 EXTREMIES (symmetrically) and migrates upward over time. It can be so severe the person will experience paralysis.
There is another type called: Miller Fisher Syndrome. Eye paralysis is usually the first sign and symptom with this type.
What is happening in GBS?
Peripheral nervous system nerves are involved! Therefore, we’re talking about all the nerves outside the brain and spinal cord.
The PNS creates a connection between our brain/spinal cord to the rest of our body (so our limbs, muscle, and some of the organs are involved). AIDP is the most common type of GBS in the U.S.
Most patients start to have this weird tingling or numbness sensation (PARAESTHESIA) in their feet, which will gradually spread upward (symmetrically). Paralysis, absent reflexes, and loss of muscle tone is likely to follow the paresthesia.
As a side note: It’s very important to note that GBS PEAKS in about 2 weeks with its severity of symptoms, and then slowly recovery occurs (remylenation of the myelin sheath). Nurse: reassure the patient and always communicate with them because patients who experience GBS are extremely fearful.
In addition, it takes about 1-2 years for the patient to return to baseline (most patients have to complete some type of physical rehab after experiencing GBS due to the complications associated with it in regards to muscle atrophy and nerve damage).
As the demyelination spreads, it can start to affect the autonomic nervous system of the PNS. Remember the PNS can be separated into the somatic nervous system (controls voluntary movement functions) and autonomic nervous system (involuntary functions).
***In severe cases of GBS, the autonomic system (parasympathetic and sympathetic nervous system) can be affected. Therefore, we’re talking about the nerves that regulate our blood pressure, heart rate/rhythm, temperature, vision, GI (constipation… decrease in motility of the GI system) and renal (retention of urine due to sphincter issues).
Cranial nerves: In addition, there can be cranial nerve involvement, as it gradually migrates up to the area of the brain stem where the cranial nerves are located. This leads to vision problems, paralysis of the face, issues swallowing, trouble speaking etc.
 However, they’ve recovered from it but now are presenting with this tingling, numbness, and weakness in the feet (called paresthesia) and it’s making walking difficult. They tell you they haven’t injuried themselves and the sensation is getting worst.
This is how some patients may present with GBS (but this syndrome is just starting).
As time goes on, you will find that these signs and symptoms start to migrate up and are symmetrical in origin. The patient’s reflexes will become majorly diminished or absent. This will affect the legs, arms, chest muscles used for breathing, face/eyes/swallowing ability (cranial nerves), and in severe cases the autonomic nervous system.
As more time goes on the signs and symptoms go from weakness to paralysis (ex: paralyzed from neck down), lose muscle tone, absent reflexes, facial paralysis, issues swallowing, talking, weak cough (need suctioning, short of breath, reports they can’t breathe in very well) and autonomic issues.
****Respiratory system is a major focus for the nurse!!! When this system is affected, most patients will need to be intubated or have a tracheostomy for assistance to breathe. Monitor for signs and symptoms that this system is being affected.
These signs and symptoms peak at about 2 weeks from when the symptoms started. Then slowly the signs and symptoms (remyelination of myelin sheath) start to resolve slowly. Most patients can make a full recovery within 1-2 years, but there are usually major complications afterwards due to paralysis that puts the patient on a long road to recovery.
One important thing to point out that although the patient is experiencing paralysis or weakness, many patients will experience severe pain like muscle pain/ cramps. Exact reason not known….may be due to nerve damage. But it’s very important as the nurse to evaluate the patient for pain using some type of communication technique.
However, because of severity of the muscle weakness most patients end up needing to be intubated (as stated above), develop infection (pneumonia from aspiration or ventilator acquired), at risk for blood clots and pressure injuries due to immobility, severe weight loss from nutrition issues, and will need intense physical therapy.
How is Guillain-Barré syndrome Diagnosed?
Lumbar puncture: elevated protein without elevated white blood cells.
Spread of the paresthesia or paralysis?
Change in reflexes?
Immunoglobulin therapy: IV immunoglobulin from a donor given to the patient to stop the antibodies that are damaging the nerves.
Please note that from 4 October fees for stock trading on the Stock Exchange of Hong Kong will be changed.
The detailed information is available on our webpage in “Changes in Tariffs”.
This is to inform that starting from June 1 several commission fees on processing and delivering of account statements, cancellation or changes in outgoing payment orders, submitted transfer inquiry and services to financial institutions will be changed. Some positions will be excluded from the price list.
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Front Page News & Analysis is a review of some of the news items that make the front pages of our national dailies. If you missed the show in the morning, you can listen to the podcast here and get updated on news and issues happening in the country as reviewed by Bukola. You can also join in the conversation by using or following the hashtag #FPN.
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All lawyers are now global lawyers.
AILFN (Association of International Law Firm Networks) announced today Requests for Qualifications (RFQ) will launch on October 30, 2017. RFQ is an application that captures professional and personal relationships formed over three decades among members of the 50 leading law firm networks at an estimated cost $1.5 billion dollars. Network members range from small firms to firms with more than 1,000 attorneys. Collectively the 3,500 members of the networks already provide clients 17.1% of the world’s legal services.
RFQ permits real-time direct access for free to determine network member’s expertise in 150 countries. This expertise is available for routine matters to billion dollar acquisitions across multiple countries. The expertise of 300,000 attorneys is accessible in minutes.
For more information about the Association of Independent Law Firm Networks, click here to visit the AILFN website.I really don’t think he puts stuff together trying to be vague though. Yes, I think his writing tries to get across a relativistic viewpoint (there’s no right or wrong but thinking makes it so - butchered that), but he’s not an abstract lyricist, at least not to me. I feel like he’d hate this but I think he has a lot of wisdom in his songs, and the take-away isn’t “don’t think too hard”, though obviously it’s counterproductive to reach beyond one’s ability, but, for me, it’s “keep coming back”, because there’s a lot that can be revealed by precisely looking at it from different angles: yours and mine.For two decades now, the ‘leadership case’ for sustainable business has been made in UN conferences, popular management books, scholarly articles and professional fora. Pretty well every executive function of the firm from CEO and CFO to Director of Operations and Director of Communications has been examined for ‘sustainability fit’ and the special contribution the role might make to the transformation of business in line with sustainability principles.
In a 2011 Financial Times article, Anthony Goodman even mused on the prospects for the new phenomenon of the ‘Chief Sustainability Officer’ becoming a stepping stone to the CEO job, such was the need for leadership skills, capacity for innovation and technical knowledge required by a CSO. So it is intriguing that in their current ‘Lessons from Leaders’ series examining the roles of ten C-suite players in sustainable business, Accenture completely overlooks one vital role from consideration – that of the General Legal Counsel.
In February this year the Chartered Institute of Personnel and Development published a series of think pieces on The Responsible and Sustainable Business: HR leading the way in an attempt to galvanise the HR profession into a more strategic contribution to the sustainability agenda. If sustainability is a complex and context-specific concept involving the interplay of organisational leaders, corporate values and employee belief systems, then the guardians of pay, performance and organizational development must surely be part of the transformation.
We should wish the CIPD well in their campaign because “look out, here comes HR” is another standing joke of corporate life