Guillain Barre

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What if your life was suddenly disrupted by a mysterious condition that started in your legs and gradually progressed to your face, causing numbness, tingling, and in severe cases, paralysis? This is the reality for patients suffering from Gilan Boree, a baffling syndrome that we explore on this episode of Nursing with Dr Hobbock. After a closer look at this perplexing syndrome, thought to be triggered by a viral infection, we lay bare the consistent patterns of its manifestation, starting from the legs, and progressing to the upper extremities, the trunk, and the face. 

From tingling and numbness to complete paralysis affecting crucial functions like talking, chewing, and swallowing, the insidious nature of this condition is alarming. However, the real danger is in its ability to cause respiratory failure, which is why this episode focuses on recognizing the key indicators of this potential outcome. We delve into the crucial role of monitoring patient respirations and discuss the potential for rapid development of weakness or paralysis of the intercostal and diaphragm muscles. As we wrap things up, we further stress the need for vigilance in patient monitoring and prepare listeners to deal with possible respiratory distress and the potential need for mechanical ventilation.

Episode Transcript

Speaker 1 (00:00):
Hey and welcome to Nursing with Dr Hobbock.
I'm thinking about Gilan Boree.
That is a condition that isnamed after two French doctors,
and I apologize to anyone whospeaks French who hears my
pronunciation I am not supergreat at pronouncing French.
I really need to practice, buthopefully you'll forgive me.

(00:24):
This is a syndrome we don'treally understand well and it
involves peripheral and cranialnerves.
What usually happens is apatient gets a viral infection,
either a respiratory or a GIinfection so think influenza
virus or some other type ofvirus and about one to four

(00:48):
weeks after that they start tohave neurological deficits.
These neurological deficitstypically follow a pattern.
It usually starts in thepatient's legs and progresses to
the upper extremities, thetrunk and the face, and this is
a peristhesia.
They might have tingling andnumbness.
They may have some paralysis,maybe ocular, facial, oral,

(01:13):
pharyngeal muscles.
This is going to make it reallyhard for them to talk or chew
or swallow.
Your priority for this patientis to monitor their respiratory
status because if thoserespiratory muscles get affected
, this patient can go intorespiratory failure.
So we need to constantlymonitor them for respiratory
failure.
Most patients about 70% willhave a full recovery within

(01:37):
several months to a year afterthe onset of symptoms, around
30% are left with a residualdisability and about 5%
fortunately pass away.
So what are you looking forwhen you're watching for that
respiratory failure?
You're watching forbreathlessness while they're
talking, shallow or irregularbreathing, use of accessory

(01:58):
muscles, any change in theirrespiratory pattern.
Make sure that your whoever ismeasuring respirations is
actually measuring them.
I can't say how many times I'vegone in and seen a patient who
had 16 respirations.
The entire time they've beensomeplace and only to find out
it was actually in the 30s.
So make sure that you talk withwhoever you delegate that to

(02:20):
then make sure that they arereally checking those
respirations.
I try to harp on that with mystudents, with my face-to-face
students, because respirationsis something that will change
really quickly.
So if something is going onwith the body, you'll see change
in those respirations muchearlier than you would think.
So keeping an eye on them isreally important.

(02:43):
Any paradoxical inward movementof the upper abdominal wall
well, in the supine position,that indicates weakness or
impending paralysis of thediaphragm.
So I want to make sure that weare watching for those things.
Any changes in pulse rate orrhythm.
They may have some transienthypertension or orthostatic
hypotension could have some painin their back and their calves

(03:07):
of their legs, and weakness orparalysis of the intercostal and
diaphragm muscles can developquickly.
So again, we are keeping a veryclose eye on these patients.
We want to monitor for thatrespiratory distress and
initiate mechanical ventilationif it's going to be needed.
That's the quick rundown onGilan Berre and I hope that you
enjoyed this short, shortepisode.

(03:28):
Join me again next time onNursing with Dr Hobbock.