Question

A 24-year-old male presents to the ED with complaints of unable to hold an object and stand, change in voice, and inability to swallow solid foods. Examination of the patient revealed an absence of gag reflex, regurgitation of food, and hoarseness of his voice. The motor examination revealed grade 2 weakness in his upper distal extremities and grade 3 weakness in lower limbs. Deep tendon reflexes were absent in both upper and lower limb. Babinski sign was absent. CT scan showed that the head was normal. The patient notes that his symptoms began in his lower legs and then eventually worked their way up towards his head.

Patient was treated with supportive treatment initially with intravenous immunoglobulins for 5 days. After 4 days of admission, patient developed paradoxical breathing and was then intubated and placed on ventilatory support. An X-ray of his chest was done, which showed sign of aspiration pneumonia on the right side.

1. What is the patient’s diagnoses?
2. How did the patient develop pneumonia and how would you prevent this from reoccurring?

Answer 1

1. The possible diagnosis of this patient is GBS (Guillain-Barré syndrome). It is an autoimmune disorder where the body's own immune system creates an antibody that attacks the peripheral nerve cells and damages them. It may trigger by some bacterial or viral infections like respiratory infection, stomach flu, and Hiv infection.

In this case, the CT scan showed that the head was normal but the signs and symptoms of motor weakness conform to the diagnosis.

2.

The patient developed pneumonia by aspiration(Backflow) of stomach content to the lungs. To prevent further occurrence nurse should follow some rules

- Give food and water to the patient in semi fowlers position.

- Prefer left lateral position over the prone position during rest.

- Keep the patient on the left lateral position during vomiting.

- Initiate NG tube feeding