Mr. A is a 58-year-old Japanese-American admitted to the unit from the emergency department with complaints of paresthesias, lower extremity weakness (onset 2 days ago), and difficulty walking today. Mr. A reports to being in “good health” except for having the flu 3 weeks ago. Mr. A is married and the manager of a local restaurant.
Clinical Assessment
Mr. A is awake, follows commands, and is oriented to person, place, and time. Mr. A is quiet, shows no emotion, avoids all eye contact with the nurse, and only speaks when spoken to. Mr. A verbalizes that he has symmetrical weakness, numbness, and paresthesia in both legs (2 cm above the knee). Within a few hours of admission to the unit, Mr. A is having trouble swallowing, has diminished reflexes, and cannot move his arms or legs to move in bed. Mr. A remains stoic and denies pain.
Diagnostic Procedures
Mr. A’s vital signs include blood pressure of 142/82 mm Hg, heart rate of 98 beats/min, respiratory rate of 32 breaths/min, temperature of 98.9°F, and Spo2 of 92% on O2 at 2 L/nasal cannula. Cerebral spinal fluid shows protein levels of 15 mg/dL. Electromyography (EMG) and nerve conduction tests reveal reduced nerve conduction and velocity in the lower extremities. Serum sodium, 135 mEq/dL; serum potassium, 4.2 mEq/dL; and serum magnesium, 2.2 mEq/dL.
Medical Diagnosis
Guillain-Barré Syndrome (GBS)
Questions
1. What major outcomes do you expect to achieve for this patient?
2. What problems or risks must be managed to achieve these outcomes?
3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
5. What possible learning needs would you anticipate for this patient?
6. What cultural and age-related factors may have a bearing on the patient’s plan of care?
Q. No. 1. Answer :
Major outcomes we expect to achieve for the patient :
* Mr. A 58 yrs old man is having guillain barre syndrome.
* to improve normal walking levels by reducing weakness of the legs.
* Improves the eye to eye contact by neurological examination and treat ment.
* Improving the normal swallowing capacity by improving reflexes by proper treatment.
* to reduce the pain by pain medications.
* maintain normal strength of arms and legs by proper physiotherapy.
* to maintain normal vital signs.
Q. No. 2. Answer :
* it is one of the neurological problem it may take time to maintain normal status like walking and normal strength maintainance of arms and legs ect.
* it needs daily physiotherapy, to recover soon. As the treatment provided like plasmaparesis that means exchange of blood and transmit the IVIG immonoglobuline, it is very cost, so it is one of the risk.
* there is a risk to maintain normal respiration some times the respiratory muscles weakness leads collapse. So that time ventilator support also needed.
* parents and patients emotional and psychological problems are one of the risk factors.
Q. No. 3. Answer :
* Neurological assessment and muscle strength reflexes should be done to know the capacity of client.
* close monitoring of client should be there to prevent the respiratory and cardiac arrest due to this syndrome.
* pain medications should be administered to reduce pain.
* by regular physiotherapy should be need to client.
* provide psychological support and emotional support and improve eye to eye contact by good communication.
Q. No. 4. Answer :
To promote optimal functioning and safety and well-being of client through :
* Providing side rails to prevent falls from bed.
* stay along with the client at least one member to support in daily living activities.
* up to recovery time provide bed pan and urinals or keep Foleys catheter to pass urine.
* provide physiotherapy continueously.
* all needed articles keep nearer to the client.
* keep alarm system to meet the client needs.
* regular monitoring of client to see improvement.
* provide psychological support and emotional support.
Mr. A is a 58-year-old Japanese-American admitted to the unit from the emergency department with complaints...
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