muscle, smooth
muscle, or a gland).

The autonomic nervous system has two subdivisions, the

• sympathetic nervous system and the


• parasympathetic nervous system.

The Sympathetic Nervous System

The preganglionic motor neurons of the sympathetic system arise in the


spinal cord. They pass into sympathetic ganglia which are organized into two chains
that run parallel to and on either side of the spinal cord.

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The preganglionic neuron may do one of three things in the sympathetic
ganglion:

• synapse with postganglionic neurons which then reenter the spinal nerve
and ultimately pass out to the sweat glands and the walls of blood vessels
near the surface of the body.
• pass up or down the sympathetic chain and finally synapse with
postganglionic neurons in a higher or lower ganglion
• leave the ganglion by way of a cord leading to special ganglia (e.g. the solar
plexus) in the viscera. Here it may synapse with postganglionic sympathetic
neurons running to the smooth muscular walls of the viscera. However,
some of these preganglionic neurons pass right on through this second
ganglion and into the adrenal medulla. Here they synapse with the highly-
modified postganglionic cells that make up the secretory portion of the
adrenal medulla.

The neurotransmitter of the preganglionic sympathetic neurons is


acetylcholine (ACh). It stimulates action potentials in the postganglionic neurons.

The neurotransmitter released by the postganglionic neurons is


noradrenaline (also called norepinephrine).

The action of noradrenaline on a particular gland or muscle is excitatory is


some cases, inhibitory in others. (At excitatory terminals, ATP may be released
along with noradrenaline.)

The release of noradrenaline

• stimulates heartbeat
• raises blood pressure
• dilates the pupils
• dilates the trachea and bronchi
• stimulates the conversion of liver glycogen into glucose
• shunts blood away from the skin and viscera to the skeletal muscles,
brain, and heart
• inhibits peristalsis in the gastrointestinal (GI) tract
• inhibits contraction of the bladder and rectum
• and, at least in rats and mice, increases the number of AMPA
receptors in the hippocampus and thus increases long-term
potentiation (LTP).

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In short, stimulation of the sympathetic branch of the autonomic nervous
system prepares the body for emergencies: for "fight or flight" (and, perhaps,
enhances the memory of the event that triggered the response).

Activation of the sympathetic system is quite general because

• a single preganglionic neuron usually synapses with many


postganglionic neurons;
• The release of adrenaline from the adrenal medulla into the blood
ensures that all the cells of the body will be exposed to sympathetic
stimulation even if no postganglionic neurons reach them directly.

The Parasympathetic Nervous System

The main nerves of the parasympathetic system are the tenth cranial nerves, the
vagus nerves. They originate in the medulla oblongata. Other preganglionic
parasympathetic neurons also extend from the brain as well as from the lower tip of the
spinal cord.

Each preganglionic parasympathetic neuron synapses with just a few


postganglionic neurons, which are located near - or in - the effector organ, a muscle or
gland. Acetylcholine (ACh) is the neurotransmitter at all the pre- and many of the
postganglionic neurons of the parasympathetic system. However, some of the
postganglionic neurons release nitric oxide (NO) as their neurotransmitter.

Parasympathetic stimulation causes

• slowing down of the heartbeat


• lowering of blood pressure
• constriction of the pupils
• increased blood flow to the skin and viscera
• peristalsis of the GI tract

In short, the parasympathetic system returns the body functions to normal after
they have been altered by sympathetic stimulation. In times of danger, the sympathetic
system prepares the body for violent activity. The parasympathetic system reverses
these changes when the danger is over.

The vagus nerves also help keep inflammation under control. Inflammation
stimulates nearby sensory neurons of the vagus. When these nerve impulses reach the
medulla oblongata, they are relayed back along motor fibers to the inflamed area. The
acetylcholine from the motor neurons suppresses the release of inflammatory cytokines,
e.g., tumor necrosis factor (TNF), from macrophages in the inflamed tissue.

22
Although the autonomic nervous system is considered to be involuntary, this is
not entirely true. A certain amount of conscious control can be exerted over it as has
long been demonstrated by practitioners of Yoga and Zen Buddhism. During their
periods of meditation, these people are clearly able to alter a number of autonomic
functions including heart rate and the rate of oxygen consumption. These changes are
not simply a reflection of decreased physical activity because they exceed the amount
of change occurring during sleep or hypnosis.

IMMUNE SYSTEM

The immune system is composed of many interdependent cell types that


collectively protect the body from bacterial, parasitic, fungal, viral infections and from the
growth of tumor cells. Many of these cell types have specialized functions. The cells of
the immune system can engulf bacteria, kill parasites or tumor cells, or kill viral-infected
cells. Often, these cells depend on the T helper subset for activation signals in the form
of secretions formally known as cytokines, lymphokines, or more specifically
interleukins.

The Organs of the Immune System

Bone Marrow -- All the cells of the immune system are initially derived from the bone
marrow. They form through a process called hematopoiesis. During hematopoiesis,
bone marrow-derived stem cells differentiate into either mature cells of the immune
system or into precursors of cells that migrate out of the bone marrow to continue their
maturation elsewhere. The bone marrow produces B cells, natural killer cells,
granulocytes and immature thymocytes, in addition to red blood cells and platelets.

Thymus -- The function of the thymus is to produce mature T cells. Immature


thymocytes, also known as prothymocytes, leave the bone marrow and migrate into the
thymus. Through a remarkable maturation process sometimes referred to as thymic
education, T cells that are beneficial to the immune system are spared, while those T
cells that might evoke a detrimental autoimmune response are eliminated. The mature T
cells are then released into the bloodstream.

Spleen -- The spleen is an immunologic filter of the blood. It is made up of B cells, T


cells, macrophages, dendritic cells, natural killer cells and red blood cells. In addition to
capturing foreign materials (antigens) from the blood that passes through the spleen,
migratory macrophages and dendritic cells bring antigens to the spleen via the
bloodstream. An immune response is initiated when the macrophage or dendritic cells
present the antigen to the appropriate B or T cells. This organ can be thought of as an
immunological conference center. In the spleen, B cells become activated and produce
large amounts of antibody. Also, old red blood cells are destroyed in the spleen.

23
Lymph Nodes -- The lymph nodes function as an immunologic filter for the bodily fluid
known as lymph. Lymph nodes are found throughout the body. Composed mostly of T
cells, B cells, dendritic cells and macrophages, the nodes drain fluid from most of our
tissues. Antigens are filtered out of the lymph in the lymph node before returning the
lymph to the circulation. In a similar fashion as the spleen, the macrophages and
dendritic cells that capture antigens present these foreign materials to T and B cells,
consequently initiating an immune response.

The Cells of the Immune System

T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally
and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T
cell, is a pertinent coordinator of immune regulation. The main function of the T helper
cell is to augment or potentiate immune responses by the secretion of specialized
factors that activate other white blood cells to fight off infection.

Another important type of T cell is called the T killer/suppressor subset or CD8+ T cell.
These cells are important in directly killing certain tumor cells, viral-infected cells and
sometimes parasites. The CD8+ T cells are also important in down-regulation of
immune responses. Both types of T cells can be found throughout the body. They often
depend on the secondary lymphoid organs (the lymph nodes and spleen) as sites
where activation occurs, but they are also found in other tissues of the body, most
conspicuously the liver, lung, blood, and intestinal and reproductive tracts.

24
Natural Killer Cells -- Natural killer cells, often referred to as NK cells, are similar to the
killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain
tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes
and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their
targets without a prior "conference" in the lymphoid organs. However, NK cells that
have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected
targets more effectively.

B Cells -- The major function of B lymphocytes is the production of antibodies in


response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are
specialized proteins that specifically recognize and bind to one particular protein that
specifically recognize and bind to one particular protein. Antibody production and
binding to a foreign substance or antigen, often is critical as a means of signaling other
cells to engulf, kill or remove that substance from the body.

Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Another group of white


blood cells is collectively referred to as granulocytes or polymorphonuclear leukocytes
(PMNs). Granulocytes are composed of three cell types identified as neutrophils,
eosinophils and basophils, based on their staining characteristics with certain dyes.
These cells are predominantly important in the removal of bacteria and parasites from
the body. They engulf these foreign bodies and degrade them using their powerful
enzymes.

Macrophages -- Macrophages are important in the regulation of immune responses.


They are often referred to as scavengers or antigen-presenting cells (APC) because
they pick up and ingest foreign materials and present these antigens to other cells of the
immune system such as T cells and B cells. This is one of the important first steps in the
initiation of an immune response. Stimulated macrophages exhibit increased levels of
phagocytosis and are also secretory.

Dendritic Cells -- Another cell type, addressed only recently, is the dendritic cell.
Dendritic cells, which also originate in the bone marrow, function as antigen presenting
cells (APC). In fact, the dendritic cells are more efficient apcs than macrophages. These
cells are usually found in the structural compartment of the lymphoid organs such as the
thymus, lymph nodes and spleen. However, they are also found in the bloodstream and
other tissues of the body. It is believed that they capture antigen or bring it to the
lymphoid organs where an immune response is initiated. Unfortunately, one reason we
know so little about dendritic cells is that they are extremely hard to isolate, which is
often a prerequisite for the study of the functional qualities of specific cell types. Of
particular issue here is the recent finding that dendritic cells bind high amount of HIV,
and may be a reservoir of virus that is transmitted to CD4+ T cells during an activation
event.

25
An animal’s immune system protects its body from intruders: bacteria, viruses,
parasites, cancer cells, etc. An immune system is present in several animal groups,
especially within the vertebrates. Animals have both non-specific and specific defense
mechanisms to fight invaders. We will be focusing on the human immune system.

Non-specific defense mechanisms work against a wide variety of invaders.


These defense mechanisms include the barrier formed by our skin; chemicals in
perspiration, skin oil, saliva, tears, etc.; the hairs in our nostrils; the ciliary escalator
(the cilia and mucus that clean out dust and debris from our lungs and trachea) in our
respiratory tracts; the inflammatory response which is the dilation of blood vessels
and accumulation of WBCs at the site of an injury (the signs of which are that the area
is red, hot, and swollen); and fever, a raised body temperature to inhibit the growth of
pathogens. Note that a fever is caused by your body to inhibit the growth of bacteria,
etc., not by the “germs” themselves, per se.

Specific defense mechanisms are effective against specific pathogens. This


involves various WBCs called lymphocytes or leukocytes. There are several kinds of
WBCs involved in the immune system, all of which originate in the bone marrow.
Leukemia is a cancer of the bone marrow, thus it typically is treated by killing all of the
person’s bone marrow. Unfortunately, this leaves the person with no immune system,
so (s)he must be extremely careful during that time to avoid all possible pathogens.
There are two main types of specific defense mechanisms involved in the immune
system.

26
The cell-mediated immune system consists of T-cells which originate in the bone
marrow, but go to the Thymus to finish their development.
T-cells are highly-specialized cells in the blood and lymph to fight bacteria, viruses, fungi,
protozoans, cancer, etc. within host cells and react against foreign matter such as organ
transplants.
There are three kinds of T-cells. Cytotoxic T-cells directly kill invaders. Helper T-cells
aid B and other T-cells to do their jobs, and HIV lives in and kills them. Suppressor T-
cells suppress the activities of B- and other T-cells so they don’t overreact. Allergy
injections are supposed to increase the number of supressor T-cells to make the person
less sensitive to allergens.

Immunity is the ability to “remember” foreign substance previously encountered


and react again, promptly. There are two kinds of immunity: active immunity, when the
body is stimulated to produce its own antibodies, and passive immunity, where the
antibodies come from outside the person’s body. Active immunity is usually permanent,
and can be induced due to actual illness or vaccination. Passive immunity is not
permanent because the antibodies are introduced from outside the body, thus the B-
cells never “learn” how to make them. Some examples of passive immunity include
antibodies passed across the placenta and in milk from a mother to her baby, some
travelers’ shots, and the Rhogam shots we we discussed earlier this quarter. Because
antibodies are only protein, they don’t last very long and must be replaced if the
immunity is to continue.

27
Patient Health History

Hospital: Caraga Regional Hospital

Room Number: Pediatric Ward, Miscellaneous

Case number: 15-07-56

Name of the Patient: Patient R

Age: 16 years old

Date of Birth: October 21, 1993

Civil Status: Single

Religion: Iglesia Filipina Independiente

Highest Educational Attainment: High School level

Occupation: NONE

Home Address: Esperanza, Loreto, Dinagat Island, Surigao del Norte

Health Care Financing and Usual Source of medical Care: Family income

Mode of Admission: carried by his father

Date of Admission: September 25, 2009

Time of Admission: 10:25 am

Vital Signs upon Admission:


Temperature: 36.7'c
Pulse Rate: 86bpm
Respiratory Rate: 18cpm
Blood Pressure: 120/70 mmHg

Chief Complain: Present condition noted as sudden onset of weakness of left lower
extremities for almost 3 weeks, then after right lower extremities a week after

Admitting Diagnosis: Guillain Barre' Syndrome

Final Diagnosis: Guillain Barre' Syndrome

28
Attending Physician: Dr. Asodisen (from September 25-30)
Dr. Moleta ( from October 1-6)

Name of Informant: Patient's mother

Date of Discharge: October 6, 2009

Condition upon Discharge: Improved

Source of Stability of Data gathered: Primary source (patient),


Secondary Source (patient's SO and chart)

IBW = 118 118


-10 +10

129 - 128 lbs patient is only 103.61 lbs, therefore patient is underweight

BMI = weight (in kgs) / height (in m)2


= 47 kg / (1.585 m)2
= 47 / 2.51

= 18.72 patient’s BMI is normal

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A. History of Present Illness

On the 2nd week of August 2009, patient stated that he experienced abdominal
cramps and diarrhea with watery stool characterized with yellow-green in color which
lasted for 2 days after he had eaten kinilaw.

After two weeks, patient started to complain a tingling sensation or something


like an electric current on his feet and climbed up to the thighs and a little numb. Patient
suspected that the cause of this was the usual bathing of legs after having a walk for
approximately 4kms everyday going to school and back home.

On the 2nd week, patient experienced weakness, especially on his left leg that
made him not able to walked and had limited range of motion. On the following days, his
condition worsens. He felt weakness accompanied with tingling sensation which often
attack early in the morning and late afternoon and a couple of time during hour sleep as
claimed by the patient. The day after, numbness on lower extremities with uncontrolled
movements/tremors occurs which last about ten minutes. At that time, he couldn’t sit on
his own and when he did sit up with assistance as well as in his elimination purposes.
He felt like an egg as stated by the patient.

Patient’s family sought advice from the local “manghihilot” who massaged the
affected area with his own-made mixture of herbs. The latter believed that patient
condition is caused by “buyag sa engkanto”. They also asked help from a
“mantayhopay” who gave the same impression. His mother followed the instructions of
the said persons such as soaking his feet with “nilagang sambong” every morning and
at night before sleeping. Hospitalization was not possible during the said span of time
because of financial constraints.

One day prior to hospitalization, our patient was seen by his mother crying on the
floor of their sala. Patient stated that “ gusto na nako magpahospital, nahadlok na ako
basin dili na ako makalakaw pagbalik. That incident prompted his mother to bring him to
Loreto District Hospital that day but was referred directly to Caraga Regional Hospital
for further assessment and management.

Patient was admitted to Caraga Regional Hospital last September 25, 2009 at
exactly 10:25 am for chief complaints: noted as sudden onset of weakness of left lower
extremities for almost 3 weeks, then after right lower extremities a week after

Upon confinement, the doctor prescribed the following:


• IVF D5IMB100 @ 25 gtts/min
• Vitamin B complex 1 cap OD
• Hydrocortisone 100mg IVTT q80

Laboratory tests were also ordered by the attending physician such as:
• Hematology
• Electrolytes

30
• Urinalysis

B. Past Health History

Childhood Illness
Patient’s mother claimed that his son don't have any childhood illnesses
like mumps, chickenpox, rubella and pertussis, etc. He experienced diarrhea last
January 2009 which lasted for almost 2 and a half days characterized with watery stool
yellowish-green in color. After that incidence he suffered diarrhea again last May 2009
with the same duration and feature but he was not able to hospitalized. Patient
experienced 1 week fever accompanied with productive cough with thick yellow sputum
on the last week of July 2009.

Immunization
Patient's mother claimed that only BCG had been immunized to her son
since health center is far away from their house.

History of Hospitalization
Patient has no history of hospitalization; in fact this is his first time of
being admitted in the hospital.

Surgical History
Patient claimed that he did not undergo any surgical procedure.

Accidents and Injuries


A week before he confined at Caraga Regional Hospital, he stated that
when he was having an exercise early in the morning nearby shore approximately 7-10
meters away from their house suddenly he felt weakness on his legs and tingling
sensation accompanied by tremors that made him fall down to the ground. He was
trying to drag himself going to their house that causes abrasion and wounds on his legs,
left foot, right and left knees. Until now his wounds are in the healing process, his
mother used herbal plants like malungay to treat his wounds.

Allergic and Type of Reaction


Patient claimed that he don't have any food allergy or drug allergy.

Family Health History


Patient was the eldest of five. His mother is 43 years old and in good
condition. His father is 56 years old currently suffering from cough for almost two weeks
and has arthritis. The usual sickness of his siblings experienced, were colds and cough
which can be relieved by over the counter drugs such as biogesic, neozep,
carbocisteine and paracetamol. The grandmother/father in the mother side are alive
with no underlying illness. The grandfather/mother in the father side were already
deceased. His grandfather died last 1998 according to them it was just sudden onset of

31
swelling on his lower extremities and a week after the upper extremities and developed
into entire body. He was not hospitalized and was not diagnosed, in fact according to
their belief and rumors his grandfather was "na barang". After one month of suffering
from generalized swelling ha was died lying on the bed unnoticely. After 7 years, that is
2005 his grandmother died as claimed by the patient's mother, she died with the same
case to her husband because of generalized swelling but patient's mother claimed that
she can't recall if what happened to her mother-in-law since they were apart from here
when that time happened, all she knows is that after one month also of suffering from
swelling she died.

Personal Health History

Lifestyle

1. Personal Habit
Before Hospitalization
Patient is a non-smoker and non-drinker and don't even used harmful
drugs. Before he was confined at hospital, he already felt weakness on his legs that
made him just stay on their house. He just watched wowowee and listening music and
when he got bored he just sit nearby the window and just looked around to his friends
outside since he can't walk and join with them. He just study his lesson by himself since
he stop going to school for almost 3 weeks because of his condition.
During Hospitalization
Since patient was weak and can't moved his legs , he just lied on the
bed and sometimes sit but still his legs were in straight and flat position. Patient has
limited movement that made him uncomfortable. He just sleep and sometimes awake if
tingling sensation occur. He also used to have little conversation to his family. He just
keep on smiling whenever there were people looked at him.

2. Diet
Before Hospitalization
Patient typical food is fish since they lived nearby the sea and his father
occupation is fishing and also vegetables. Patient eats his meals 3x a day but
sometimes he doesn’t want to eat in the breakfast. Patient drinks 8-10 glasses of water
a day he don't have any special diet or any food restriction. Patient was fond of eating
“kinilaw” with vinegar than cooked. He eats 3 large meals a day and drinks 5-6 glasses
of water. Patient is fond of eating raw egg with salt. He eats junk foods as his snacks.
He drinks coffee and Milo sometimes if it is available on their kitchen.
During Hospitalization
Patient eat the food that is being serve in the hospital but sometimes his
mother buy food outside like tinolang baka and any food that has soup. He also eats
fruits like orange, banana and mango. And early in the morning his mother will make
milk/milo for him. Sometimes he refuses to eat because he felt fullness, he drink 3-4

32
glasses of water a day. He doesn’t have any order of food restriction or any special diet
from the dietician but the doctor ordered 1 banana last September 26, 2009.

3. Sleep and Rest Pattern


Before Hospitalization
Patient usually sleep at 8pm and wake up 6am, before the present
illness he had no difficulties in sleeping, but when he started to felt weakness and
tingling sensation he can't sleep appropriately cause he can't moved his legs side by
side.

During Hospitalization
Patient has difficulty of sleeping and wakes up a number of times during
hour sleep. He claimed that his not comfortable to sleep in the hospital as well as his
position in sleeping, he felt he's like a dead person lying in a straight and flat position.
And sometimes he's mother awaken him when uncontrolled movements of muscle
occur since patient couldn’t felt any sense.

4. Elimination Pattern
Before Hospitalization
Patient urinate 3x a day characterized by large amount with yellow in
color and defecate once a day characterized by scanty amount with yellowish/brownish
in color with no history of difficulty or pain in urinating and defecating. Patient did not
experience constipation. Before the present illness , he eliminate with himself but
because of his condition he really needs assistance for elimination purposes, usually his
father carried him in going to comfort room.
During Hospitalization
Patient urinate 4-5x a day, when he void he just sit on the bed and his
mother will offer plastic container of the IVF since he can't go by himself to the comfort
room. Sometimes it takes 3-4 days before he can defecate and his father carried him
going to the comfort room. His last void is scanty and yellow in color and his fecal is
hard stool, yellowish in color.

5. Activities of Daily Living


Before Hospitalization
Even though before hospitalization patient has difficulty on his activities
of daily living because of his condition he cant take a bath and dress alone, his mother
has been always there for him in doing his grooming and hygiene as well as in his
elimination and locomotion, he had limited movements. The only thing he can do for
himself is just that when he eat or holds any object. He couldn’t help in household
chores unlike before.
During Hospitalization
Patient doesn’t have any activities, he just lies on the bed. He claimed
that he was bored; he wants to have some exercise as what he usually did before his

33
condition. He just has some conversation with his mother and after that he fined himself
sleeping and awakens for a few hours.

6. Recreation and Hobbies


Before Hospitalization
Patient usual recreation and hobbies were watching television and listen
drama in the radio. He used to read pocketbooks when he got bored. Before his
condition he exercised everyday early in the morning and swimming in the sea.
During Hospitalization
Patient just lies in the bed. When the patient is in fine mood, he usually
chatty and lights up when he is talking to his visitors/parents. He always war beautiful
smiles on his face despite of his condition.

7. Social Data
The patient usually turns to his parents for support during time of stress
and school problem especially about what he felt on his first trimester of illness. He
reported to his parents for every detailed event that happened to his condition. Patient
does not believe in superstitious belief or quack doctors even though his parent do
so. Patient is currently studying first year high school but eventually stopped because of
his condition.

8. Occupational Activity
Not applicable. Patient is still studying.

9. Environmental Data
Patient lived at Esperanza, Loreto, Dinagat Island, SDN. Their house is
located nearby the sea approximately 10-12 meters away from their house. Their house
is made of wood and nipa hut. They have one sala, room, and kitchen and comfort
room. Their house is surrounded with plants and they have garden wherein they plant
vegetables for their food consumption. And also a little chicken poultry for their
consumption of eggs. They have a clean environment where in he can breathe fresh air
with no pollution.

10. Psychological Data


Patient major stressor in life was his condition now, he was worried
about his legs if it will be back in normal again but despite of his problem he was trying
to be strong and tend to be happy for he believed that he will be cured and nothing is
impossible with God.

11. Pattern of Health Care


Patient is a non-member of Phil Health, GSIS and SSS. Patient’s mother
used herbal plants and sought “quack doctors” and “manghihilot” whenever his son got
sick. They used their personal family fund to sustain his need for medical care.

34
REVIEW OF SYSTEM

Integumentary system
Patient has no any allergic reaction to certain foods or medication, he don’t have
any history of itchiness. He has lesions, abrasions and scars in his lower extremities. No
hair dyes, curling or strengthening preparation.

Head, Eyes, Ears, Nose, Throat


Patient doesn’t felt any dizziness, lightheadedness and headache. Sometimes
he experienced seizures especially when it is cold and tingling sensation attack. He
doesn’t use any eyeglasses. No hearing problem patient experienced nasal stuffiness
sometimes.

Neck
Patient claimed that he doesn’t have any neck lumps and was not diagnose
with any thyroid problem.

Breast and Axillae


Patient did not experience any pain on his breast and axillae.

Thorax and Lungs


Patient experienced productive cough with thick yellow sputum. No history and
dyspnea, asthma, pneumonia, and emphysema. He doesn’t felt any chest pain.

Cardiovascular System
Patient doesn’t have any history of cardiovascular disease.

Gastrointestinal System
Patient experienced abdominal cramps and hyperactive bowel movement with
watery stool characterized with yellow-green in color which lasted for two days. Patient
experienced abdominal pain in the lower portion of the abdominal cavity; it just lasted
for few minutes and diminished. He used to drink hot water to relieve the pain, he also
experienced flatulence for 5x a day, for that day only. He don’t any have difficulty in
swallowing.

Musculoskeletal System
Patient claimed that he experienced like an electric current sensation on his
both legs. It is gradual characterized first by the weakness of his legs followed by the
tingling sensation and numbness on his legs especially in the left leg. Because of this,
he had limited range of motion and he can’t move his both legs. Tingling sensation often
attack early in the morning and late afternoon and a couple of time during hour sleep as
claimed by the patient. He also had loss of function without pain in her legs.

35
Neurologic System
Patient experienced tingling sensation, numbness and uncontrolled
movements accompanied with tremors on his lower extremities. Patient can’t feel light
pressure only deep pressure and pain through pointing point object.

Urinary System
Patient urinates 2-3x a day, he have difficulty in urination because he need
assistance tot go to comfort room. But he doesn’t have any painful urination.

Hematologic
Patient claims that he doesn’t have any history of anemia.

Endocrine System
Patient verbalizes upon assessment that he cannot tolerate warm
environment since in their place they have fresh air. He doesn’t have any thyroid
problems.

Psychiatric
Patient can manage the stress that his having now. In fact, he is a happy
person. He has a good memory and but he also tend to get nervous easily when
strange people like us talk to him and he tend to perspire more.

36
PHYSICAL ASSESSMENT

Date of Assessment: September 28-29, 2009


Time of assessment: 05:45pm
Vital signs upon assessment:

September 28, 2009 September 29, 2009


T = 36.7°C T = 36.8°C
P = 88 bpm P = 90 bpm
R = 20 cpm R = 19 cpm
BP= 110/70 mmHg BP= 110/70 mmHg

General Survey:

Patient is awake appeared pale and his legs were numb and weak, patient lies
on bed in a supine position. He appeared untidy with oily face, hair which is not properly
combed and tangled. Patient is coherent and responsive during our interview; he keeps
in smiling and felt shy to answer our questions. Ongoing IVF solution of D5IMB with the
drop rate of 15gtts/min, patently hooked at the right dorsal metacarpal vein.

Integumentary System:

Skin:

• Patient has a fair skin


• Good skin turgor noted
• Lesion noted in the lower extremities
• Scar noted at the left knee and left foot
• Dry skin noted

Hair:

• Hair is short, thick and reddish/brownish in color, brittle hair


• Doesn’t use hair dyes
• No lice infestation noted
• Dandruff noted

Nails:

• Untrimmed, dirty nails on both fingers and toes


• Blanch capillary refill test <3 seconds
• Patients fingernails and toenails are thick
• Nails are convex with an angle at about 160 degrees

37
Head, Eyes, Ears, Nose, Throat (HEENT)

Skull and Face:

• Normocephalic and symmetrical with frontal, parietal, and occipital prominence


• Absence of nodules and masses upon palpation
• Can flex head without support
• Facial features and movements are symmetrical

Eyes and Vision:

• Eyebrows are thin, but symmetrically aligned


• Frequent eye blinking
• No discharges, no discoloration and no masses noted
• Sunken eyes and eye bags noted
• Pupil Equally Round Reacted to Light and Accommodation

Ears and Hearing

• Auricles same color as facial skin, symmetrical and are aligned with outer
canthus of eye
• Able to hear spoken words clearly
• Able to hear watch ticking in both ears
• Pinna is mobile, firm and not tender
• Pinna recoils after it is folded
• Presence of cerumen noted

Nose and Sinuses


• External nose has same color as facial skin except for same parts with small
pigments
• No discharges noted
• No tenderness and masses noted
• No sinusitis noted

Oropharynx (mouth and throat)

• Lips are pale and dry


• No swelling of the tongue noted
• No palpable nodules
• Bad breath noted
• No bleeding and swelling of gums noted

38
• Plaques on teeth noted
• No tonsillitis noted
• Gag Reflex noted

Neck:

• Thyroid gland is not visible


• Patient can turn head left and right, up and down without pain
• No palpable nodules

Thorax and Lungs

• No difficulty of breathing
• No abnormalities noted

Posterior Thorax

• Normal curvature
• No tenderness upon palpation
• Symmetric

Anterior Thorax

• Chest is symmetric
• Normal breath sounds noted
• No evidenced of any secretions

Breast and Axillae

• No discharges noted
• Skin uniform in color, areola darken in color
• No evidence of enlargement of liver and spleen
• Audible bowel sounds

Musculoskeletal System

• Limited movements in the lower extremities


• Weakness of his legs both right and left
• Tingling sensation, uncontrolled movements
• Numbness of the legs both right and left
• Patient didn’t response to light touch
• Patient response to deep pressure only

39
• limited ability to perform gross/fine motor skills,
• difficulty turning his body
• slowed movement and uncoordinated movement
• postural instability,
• inability to maintain activity.

Cardiovascular System

• No abnormalities noted
• Lub-dub sounds noted upon auscultation
• No edema

Urinary System

• Patient urinate 3x a day


• Patient’s urine is yellowish in color

Gastrointestinal System

• No vomiting
• No diarrhea
• No difficulty in swallowing
• Hard stool noted

Neurologic System

Mental Status:

Language

• Patient does not have any speech problems. He can understand and converse
well using Bisaya dialect. He used non-verbal communication such as eye
movements, gestures and interaction with the support person. He had a
congruence of non-verbal and verbal expression.

Orientation

• Patient is oriented to place, time and is able to answer our questions correctly
during interview.

Memory

• He has good memory and can recall what happened in the past.

40
Attention Span

• Patient is responsive and coherent.

CRANIAL NERVE ASSESSMENT

41
CRANIAL NERVE NAME RESULT
I Olfactory Patient is able to smell
and he can identify if
what he smells.
II Optic He was able to read our
nameplates about 14
inches. He has bright
eyes and can see clearly.
III Occulomotor Patient’s pupil reacted to
light. Pupils constrict
when looking at near
object and dilate when
looking far object. It also
converges when penlight
was moved towards his
nose.
IV Trochlear When penlight was
moved at six cardinal
fields of gaze using the
six ocular movements
namely: superior rectus,
lateral rectus, inferior
rectus, superior oblique,
medial rectus and inferior
oblique patients both
eyes were coordinated
and moved in unisonwith
parallel alignment.
V Trigeminal Positive blink reflex with5
blinks/minute and can
determine blunt and
sharp ends.
VI Abducens Using the six ocular
movements, he was able
to move eyeballs laterally
of both eyes with unison
and in parallel alignment.
VII Facial Patient flashed his smile
when asked of something
private and personal. And
close his together and
able to raise eyebrows.

VIII Acoustic/Auditory Patient can hear clearly


and only seldom
questions will be
repeated while we were
interviewing him.

IX Glossopharyngeal The patient will be able to


identify various taste
placed on tip and sides of
tongue. He was also able
to move tongue from side
to side and up and down 42
when asked to do.
Positive gag reflex.
43
Glasgow Coma Scale

Faculty Measured Response


Score

Eye Opening Spontaneous-open with blinking at baseline__________4pts ****


To verbal stimuli, command, speech________________3pts
To pain only(not applied to face)___________________2pts
No response___________________________________1pt

Verbal Response Oriented______________________________________5pts


Confused conversation, but able to answer question____4pts *****
Inappropriate words_____________________________3pts
Incomprehensible speech_________________________2ptS
No response___________________________________1pt

Motor Response Obeys command for movement____________________6pts


Purposeful movement to painful stimulus____________5pts ****
Withdraw in response to pain_____________________4pts
Flexion in response to pain(decorticate positioning)___3pts
Extension response to pain(deceberate positioning)___2ptS
No response__________________________________1pt

_________________________________________________________________________________________________

Total Score = 13/15

44
MUSCLE STRENGTH SCALE

0 No detection of muscular contraction


1 A barely detectable flicker on trace of
contraction with observation in
palpation.
2 Active movement of body part with
eliminate of gravity.
3 Active movement against gravity only
and not against resistance.
4 Active movement against gravity and
some resistance.
5 Active movement against full resistance
without evident fatigue (normal muscle
strength)

MUSCLE STRENGTH

Left Lower Extremities Right Lower Extremities

Plantar flexion 0 0

Dorsiflexion 0 0

Knee Flexors 0 0

Knee Extensors 0 0

Hip Flexors 0 0

Hip Extensors 0 0

Inversion and eversion 0 0

45
Reflex: The patient’s Biceps, Triceps, Brachioradialis, Patellar and Achilles have
the following grade of responses: +2, +2, +1, 0, 0, 0 respectively.

Scale of grading Reflex:

0-10 reflex response


+1= minimal activity (hypoactive)
+2= normal response
+3= more active than normal
+4= maximal activity (hyperactive)

“Patient R”

RIGHT LEFT
BRACHIORADIALIS BRACHIORADIALIS
+1 +1

BICEPS BICEPS

46
+2 +2
TRICEPS TRICEPS
+2 +2

KNEE REFLEX/ PATELLAR KNEE REFLEX/ PATELLAR


0 0

ANKLE REFLEX ANKLE REFLEX


0 0

47
DOCTOR’S ORDER

09/25/09
10:25 am
 Pls. admit pt. to pedia misc.
 TPR every 4 hour
 Labs: CBC, Na, Creatinine, u/a

Urinalysis
AFB AST
 Start D5IMB to few at 15
 Monitor v/s every 4 hours

Dr. Patiño

11:45 am
 refer result when in noted
 ascending paralysis

09/26/09
T= 37.2˚C
 Vit. B complex
 Eat 1 banana
 Follow up IVF

Dr. Patiño
10:50 pm
 Hydrocortisone 100mg IVTT every 8˚
09/27/09
T= 37.1˚C
 Continue medication
09/28/09
09:15am
 Continue medication
10:24 pm
 IVF to follow D5IMB 500ml

Dr. Mantilla

 warm compression BID


 Continue medication
 Follow up IVTT with 15 gtts/min.

Dr.Mantilla

48
09/30/09

 continue medication
 Bisacodyl pediatric rectal suppository
 Hydrocortisone 250mg every 8 hours

10/01/09

 afebrile
 continue medication
 follow IVF with D5LR IL 15gtts/min.
10/02/09

 continue medication
 Follow IVF with D5LR IL 15gtts/min.

10/03/09

 continue medication
 Follow IVF with D5LR IL 15gtts/min.
 Decrease Hydrocortisone to 250g and IVTT every 12 hours

10/05/09

 continue medication
 Follow IVF with D5LR IL 15gtts/min.
10/06/09
 May go home
 Home medication
 Follow up check up at OPD after 2 weeks

49
LABORATORY TESTS

ELECTROLYTE
September 26,2009

ELECTROLYTES RESULTS NORMAL VALUES SIGNIFICANCE


SODIUM 143mmol/L 135-145mmol/L NORMAL
POTASSIUM 5.4 mmol/L 3.5-5.5mmol/L NORMAL

HEMATOLOGY
September 26,2009

Criteria Result Normal Values Significance


Hematocrit 35% M:40-52% Reduced number
F:36-48% of RBC in the
blood (anemia)
Platelet ADEQUATE 150 – 400 Normal
WBC 8.4 x 10 9/L 4.0 – 11 Normal
Neutrophils 60 25-75% Normal
Lymphocytes 40 15-35% Lymphocytes
increased with
infectious
mononucleosis,
viral and some
bacterial infection

Urinalysis
October 03, 2009

Result Normal Result Significance


Color yellow Amber yellow Normal
Reaction 6.0 4.5-8ph Normal
Sugar negative negative Normal
Transparency clear clear Normal
Sp. gravity 1.030 1.015=1.035 Normal
Protein negative negative Normal

PONCIANO LIMCANGCO, MD, FPSP

50
Pathologist
Drug Study

Bisacodyl

Classifications: Gastrointestinal Agent; Stimulant Laxative

Action: Expands intestinal fluid volume by increasing epithelial permeability.


Relieves constipation. Stimulant laxative that increases peristalsis, probably by
direct effect on smooth muscle of the intestine, by irritating the muscle or
stimulating the colonic intramural plexus. Drug also promotes fluid accumulation
in colon and small intestine

Indication:
• temporary relief of acute constipation and
• for evacuation of colon before surgery, prostoscopic, sigmoidoscopic,
• radiologic examinations.
• Also used to cleanse colon before delivery and to relieve constipation in
patients with spinal cord damage.
• Chronic constipation; preparation for childbirth, surgery, or rectal or bowel
examination

Dosage, Route of administration: IVTT every 8 hours , rectal suppository

Contraindication:

Contraindicated in patients hypersensitive to drug or its


components and in those with rectal bleeding, gastroenteritis, intestinal
obstruction, abdominal pain, nausea, vomiting, or other symptoms of
appendicitis or acute surgical abdomen.

Adverse Reaction:

• Mild cramping
• nausea,
• diarrhea
• fluid and electrolytes disturbances (especially potassium and calcium).
GI: nausea, vomiting. Abdominal cramps, diarrhea, burning sensation in
rectum, protein-losing enteropathy, laxative dependence
Metabolic: alkalosis, hypokalemia
Musculoskeletal: muscle weakness, tetany

51
Nursing Implication:
• Add high-fiber foods slowly to regular diet to avoid gas and diarrhea.
Adequate fluid intake includes at least 6-8glasses/d.
• Do not breastfeed while taking this drug without consulting physician.
• Give drug at times that don’t interfere with scheduled activities or
sleep. Soft, formed stools are usually produced 15 to 60 minutes after
rectal use.
• Before giving for constipation, determine whether pt. has adequate
fluid intake, exercise, intake and diet.
• Tablets and suppositories are used together to clean the colon before
and after surgery and before and after surgery and before barium
enema.
• Insert suppositoryas high as possible into the rectum , and try to
position suppository against the rectal wall. Avoid embedding within
fecal material because doing so may delay onset of action.
Bisco-Lax may contain tartrazine

52
Generic name: Ascorbic Acid (Vitamin C)

Brand names: Apo-C, Ascorbicap, Cebid, cecon, cenolate, cemin, c-span,


cetane, cesvacin

Classification: Vitamin

Action:
Water-soluble vitamin essential for synthesis and maintenance of collagen and
intercellular ground substance of the body tissues cell, blood vessels, cartilages, bones,
teeth, skin, and tendons.
Indication:
Prophylaxis and treatment of scurvy and as a dietary supplement.
To prevent vit. C deficiency in pt. w/ poor nutritional habits or increased requirements.

• RDA
• Frank and subclinical scurvy
• Extensive burns, delayed fracture or wound healing, postoperative wound healing,
severe febrile or chronic dse. State.
Dosage, Route of administration: 1 tab OD, PO

Contraindication:
Use of sodium ascorbate in patients on sodium restriction; use in calcium
ascorbate in patients receiving digitalis.

Adverse Reaction:
Nausea, vomiting, heartburn, diarrhea, or abdominal cramps, acute hemolytic
anemia, sickle cell crisis, headache or insomnia, urethritis, dysuria, crystauria,
hyperlaxalunia, hyperuricemia, mildness soreness at injection site, dizziness, temporary
faintness with rapid IV administration

Nursing implication:
• High doses of vitamin C are not recommended during pregnancy.
• Take large doses of vitamin C in divided amounts because the body uses
only what is needed at a particular time and excretes the rest in urine.
• Megadoses can interfere with the absorption of vitamin B12.
• Note: vitamin C increases the absorption of iron when taken at the same
time as iron rich-foods.
• Do not breastfeed while taking this drug without consulting physician.
• Stress proper nutritional habits to prevent recurrence of deficiency.
• Advise smokers to increase intake of vitamin C.
• When giving for urine acidification, check urine pH to ensure efficacy.
• For pt. receiving vit. C I.M., explain that M.I, route may promote better
utilization.

53
Generic name: Hydrocortisone

Brand name: Cortef, cortenema, hydrocortone

Classification: Skin and Mucous Menbrane Agent; Anti-Inflammatory; synthetic


Hormone; adrenal corticosteroids; glucocorticoid; mineralocorticoid

Action: Short-acting synthetic steroid with both glucocorticoid and


mineralocorticoid properties that affect nearly all system of the body. Hydrocortisone
has anti-inflammatory, immunosuppressive, methabolic function in the body.

Indication: Replacement therapy in adrenocortical insufficiency; to reduce serum


calcium inhypercalcemia, to suppress undesirable inflammatory or immune responses,
to produce temporary remission in nonadrenal disease, and to block ACTH production
in diagnostic tests. Use as anti-inflammatory or immunosuppressive agent largely
replaced by synthetic glucocorticoids that have minimal mineralocortocoid activity.
Dosage, Route of administration:
100 grams IVTT every 8 hours
Contraindication: Hypersensitivity to glucocorticoids, idiopathic
thrombocytopenic purpra, psychoses, acute glomerulonephritis, viral or bacterial
diseases of skin.
Adverse Reaction: euphoria, insomnia, psychotic behavior, pseudotumor
cerebri, seizures, heart failure, hypertension, edema. Arrythmias, thromboembolism,
cataracts, glaucoma, peptic ulceration, gastrointestinal irritation, increase appetite,
pancreatitis, hypokalemia, hyperglycemia, carbohydrate intolerance, muscle weakness,
growth suppression in children, osteoporosis, hirsutism, delayed wound healing, acne,
various skin eruption, easy bruising.
Nursing Implication:
• Teach patient signs of early adrenal insufficiency
• Warn patient about easy bruising
• Advise him to consider exercise or physical therapy
• Warn patient receiving long-term therapy about cushingoid symptom
• Determine whether the pt is sensitive to other corticosteroid.
• Give oral dose with food when possible.pt. may need another drug to prevent GI
irritation.
• Most adverse reaction to corticosteroids are dose-duration-dependent.
• Monitor pt. weight BP, and electrolyte level
• Monitor pt. cushingoid effects including moon face, buffalo hump, central obesity,
thinning hair, hypertension and increased susceptibility to infection.

54
GENERIC NAME: VITAMIN B COMPLEX - ORAL

BRAND NAME(S): Surbex, Theravite, Vicon-C, Z-Bec

USES: Vitamins are the building blocks of the body. They are used to prevent or treat a
vitamin deficiency due to poor nutrition, certain illnesses or during pregnancy.

HOW TO USE: Take as directed. Food may affect the absorption of certain vitamin
products. Consult your pharmacist. Chewable tablets must be chewed thoroughly
before swallowing followed with a glass of water. Timed-release capsules or tablets
must be swallowed whole.

SIDE EFFECTS: This medication may cause mild nausea or unpleasant taste. Consult
your doctor if any of these effects persist or become severe. If you notice other effects
not listed above, contact your doctor or pharmacist.

PRECAUTIONS: Before using this medication, tell your doctor or pharmacist your
medical history, especially of: diabetes, blood disorders such as vitamin B12 deficiency
(pernicious anemia). Tell your doctor if you are pregnant before using this medication.
No problems have been reported in pregnant or nursing women when this medication
was used in normal doses.

DRUG INTERACTIONS: Tell your doctor if you take any other medication, including
nonprescription. This medication may affect certain urine lab tests, including some urine
glucose tests. Do not start or stop any medicine without doctor or pharmacist approval.

OVERDOSE: If overdose is suspected, contact your local poison control center or


emergency room immediately. US residents can call the US national poison hotline at 1-
800-222-1222. Canadian residents should call their local poison control center directly.
Symptoms of overdose may include diarrhea, loss of coordination; numbness of the
hands or feet; joint pain, or painful urination.

55
56
Predisposing factor: PATHOPHYSIOLOGY Precipitating factor:
(Diagram)

DIET: 1. eating uncooked food


Gender: Male
(esp. poultry products)
(Male to female ratio is 1:5:1)
2. “Kinilaw”
Age: 16 years old
3. Raw eggs
(Young adults age 15-35 y-o)
DIARRHEA
(Elderly age 50-75 y-o)

Infectious organism: invasion of Campylobacter jejuni via oral route

To cause gastrointestinal infection (diarrhea & abdominal cramping)

C. jejuni undergoes significant physiologic changes w/in the intracellular


environment to avoid mixture to lysosomal enzymes w/c could eat & kill
them

Immune system will response to


the intracellular invasion of
MOLECULAR MIMICRY microorganism

DUAL RECOGNITION

Cell-mediated Humoral
immunity immunity

57
Mistaken immune Activates specific T
lymphocytes or T-cells Secrete
attack may arise antibodies

Increased level of
Penetration of macrophage and antibodies into lymphocytes level Antibodies will
basement membrane around nerve fibers fight foreign
microorganisms
T-cells released
Inflammation of the nerve cells lymphokines

Inflamed cells secrete cytotoxic substances Lymphokines produced


that affect or damage the Schwann cells macrophages activation

Decreased myelin production

DEMYELINATION Ascending paralysis

Sensory
Tingling sensation Impaired Immobility of the
and
transmission of LE
motor
nerve conduction
loss
Numbness
Inability to
perform ADL
Weakness of the
LE
Constipation

GUILLAIN BARRE SYNDROME


58
NURSING CARE PLAN #1
September 28, 2009

Subjective cues:
“Pasmo ra man daw ni sa kusog kay manhimasa man ko human baktas” as
verbalized by the patient.

Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Apathy noted
• Misinterpretation of information

Diagnosis:

Knowledge deficit related to cognitive limitation

Planning:

After 4 hours of rendering nursing intervention patient will be able to verbalize


understanding of condition disease process and treatment

Intervention: Rationale
1. Determined information the To facilitate learning and determine the
client already knows and move client and SO’s cognitive limitation
to what the client does not know,
progressing from simple to
complex
2. Explained the cause of the
symptoms and disease To provide knowledge

3. Explained the goal of treatment To provide appropriate information

4. Provide an environment that is To facilitate learning


conducive to learning
5. Identify support persons or SO To let the SO aware of the condition of
requiring information the client

Evaluation:

Goal met. After 4 hours of rendering of nursing intervention the patient was able
to participate in learning process and was able to verbalize understanding of condition
of treatment.

59
NURSING CARE PLAN #2
September 28, 2009

Subjective Cue:
“Dili ko kalakaw ma’am kay wala gajud kusog ako tiil”. As verbalized by the patient

Objective cues:
Limited range of motion, limited ability to perform gross/fine motor skills, difficulty
turning, slowed movement uncoordinated movement, movement induced, postural
instability, inability to maintain activity.

V/S taken as follow:


Temp: 36.5 °C RR: 18 cpm PR: 86 bpm BP : 110/70 mmHg

Nursing Diagnosis:
Impaired physical mobility related to inability to maintain activity as evidenced by
limited range of motion.

Planning:
Within 8 hours of giving appropriate nursing intervention, patient will be able to
participate in Activities of Daily Living and desired activities.

Interventions:

1. Monitor vital signs


• Baseline data during medication of procedures.
2. Observe movement when client is unaware of observation.
• To note any incongruence with reports of abilities.
3. Note emotional/ behavioral responses to problems of immobility.
• Feelings of frustration/powerless may impulse attainment of goals.
4. Encourage participation in self care, diversional activities.
• Enhances self concept and sense of independence.
5. Identify energy- conserving techniques for ADL’s.
• Limits fatigue, maximizing participation.
6. Encourage adequate intake of fluids/ nutritious foods
• Promotes well being and maximizes energy production.
7. Encourage clients/SO’s involvement in decision making as much as possible.
• Promotes well being and maximizes energy production.

Evaluation:
Goal was not met. Patient was not able to participate in Activities of Daily livings
and desired activities.

51

60
NURSING CARE PLAN #3
September 28, 2009

Subjective cue:
“Waya pa ako kaligo pila na kaadlaw” as verbalized by the patient.

Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Dirty nails noted


• Bad body odor noted
• Dandruff noted
• Halitosis noted
• Patient is not properly groomed
• Dry skin noted

Diagnosis:
Self-care deficit related to impaired physical mobility

Planning:
After 2 hours of rendering nursing intervention patient will be able to perform self-
care activities within physical limitations.

Intervention: Rationale
1. Determined individual strengths To know the strengths and weaknesses
and skills /of the client of the client as basis in giving
appropriate interventions
2. Provide for communication To gain trust and cooperation from the
among those who are involved client and SO
in caring
3. Provide health teaching to To promote good hygiene to the patient
patient about the importance of
good hygiene
4. Develop plan of care appropriate To encourage performance of ADL
to individual situation, within physical limitation
scheduling activities to conform
to clients normal schedule
5. Plan time for listening to the To discover barriers to participation in
client and SO regimen
6. Demonstrated to the client and To provide awareness that self care
SO the basic ways in self care activities are still possible even with
such as hand washing, combing physical limitations
the hair, trimming nails, tooth
brushing and bathing

61
7. Encouraged patient and SO to To promote self care
use products to enhance self
image such as deodorant

Evaluation:
Goal met. After 4 hours of rendering nursing intervention patient was able to
perform self-care activities such as combing, tooth brushing and trimming of nails.

62
NURSING CARE PLAN #4
September 28, 2009
Subjective cues:
“ Nanhina man ako maam, murag nawal an ko ug kusog” , as verbalized by the
patient.
Objective Cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg
• Decreased physical strength
• Decreased mobility
• Weakness

Nursing Diagnosis:
Powerlessness related to decreased physical strength.

Planning:
After 8 hours of rendering nursing care the patient will be able to express sense
of control over the present situation and hopefulness about future outcomes.

Interventions:
1. Encourage client to be active in own health care management
and to take responsibility for choosing own actions and reactions.

• Can enhance feelings of power and sense of positive self –esteem.

2. Express hope for client and encourage review of past


experiences with successful strategies.
• Show concerns to client as a person.

3. Accept expressions of feelings, including anger and reluctance,


to try to work things out.
• Being able to express feelings freely enables client to sort out
what is happening and come to a positive conclusion.

4. Make time to listen to client’s perceptions of the situation.


• Shows concern for client as a person.

5. Listen to statements client makes which might indicate feelings of


powerlessness.
• Suggest concerns regarding on power/ ability to control
situation.
6. Monitor vital signs.
• To have baseline data.
Evaluation:
Goal met. Patient was able to express sense of control and hopefulness about
future outcomes.

63
NURSING CARE PLAN #5
September 28, 2009

Subjective cue:
“Nabiro ko nga di na ko makalakaw” as verbalized by the patient

Objective cue:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Poor eye contact


• Tearfulness during conversation
• Verbalization of concerns (refer to subjective cue)

Analysis:
Anxiety related to threat on role function secondary to physical illness
Planning:
After 8 hours of duty patient will be able to identify healthy ways to deal with and
relieve anxiety

Intervention Rationale

1. Provided opportunities for question Enhance sense of trust and nurse client
and answer session relationship

2. Compared verbal and non-verbal To note misperception of situations


responses

3. Encouraged verbalization of feelings To provide appropriate emotional


supportive care

4. Discussed the disease of Guillain- To provide information that could help


Barre Syndrome patient understand conditions

5. Enumerated ways the patient may To provide information and to boost


use to relieve anxiety such as accepting patient’s hope
the reality of his condition, optimistic
way of seeing things and having faith in
God’s love

Evaluation:
Goal partially met. After 8 hours of intervening, the patient was able to enumerate
ways to relieve anxiety but verbally said, “ Bisan nakasabot na ko..Dili gajud naku
malikayan na mag-isip ng ako kahimtang karon.”

64
NURSING CARE PLAN #6
September 28, 2009

Subjective cues:
‘ Mahadlok lage ako motindog kay basin matumba ako” as verbalized by the patient.
Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Diminished productivity
• Avoidance behavior
• Increased perspiration
• Pallor
Diagnosis:
Fear related to loss of physical support as evidenced by diminished productivity.

Planning:
After two days of rendering appropriate nursing care patient will display
appropriate range of feelings lessened fear.

Interventions:

1 .Compare verbal/ non-verbal responses.


• To note congruencies as of situation.
2. Stay with the client or make arrangements to have someone else be there.
• Sense of abandonment can exacerbate fear.
3. Provide information in verbal and written form. Speak in simple sentences and
concrete terms.
• Facilitate understanding and retention of information.
4. Provide opportunity for questions and answer honestly.
• Enhances sense of trust to nurse-client relationship
5.Present objectives information when available an d allow client to use it freely. Avoid
arguing about client perceptions of the situations.
• Limits conflicts when fear response may impair rational thinking.
6.Promote client control where possible and health client identify and accept those
things over which control is not possible.
• strengthen internal locus of control
7.Explain procedures within level of clients ability to understand and handle.
• To prevent confusion or overload
8.Encourage assist client to develop exercise program.
• Provides a healthy outlet for energy generated by fearful feelings and promotes
relaxation.
Evaluation:

65
Goal is met. After 2 days of rendering appropriate nursing care, patient is able to
display appropriate range of feelings and lessened fear.

NURSING CARE PLAN #7


September 29, 2009

Subjective cue:
“Ma’am dili naman ko kalibang tapos tag dugay” as verbalized by he patient.

Objective cue:
irritable, restlessness, weakness, unable to move, hard stool.
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

Nursing Diagnosis:
Altered Bowel Movement: Constipation related to Insufficient Physical Activity.

Planning:
After 8 hours of duty, patient will be able to verbalize understanding of the
importance of mobility and diet to normal bowel movement

Interventions:

INTERVENTIONS RATIONALE
Independent:
1. Advised patient to drink adequate -to promote moist and soft stool
fluid and include foods that are high in
fiber like papaya, oatmeal and
pineapple
2. Encouraged activity/exercises within -to stimulate abdominal muscle
personal limitation. contraction.
3.Provided with privacy and routinely -to promote defecation
scheduled time defecation
4.Educated patient about the -to provide information
importance of mobility and diet to
normal bowel movement
5.Note energy. Activity level and - sedimentary lifestyle may affect
exercise pattern. elimination patterns
6. Auscultate abdomen for the - reflecting bowel activity
characteristics of bowel sounds
Dependent:
1.Administered Bisacodyl (pedia) To increase peristalsis promoting easy
suppository as prescribed defecation

Evaluation:

66
Goal met. After 8 hours of duty, patient able to defecate and verbalized “
nakalibang na gajud ko maam,importante diay gajud ang exercise ug diet labaw na
adtong tambal na tagsuksuk sa ako lubot.”

NURSING CARE PLAN #8


September 29, 2009

Subjective:
“Dili ko karajaw makatulog” as verbalized by the patient.

Objectives:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Eyebags noted
• Frequent yawning noted
• Restlessness noted
• Sunken eyes noted
• Fatigue
• Anxiety
• Decreased ability to function

Nursing Diagnosis:
Sleep Pattern Disturbance related to environmental factors such as external
noise and lack of sleep privacy.

Planning:

After 8 hours of duty, patient will be able to report improvement in sleep pattern.

INTERVENTIONS RATIONALE
Independent
1. Provided with quiet and calm To promote rest and sleep
environment during bedtime
2. Advised to limit fluid intake in -to reduce need for nighttime
evening micturation
3. Encouraged participation in regular -to aid stress control/release of energy
exercise program during day
4. Identified the factors that affect the -to reduce sleep disturbance
sleeping pattern
5..Recommended to limit intake of Such beverages are stimulants that
chocolates and caffeinated beverages inhibits sleep
Dependent
1. Administered sedative / other sleep -to enhance clients ability to fall asleep
medication when indicated

67
Evaluation:
Goal met. After 8 hours of duty, patient able to sleep comfortably and report
improvement of sleep pattern.

NURSING CARE PLAN #9


September 29, 2009
Subjective cue:
“Maulaw nako sa ako kahimtang karon,” as verbalized by the patient.

Objective cue:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Loss of body function noted


• Restlessness noted
• Hiding body parts with blanket (lower extremities)
• Less eye contact
• Weakness and numbness (lower extremities)
Analysis:
Disturbed body image related to physical illness as evidenced by inability
to walk

Planning:
After 8 hours giving appropriate nursing intervention, patient will acknowledge
self as an individual who has responsibility for self.

Intervention Rationale
1.Encouraged family member to treat To avoid feeling of isolation or rejection
client normally and not as invalid.
2.Encouraged expression of feeling To provide appropriate emotional support
regarding his condition.
3.Encouraged client to look and touch To begin to incorporate changes into body
affected body parts. image
4.Discussed meaning of loss change to A change of function such as immobility
client. may be more different for some to deal
with than a change in appearance
5.Visited client frequently and Provides opportunities for listening of
acknowledged the individual as someone patient’s concerns and questions.
who is worthwhile

Evaluation:
Goal met. After 8 hours giving appropriate nursing intervention, patient
verbalized feeling of acceptance and responsibility of his affected body parts as
evidenced by frequent checking and touching of his lower extremities.

68
NURSING CARE PLAN #10
September 29, 2009

Subjective cue:
“Taglaay na man ko diri sa hospital”, as verbalized by the client.

Objective cues:
v/s taken as follow:
Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Restlessness noted
• Frequent yawning noted
• Verbal expression of boredom
• Keep on lying in bed

Nursing Diagnosis:
Deficient diversional activity related to physical limitations and lack of
sources.

Planning:
After 8 hours of giving appropriate nursing intervention, patient will be able to
engage in satisfying activities within personal limitations.

Intervention: Rationale
1.Acknowledged reality of situation and To establish therapeutic relationship
feelings of the client.
2.Provided with diversional activities To refocus the attention of the client .
such as reading materials and talking To relieve boredom.
to the client.
3.Provided change of scenery . To direct attention.

4.Encouraged expression of feelings To determine concerns that needs


intervention.
5.Provided requirements for mobility For mobility.
such as wheelchair.
6.Developed plan of care appropriate To encourage performance of ADL
to individual situation, scheduling within physical limitation.
activities to conform to clients normal
schedule.

Evaluation:

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Goal met. After 8 hours of giving appropriate nursing intervention, patient
verbalized feelings of satisfaction in activities engaged with in personal limitations.

NURSING CARE PLAN #11


September 29, 2009
Subjective Cues:

“Kadaghan sad diri tawo, gusto na ako ra isa,” as verbalized by the patient.

Objective Cues:

v/s taken as follow:


Temp: 36.5 c RR: 18cpm PR: 86bpm BP:110/70mmHg

• Fatigue
• Observed discomfort
• Observed use of unsuccessful social in reactions behavior
• Insecurity in public
• Dysfunctional interaction with others

Diagnosis:
Impaired social interactions related to limited physical mobility.

Planning:
After 8 hours of giving appropriate nursing intervention patient will express
desire/be involved in achieving positive changes in social behaviors and interpersonal
relationships.

Interventions:

1. Interview family, SO, and friends.


• To obtain observation of clients behavior changes.
2. Determine client use of coping skills and defense mechanism.
• Affects ability to be involved in social situation
3. Have client list behaviors that cause discomfort.
• Once recognized, client can choose to change.
4. Work with the client to alleviate underlying negative self concepts
• Because they after impede social interactions
5. Encourage client to verbalized problems and perceptions of reasons for problems
• Active listen to note indications of hopelessness, powerlessness, fear, anxiety,
grief, anger, feeling unloved or unlovable; problems with sexual identity.

Evaluation:

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Goal met. After 8 hours of giving appropriate nursing intervention, patient
express desire/be involved in achieving positive changes in social behaviors and
interpersonal relationships.

NURSING CARE PLAN #12


Potential Nursing Care Plan

Subjective cue:

Objective cues:

• Ascending paralysis noted (from feet to the pelvic part)


• Limited ROM
• Slowed body movements noted
• Weakness

Nursing Diagnosis:

High risk for impaired skin integrity related to immobility as evidenced by


ascending paralysis

Planning:

After 8 hours of rendering appropriate nursing interventions, patient will be free


from any risk of impaired skin integrity.

INTERVENTIONS RATIONALE
1. Changed patient position every 2 -to promote circulation and prevent bed
hours. sore and constipation
2. Removed wet/wrinkled linens -moisture potentiates skin breakdown
promptly.
3. Developed repositioning schedule -to enhance understanding and
for client, involving client in reasons for cooperation.
and decisions about times and
positions in conjunction w/ other
activities.
4. Provided w/ well ventilated -To promote comfort
environment.
5. Elevated both legs with a pillow To promote blood venous return
6. Encouraged patient to touch his -To remind the patient that his lower
lower extremities every now and extremities are present and still needs
then care

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7. Increased fluid and high fiber in diet. -to prevent constipation.

Evaluation:

NURSING CARE PLAN #13


Potential Nursing Care Plan

Subjective cue:

Objective cues:
• Physical immobility
• Motor dysfunction
• Weakness and numbness (lower extremities)

Nursing Diagnosis:
Risk for Injury related to Physical Immobility.

Planning:
Patient will be able to understand of individual factors that contribute to possibility
of injury.

Nursing Intervention:

1. Perform thorough assessment regarding safety issues when planning


for client care and/or preparing for discharge from care.
• Failure to accurately assess and intervene or refer these
issues can place the client at needless risk and creates
negligence issues for the health care practitioner.
2. Ascertain knowledge of safety needs/injury prevention and
motivation.
• To prevent injury in home and community.
3. Note clients’ developmental stage, decision- making ability, level of
cognition/competence.
• Affects clients ability to protect self and influence choice of
intervention.
4. Assess mood, coping abilities, personality styles.
• That may result in carelessness/increased risk-taking without
consideration of consequences.
5. Assess clients’ muscle strength, gross and fine motor coordination.
• To identify risk for falls.
6. Identify interventions/safety devices.
• To promote safe physical environment and individual safety.
7. Discuss importance of self monitoring of condition/emotions.

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• That can contribute to occurrence of injury.

Evaluation:

DISCHARGE PLAN

Name: Patient R

Final Diagnosis: Guillain Barre’ Syndrome

Condition upon Discharge: Improved

Date of Discharge: October 06, 2009

Medications:

• Instructed patient and SO to take the medication on time.


• Completed duration of those of medications take home.
• Instructed SO to give patient with Multivitamins.

Environmental Concerns:

• Instructed SO to provide clean environment to prevent lodging of infectious


microorganisms.
• Instructed SO to provide proper disposal of wastes.
• Instructed SO to remove or lessen any environmental hazards.
• Changes in your home environment can aid in your recovery by making it easier
for you to bathe, dress and prepare meals while your muscles return to normal
levels of strength.

Treatments:

• Encouraged patient doing light exercise such as walking.


• Encouraged patient to have an adequate rest periods.
• Encouraged SO to provide comfort measures to the patients.
• Instructed SO to change the position of the patient when lying in bed for long
periods of time to prevent bed sores.
• Find a good physical therapy program from which you can learn specific
isometric, isotonic and resistance exercises to rebuild weakened muscles. You
may do these exercises on an outpatient basis and continue them at home.
Remember to pace yourself and get adequate rest, as fatigue is to be expected
with Guillain-Barre Syndrome.

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Health Teachings:

• Provided patient health teaching about:


- Proper hand washing
- Proper personal hygiene
- Tell patient to frequently change positions when lying in bed for long
periods of time to prevent bed sores.
• Tell patient’s mother about monitoring signs & symptoms or recurring Guillain-
Barre Syndrome, eg. Tingling sensation, difficulty of swallowing, restlessness,
fever.
• Instructed patient to avoid some heavy works.
• Instructed SO to well cook the food.
• Wear comfortable shoes and socks to help soothe pain and burning from
neuropathy in the feet. Inspect your feet often to be sure there are no cuts or
blisters that you may not have noticed.

Out Patient (follow up check-up):


• Encouraged patient to have follow up check-up after 3 weeks.
• Instructed patient to notify physician if there is any undesired feeling about the
disease.

Diet
• Encouraged patient to eat nutritious food like vegetables.
• Encourage patient to eat fruits rich in vitamin C for strong immunity.
• Advised patient to take low-sodium diet.
• Instructed patient to avoid junk foods.
• Follow a healthy eating plan with fresh, seasonal fruits and vegetables, lean
meat and fish, whole grains and plenty of colorful salads. Eating well may help
you to sustain your energy and can boost your mood.

Spiritual
• Encouraged patient to attend mass as frequent as he can, or even once a week
together with his family.
• Encouraged patient to always pray to God to help him to recover immediately.
• Encouraged patient thank God for the gift of life.
• Encouraged SO to pray for the health of the patient.

Emotional

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Seek emotional support to cope with feelings of depression and anxiety that are part of
living with Guillain-Barre Syndrome. Discuss antidepressant medication with your doctor
if you are having trouble with activities necessary for daily living.

75
SUMMARY OF INTRAVENOUS FLUIDS

Date/Time Started Intravenous Fluids and Drop Rate Number of hours to be


Volume Infused

09/25/09 D5IMB 1L 15gtts/min. 16 hours and 30 minutes

09/26/09 D5IMB 1L 15gtts/min. 16 hours and 30 minutes


D5IMB 500ml 15gtts/min. 8 hours and 15 minutes
09/27/09
D5LR 1L 15gtts/min 16 hours and 30 minutes
10/01/09
10/02/09 D5LR 1L 15gtts/min 16 hours and 30 minutes

10/03/09 D5LR 1L 15gtts/min 16 hours and 30 minutes

10/04/09 D5LR 1L 15gtts/min 16 hours and 30 minutes

10/05/09 D5LR 1L 15gtts/min 16 hours and 30 minutes

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B. GENOGRAM

Legend: 69 year old 65 year old

Mother died at the age of 71 year 1998 died at the age of 68 year 2005

Father

Grandfather 56 years old 43 years old

Grandmother

Siblings

Patient

GBS

Cough

Arthritis

Generalized Swelling

Deceased

77
Definition of Terms

Autoimmune: Pertaining to autoimmunity, a misdirected immune response that occurs


when the immune system goes awry and attacks the body itself.

Autoimmune disease: An illness that occurs when the body tissues are attacked by its
own immune system . The immune system is a complex organization within the body
that is designed normally to "seek and destroy" invaders of the body, including
infectious agents. Patients with autoimmune diseases frequently have unusual
antibodies circulating in their blood that target their own body tissues.

Axon: A long fiber of a nerve cell (a neuron) that acts somewhat like a fiber-optic cable
carrying outgoing (efferent) messages.
Bacteria: Single-celled microorganisms which can exist either as independent (free-
living) organisms or as parasites (dependent upon another organism for life).

Bacterial: Of or pertaining to bacteria. For example, a bacterial lung infection.

Blood pressure: The blood pressure is the pressure of the blood within the arteries. It
is produced primarily by the contraction of the heart muscle. It's measurement is
recorded by two numbers. The first (systolic pressure) is measured after the heart
contracts and is highest. The second (diastolic pressure) is measured before the heart
contracts and lowest. A blood pressure cuff is used to measure the pressure. Elevation
of blood pressure is called "hypertension".

Brain: That part of the central nervous system that is located within the cranium
( skull ). The brain functions as the primary receiver, organizer and distributor of
information for the body. It has two (right and left) halves called "hemispheres."

Breathing: The process of respiration, during which air is inhaled into the lungs through
the mouth or nose due to muscle contraction, and then exhaled due to muscle
relaxation.

Campylobacter jejuni: a species of curved, rod-shaped, non-spore forming, Gram-


negative microaerophilic, bacteria commonly found in animal feces.[1] It is one of the
most common causes of human gastroenteritis in the world. Food poisoning caused by
Campylobacter species can be severely debilitating but is rarely life-threatening. It has
been linked with subsequent development of Guillain-Barré syndrome (GBS), which
usually develops two to three weeks after the initial illness.

Cerebrospinal fluid: A watery fluid, continuously produced and absorbed, which flows
in the ventricles (cavities) within the brain and around the surface of the brain and spinal
cord.

78
Clinical trials: Trials to evaluate the effectiveness and safety of medications or medical
devices by monitoring their effects on large groups of people.

Cure: 1. To heal, to make well, to restore to good health. Cures are easy to claim and,
all too often, difficult to confirm.
2. A time without recurrence of a disease so that the risk of recurrence is small, as in
the 5-year cure rate for malignant melanoma .
3. Particularly in the past, a course of treatment. For example, take a cure at a spa.

Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or


decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any
problem. The diagnosis was a plugged IV.

Gastrointestinal: Adjective referring collectively to the stomach and small and large
intestines.

Heart: The muscle that pumps blood received from veins into arteries throughout the
body. It is positioned in the chest behind the sternum (breastbone; in front of the
trachea, esophagus, and aorta; and above the diaphragm muscle that separates the
chest and abdominal cavities. The normal heart is about the size of a closed fist, and
weighs about 10.5 ounces. It is cone-shaped, with the point of the cone pointing down
to the left. Two-thirds of the heart lies in the left side of the chest with the balance in the
right chest.
See the entire definition of Heart

Heart rate: The number of heart beats per unit time, usually per minute. The heart rate
is based on the number of contractions of the ventricles (the lower chambers of the
heart). The heart rate may be too fast ( tachycardia ) or too slow ( bradycardia ). The
pulse is bulge of an artery from the wave of blood coursing through the blood vessel as
a result of the heart beat. The pulse is often taken at the wrist to estimate the heart rate.

See the entire definition of Heart rate

Immune: Protected against infection. The Latin immunis means free, exempt.

Immune system: A complex system that is responsible for distinguishing us from


everything foreign to us, and for protecting us against infections and foreign substances.
The immune system works to seek and kill invaders.

Infection: The growth of a parasitic organism within the body. (A parasitic organism is
one that lives on or in another organism and draws its nourishment therefrom.) A person
with an infection has another organism (a "germ") growing within him, drawing its
nourishment from the person.

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Knee: The knee is a joint which has three parts. The thigh bone (the femur) meets the
large shin bone (the tibia) to form the main knee joint. This joint has an inner (medial)
and an outer (lateral) compartment. The kneecap (the patella) joins the femur to form a
third joint, called the patellofemoral joint. The patella protects the front of the knee joint.

Limb: The arm or leg.

Low blood pressure : Any blood pressure that is below the normal expected for an
individual in a given environment. Low blood pressure is also referred to as
hypotension.

Muscle: Muscle is the tissue of the body which primarily functions as a source of power.
There are three types of muscle in the body. Muscle which is responsible for moving
extremities and external areas of the body is called "skeletal muscle." Heart muscle is
called "cardiac muscle." Muscle that is in the walls of arteries and bowel is called
"smooth muscle."

Myelin: The fatty substance that covers and protects nerves. Myelin is a layered tissue
that sheathes the axons (nerve fibers). This sheath around the axon acts like a conduit
in an electrical system, ensuring that messages sent by axons are not lost en route. It
allows efficient conduction of action potentials down the axon. Myelin consists of 70%
lipids (cholesterol and phospholipid) and 30% proteins. It is produced by
oligodendrocytes in the central nervous system.

Nerve: A bundle of fibers that uses chemical and electrical signals to transmit sensory
and motor information from one body part to another..

Neurological: Having to do with the nerves or the nervous system.

Onset: In medicine, the first appearance of the signs or symptoms of an illness as, for
example, the onset of rheumatoid arthritis . There is always an onset to a disease but
never to the return to good health. The default setting is good health.

Pain: An unpleasant sensation that can range from mild, localized discomfort to agony.
Pain has both physical and emotional components. The physical part of pain results
from nerve stimulation. Pain may be contained to a discrete area, as in an injury, or it
can be more diffuse, as in disorders like fibromyalgia . Pain is mediated by specific
nerve fibers that carry the pain impulses to the brain where their conscious appreciation
may be modified by many factors.

Paralysis: Loss of voluntary movement (motor function). Paralysis that affects only one
muscle or limb is partial paralysis, also known as palsy; paralysis of all muscles is total
paralysis, as may occur in cases of botulism.

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Paresthesia: An abnormal sensation of the skin, such as numbness, tingling, pricking,
burning, or creeping on the skin that has no objective cause. Paresthesia is the usual
American spelling and paraesthesia the preferred English spelling.

Peripheral: Situated away from the center, as opposed to centrally located.

Peripheral nervous system (PNS): That portion of the nervous system that is outside
the brain and spinal cord.

Physical therapy: A branch of rehabilitative health that uses specially designed


exercises and equipment to help patients regain or improve their physical abilities.
Physical therapists work with many types of patients, from infants born with
musculoskeletal birth defects, to adults suffering from sciatica or the after- effects of
injury, to elderly post-stroke patients.

Plasma: The liquid part of the blood and lymphatic fluid, which makes up about half of
its volume. Plasma is devoid of cells and, unlike serum, has not clotted. Blood plasma
contains antibodies and other proteins. It is taken from donors and made into
medications for a variety of blood-related conditions. Some blood plasma is also used in
non-medical products.

Plasmapheresis: A procedure designed to deplete the body of blood plasma (the liquid
part of the blood) without depleting the body of its blood cells. Whole blood is removed
from the body, the plasma is separated from the cells, the cells are suspended in saline,
a plasma substitute or donor plasma), and the reconstituted solution may be returned to
the patient. The procedure is used to remove excess antibodies from the blood in lupus,
multiple sclerosis, multiple myeloma, etc. Plasmapheresis carries with it the same risks
as any intravenous procedure. The risk of infection increases with the use of donor
plasma, which may carry viral particles despite screening procedures. The procedure is
done in a clinic or hospital.

Protein: A large molecule composed of one or more chains of amino acids in a specific
order determined by the base sequence of nucleotides in the DNA coding for the
protein.

Proteins: Large molecules composed of one or more chains of amino acids in a


specific order determined by the base sequence of nucleotides in the DNA coding for
the protein.

Relapse: The return of signs and symptoms of a disease after a patient has enjoyed a
remission . For example, after treatment a patient with cancer of the colon went into
remission with no sign or symptom of the tumor, remained in remission for 4 years, but
then suffered a relapse and had to be treated once again for colon cancer.

Residual: Something left behind. With residual disease, the disease has not been
eradicated.

81
Respiratory: Having to do with respiration, the exchange of oxygen and carbon dioxide.
From the Latin re- (again) + spirare (to breathe) = to breathe again.

Sensory: Relating to sensation , to the perception of a stimulus and the voyage made
by incoming ( afferent ) nerve impulses from the sense organs to the nerve centers.

Spinal cord: The major column of nerve tissue that is connected to the brain and lies
within the vertebral canal and from which the spinal nerves emerge. Thirty-one pairs of
spinal nerves originate in the spinal cord: 8 cervical , 12 thoracic , 5 lumbar, 5 sacral,
and 1 coccygeal. The spinal cord and the brain constitute the central nervous system
( CNS ). The spinal cord consists of nerve fibers that transmit impulses to and from the
brain. Like the brain, the spinal cord is covered by three connective-tissue envelopes
called the meninges . The space between the outer and middle envelopes is filled with
cerebrospinal fluid ( CSF ), a clear colorless fluid that cushions the spinal cord against
jarring shock. Also known simply as the cord.

Spinal tap: Also known as a lumbar puncture or "LP", a spinal tap is a procedure
whereby spinal fluid is removed from the spinal canal for the purpose of diagnostic
testing. It is particularly helpful in the diagnosis of inflammatory diseases of the central
nervous system, especially infections, such as meningitis. It can also provide clues to
the diagnosis of stroke , spinal cord tumor and cancer in the central nervous system.

Stage: As regards cancer , the extent of a cancer, especially whether the disease has
spread from the original site to other parts of the body..

Steroid: A general class of chemical substances that are structurally related to one
another and share the same chemical skeleton (a tetracyclic cyclopenta[a]phenanthrene
skeleton).

Stroke : The sudden death of some brain cells due to a lack of oxygen when the blood
flow to the brain is impaired by blockage or rupture of an artery to the brain. A stroke is
also called a cerebrovascular accident or, for short, a CVA.

Surgery: The word "surgery" has multiple meanings. It is the branch of medicine
concerned with diseases and conditions which require or are amenable to operative
procedures. Surgery is the work done by a surgeon. By analogy, the work of an editor
wielding his pen as a scalpel is s form of surgery. A surgery in England (and some other
countries) is a physician's or dentist's office.

Syndrome: A set of signs and symptoms that tend to occur together and which reflect
the presence of a particular disease or an increased chance of developing a particular
disease.

Trigger: Something that either sets off a disease in people who are genetically
predisposed to developing the disease, or that causes a certain symptom to occur in a

82
person who has a disease. For example, sunlight can trigger rashes in people with
lupus.

Viral: Of or pertaining to a virus. For example, "My daughter has a viral rash ."

Viral infection: Infection caused by the presence of a virus in the body. Depending on
the virus and the person's state of health, various viruses can infect almost any type of
body tissue, from the brain to the skin. Viral infections cannot be treated with antibiotics;
in fact, in some cases the use of antibiotics makes the infection worse. The vast
majority of human viral infections can be effectively fought by the body's own immune
system , with a little help in the form of proper diet, hydration, and rest. As for the rest,
treatment depends on the type and location of the virus, and may include anti-viral or
other drugs.

Virus: A microorganism smaller than a bacteria, which cannot grow or reproduce apart
from a living cell. A virus invades living cells and uses their chemical machinery to keep
itself alive and to replicate itself. It may reproduce with fidelity or with errors (mutations)-
this ability to mutate is responsible for the ability of some viruses to change slightly in
each infected person, making treatment more difficult.

Viruses: Small living particles that can infect cells and change how the cells function.
Infection with a virus can cause a person to develop symptoms. The disease and
symptoms that are caused depend on the type of virus and the type of cells that are
infected.

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REFERENCES

Brunner and Suddarth’s Medical and Surgical Nursing eleventh edition

Pathophysiology 3rd edition by Thomas J. Nowak

Assessment by Lippincott Williams and Wilkins

http://en.wikipedia.org/wiki/Campylobacter_jejuni

http://www.about-guillain-barre.com/

http://www.cehs.siu.edu/fix/medmicro/cmir.htm

http://www.about-campylobacter.com/campylobacter_symptoms_risks

http://www.medicinenet.com/guillain-barre_syndrome/article.htm

http://www.direct-ms.org/pdf/MolecularMimicryOther/GillianBarrMolMimicry.pdf

http://www.microbiologybytes.com/blog/2008/01/30/how-campylobacter-jejuni-survives-
within-cells/

http://www.microbiologybytes.com/blog/2008/01/30/how-campylobacter-jejuni-survives-
within-cells/

http://en.wikipedia.org/wiki/Myelin_sheath

http://www.drkaslow.com/html/blood_cell_counts.html

http://www.scribd.com

http://www.nursingcrib.com

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