5

FIVE
4
FOUR
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THREE
2
TWO
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ONE
 Dedic
ation
To our parents, siblings and friends for their unselfish love and
overwhelming support and who much of the times have had to manage
without us while we work this case study as well as having to cope with
our struggles and frustrations.

To our clinical instructors, whose support is vital to the

accomplishment of the case study.
To our client who’s been cooperative and open during our
interview and willing to share his feelings about his condition without any
hesitation. We are hoping that through this case study we can impart
knowledge and better understanding of his underlying illness. Just hold on
and don’t give up. We have God watching and cared for us very much for
He is the Great Physician.

To all GBS patient worldwide, who deeply inspired our hearts and
mind to make a case study about it. We know that it is not easy to handle
that kind of situation. We believe that someday, somehow the cure for
GBS will be discovered.

And to all of us, may this case study will serve us as an eye opener
to call our attention and to be vigilant about GBS, for life is unpredictable
and we don’t know what will happen next.
 ACKNOWLEDGEMENT

We would like to express our deepest and heartfelt gratitude to the

following people who help, support and supervise us in making this case
presentation possible.
To our Clinical Instructors, for teaching and giving all the detailed
information and presenting their lectures properly, shared technical
expertise, made suggestions and recommendations for the success of this
case presentation.
To our class adviser, Mrs.Christine Sykimte, for being so
approachable and kind in giving sample case presentation. To Mr. Neil John
Plaza, for being so patient in sharing his ideas and comments in correcting
our case study. To Mr. Ian Tristan Abedejos, for his proficiency that
imparted to us in making better presentation.
To our parents, for their never-ending support financially in all our
school projects and contributions.
To our group mates, for being cooperative in all the tasks that were
assigned to them, for their patience, efforts, knowledge, skills, commitment,
and hard work in finalizing this plan.
To our patient and his family for being so good and understanding in
allowing us to use his medical case for this plan.
Lastly, to our Almighty Father for giving us the peace of mind and
necessary attitudes, knowledge, determination and perseverance in pursuing
this plan. For His love, power, and enlightenment which endowed to us, we
thank Him from the bottom of our heart.
 Introduction

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.
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.

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

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

banal 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.
 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
•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.
 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
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

•Muscle weakness or loss of muscle function (paralysis)
In mild cases, there may be no weakness or paralysis
May begin in the arms and legs at the same time
May get worse over 24 to 72 hours
May occur in the nerves of the head only
May start in the arms and move downward
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 •Difficulty Swallowing

•Can't take a deep breath •Drooling

•Fainting
•Difficulty Breathing
•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 (Fishear variant) may cause only ophthalmoparesis, ataxia,
and areflexia.
 Coping and support
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)

Difficulty breathing
Difficulty swallowing
Fainting
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
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, characterised 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.

The terms 'syndrome', 'disease' and 'GBS' are used synonymously in this
website, to indicate Guillain-Barré syndrome.
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 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.

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
Complications of Guillan-Barre syndrome can include:

•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 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.
•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)

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
•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.
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.
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.
 ANATOMY AND PHYSIOLOGY
THE NERVOUS SYSTEM
Typical Structure of a Nerve Cell
The nervous system is divided into the:
peripheral nervous system (PNS)
central nervous system (CNS)
A nerve cell (neuron) consists of a large
cell body and nerve fibers—one
elongated extension (axon) for sending
impulses and usually many branches
(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 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
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 sensory vision
Optic (Contain 38% of all the axons connecting to the brain.)
III motor* eyelid and eyeball muscles
Oculomotor
IV motor* eyeball muscles
Trochlear
V mixed Sensory: facial and mouth sensation
Trigeminal Motor: chewing
VI motor* eyeball movement
Abducens
VII mixed Sensory: taste
Facial Motor: facial muscles and
salivary glands
VIII sensory hearing and balance
Auditory
IX mixed Sensory: taste
Glossopharyngeal Motor: swallowing
X mixed main nerve of the
Vagus parasympathetic nervous system (PNS)
XI motor swallowing; moving head and shoulder
Accessory
XII motor* tongue muscles
Hypoglossal
*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.

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)
 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.

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.

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.

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.
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.

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.
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.
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.
 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

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

 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
•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 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 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 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. 
 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.
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.
 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

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

Skull and Face:

•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 pigment

•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

•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
•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.

Attention Span

Patient is responsive and coherent.

 CRANIAL NERVE ASSESSMENT
NAME RESULT
CRANIAL NERVE
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 when asked
to do. Positive gag reflex.

X Vagus Patients don’t have difficulty in

swallowing. No hoarseness of voice
noted.
XI Spinal Accessory Able to shrug shoulders and move head
against resistance for our group mates
hand.
XII Hypoglossal His tongue can be protrudes at midline
and can be moved from side to side,
when asked to do so.
 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
 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
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)
 “Pa
tient R”

RIGHT LEFT
BRACHIORADIALIS BRACHIORADIALIS
+1 +1
BICEPS BICEPS
+2 +2
TRICEPS TRICEPS
+2 +2

KNEE REFLEX/ PATELLAR KNEE REFLEX/

PATELLAR
0 0
ANKLE REFLEX ANKLE REFLEX
0 0
 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
 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
 LABORATORY TESTS
ELECTROLYTE
September 26,2009

ELECTROLY RESULTS
ELECTROLYTES NORMAL
RESULTS SIGNIFICANC ELECTROLY RESULTS
NORMAL VALUES NORMAL SIGNIFICANC
SIGNIFICANCE
TES VALUES E TES VALUES E

SODIUM 143mmol/L 135-145mmol/L NORMAL

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

POTASSIUM 5.4 mmol/L 3.5-5.5mmol/L NORMAL POTASSIUM 5.4 mmol/L 3.5-5.5mmol/L NORMAL

Criteria Result Normal Values Significance

Hematocrit 35% M:40-52% Reduced number of RBC in
F:36-48% 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
 HEMATOLOGY
September 26,2009

Criteria Result Normal Values Significance

Hematocrit 35% M:40-52% Reduced number of RBC in

F:36-48% 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
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
 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

 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.
Generic name: Hydrocortisone

Brand name: Cortef, cortenema, hydrocortone

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

synthetic Hormone; adrenal corticosteroids; glucocorticoid;
Action: mineralocorticoid

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:

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.
 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.
 PATHOPHYSIOLOGY

Predisposing factor:
(Diagram) Precipitating factor:

Gender: Male DIET: 1. eating uncooked

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

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

MOLECULAR Immune system will

response to the
MIMICRY intracellular invasion of
microorganism

DUAL RECOGNITION
Cell- Humoral
mediated immunity
immunity
 Mistaken Activates specific T
Secrete
immune attack lymphocytes or T-
antibodies
may arise cells
Increased level of
Penetration of macrophage and Antibodies
lymphocytes level
antibodies into basement will fight
membrane around nerve fibers foreign
T-cells released
Inflammation of the nerve cells microorganis
lymphokines
ms
Lymphokines
Inflamed cells secrete cytotoxic
produced
substances that affect or damage
macrophages
the Schwann cells
activation
Decreased myelin
production
DEMYELINATION Ascending
paralysis
Tingling Senso
Impaired Immobility of
sensation ry and
transmission the LE
motor
Numbness of nerve
loss Inability to
conduction
perform ADL
Weakness of
the LE
Constipation

GUILLAIN BARRE
SYNDROME
 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 client already knows and move To facilitate learning and determine the client and SO’s
to what the client does not know, progressing from simple to cognitive limitation
complex
1.Explained the cause of the symptoms and disease To provide knowledge
1.Explained the goal of treatment To provide appropriate information
1.Provide an environment that is conducive to learning To facilitate learning
1.Identify support persons or SO requiring information To let the SO aware of the condition of 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.
 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.
Note emotional/ behavioral responses to problems of immobility.
Feelings of frustration/powerless may impulse attainment of goals.
Encourage participation in self care, diversional activities.
Enhances self concept and sense of independence.
Identify energy- conserving techniques for ADL’s.
Limits fatigue, maximizing participation.
Encourage adequate intake of fluids/ nutritious foods
Promotes well being and maximizes energy production.
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.
 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 and skills /of the client To know the strengths and weaknesses of the client as
basis in giving appropriate interventions

1. Provide for communication among those who are To gain trust and cooperation from the client and SO
involved in caring

1. Provide health teaching to patient about the importance To promote good hygiene to the patient
of good hygiene

1. Develop plan of care appropriate to individual situation, To encourage performance of ADL within physical limitation
scheduling activities to conform to clients normal
schedule

1. Plan time for listening to the client and SO To discover barriers to participation in regimen

1. Demonstrated to the client and SO the basic ways in To provide awareness that self care activities are still
self care such as hand washing, combing the hair, possible even with physical limitations
trimming nails, tooth brushing and bathing

1. Encouraged patient and SO to use products to To promote self care

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.
 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:
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.
Express hope for client and encourage review of past experiences with successful strategies.
Show concerns to client as a person.
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.
Make time to listen to client’s perceptions of the situation.
Shows concern for client as a person.
Listen to statements client makes which might indicate feelings of powerlessness.
Suggest concerns regarding on power/ ability to control situation.
Monitor vital signs.
To have baseline data.
Evaluation:
Goal met. Patient was able to express sense of control and hopefulness about future outcomes.
 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 and answer session Enhance sense of trust and nurse client relationship

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

3. Encouraged verbalization of feelings To provide appropriate emotional supportive care

4. Discussed the disease of Guillain-Barre Syndrome
5. Enumerated ways the patient may use to relieve anxiety
such as accepting the reality of his condition,
optimistic way of seeing things and having faith in
God’s love
To provide information that could help patient understand
conditions
To provide information and to boost patient’s hope

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.”
 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:
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: -to promote moist and soft stool

1. Advised patient to drink adequate fluid and include foods
that are high in fiber like papaya, oatmeal and
pineapple

2. Encouraged activity/exercises within personal limitation. -to stimulate abdominal muscle contraction.

3.Provided with privacy and routinely scheduled time -to promote defecation
defecation

4.Educated patient about the importance of mobility and diet -to provide information
to normal bowel movement - sedimentary lifestyle may affect elimination patterns
5.Note energy. Activity level and exercise pattern. - reflecting bowel activity
6. Auscultate abdomen for the characteristics of bowel
sounds

Dependent: To increase peristalsis promoting easy defecation

1.Administered Bisacodyl (pedia) suppository as prescribed

Evaluation:
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 To promote rest and sleep

1. Provided with quiet and calm environment during bedtime

2. Advised to limit fluid intake in evening -to reduce need for nighttime micturation

3. Encouraged participation in regular exercise program -to aid stress control/release of energy
during day

4. Identified the factors that affect the sleeping pattern -to reduce sleep disturbance

5..Recommended to limit intake of chocolates and Such beverages are stimulants that inhibits sleep
caffeinated beverages

Dependent -to enhance clients ability to fall asleep

1. Administered sedative / other sleep medication when
indicated

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 client normally and not To avoid feeling of isolation or rejection
as invalid.

2.Encouraged expression of feeling regarding his condition. To provide appropriate emotional support

3.Encouraged client to look and touch affected body parts. To begin to incorporate changes into body image

4.Discussed meaning of loss change to client. A change of function such as immobility may be more
different for some to deal with than a change in
appearance

5.Visited client frequently and acknowledged the individual Provides opportunities for listening of patient’s concerns and
as someone who is worthwhile questions.

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.
 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 feelings of the client. To establish therapeutic relationship

2.Provided with diversional activities such as reading To refocus the attention of the client . To relieve boredom.
materials and talking 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 such as wheelchair. For mobility.

6.Developed plan of care appropriate to individual situation, To encourage performance of ADL within physical limitation.
scheduling activities to conform to clients normal
schedule.

Evaluation:
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:
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 hours. -to promote circulation and prevent bed sore and
constipation

2. Removed wet/wrinkled linens promptly. -moisture potentiates skin breakdown

3. Developed repositioning schedule for client, involving-to enhance understanding and cooperation.
client in reasons for and decisions about times and
positions in conjunction w/ other activities.

4. Provided w/ well ventilated environment. -To promote comfort

1. Elevated both legs with a pillow To promote blood venous return

1. Encouraged patient to touch his lower extremities-To remind the patient that his lower extremities are present
every now and then and still needs care

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:
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.
Ascertain knowledge of safety needs/injury prevention and motivation.
To prevent injury in home and community.
Note clients’ developmental stage, decision- making ability, level of cognition/competence.
Affects clients ability to protect self and influence choice of intervention.
Assess mood, coping abilities, personality styles.
That may result in carelessness/increased risk-taking without consideration of consequences.
Assess clients’ muscle strength, gross and fine motor coordination.
To identify risk for falls.
Identify interventions/safety devices.
To promote safe physical environment and individual safety.
Discuss importance of self monitoring of condition/emotions.
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.
 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
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.
 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

09/27/09 D5IMB 500ml 15gtts/min. 8 hours and 15 minutes

10/01/09 D5LR 1L 15gtts/min 16 hours and 30 minutes

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

 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.
 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
 The blood pressure is the pressure of the blood within the
Blood pressure: 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.
 A watery fluid, continuously produced and absorbed,
Cerebrospinal fluid: which flows in the ventricles (cavities) within the
brain and around the surface of the brain and spinal
cord.
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.
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 is the tissue of the body which primarily functions as a
Muscle:
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.
A bundle of fibers that uses chemical and electrical signals to
Nerve:
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.

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.
The liquid part of the blood and lymphatic fluid, which makes up about
Plasma:
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.
The return of signs and symptoms of a disease after a patient
Relapse:
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.

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.
 The major column of nerve tissue that is connected to the brain
Spinal cord:
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.
As regards cancer , the extent of a cancer, especially whether the
Stage:
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).
The sudden death of some brain cells due to a lack of oxygen
Stroke : 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 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.
A microorganism smaller than a bacteria, which cannot grow or
Virus:
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.
 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-w
http://www.microbiologybytes.com/blog/2008/01/30/how-campylobacter-jejuni-survives-w
http://en.wikipedia.org/wiki/Myelin_sheath
http://www.drkaslow.com/html/blood_cell_counts.html
http://www.scribd.com
http://www.nursingcrib.com
THE END