WorksheetsCase Study: Guillain-Barré Syndrome
Total questions: 8
Worksheet time: 16mins
Admitting History and Physical Examination
CC: muscle weakness
HPI: A 48-year-old career U.S. Navy physician made an appointment at the base hospital clinic because of the acute onset of severe muscle weakness.
The man stated that he had felt good until 3 weeks before his admission, at which time he experienced a flulike syndrome for 3 days.
About 10 days after returning to work, he noticed a tingling and burning sensation in his feet during his morning patient rounds. By dinner time that same day, the tingling and burning had radiated from his feet to about the level of his knees.
Thinking that he was just tired from being on his feet all day, he went to bed early that evening. The next morning, however, his legs were completely numb, although he could still move them. Alarmed, he asked his son to drive him to the clinic
PMH: The man was in outstanding physical condition. He was an avid runner, weightlifter and a champion at water-ski jumping.
He had never smoked and had never been hospitalized.
Assessment and plan:
Admitted for a diagnostic workup and observation.
What are the signs and symptoms of neuromuscular disease?
Recommend a laboratory test to confirm GBS:
Recommend other tests would be useful to confirm GBS.
Over the next 3 days, the laboratory results showed that the patient's cerebrospinal fluid had an elevated protein concentration with a normal cell count.
The electrodiagnostic studies showed a progressive ascending paralysis of the man's legs and arms.
He began to have difficulty eating and swallowing his food.
Recommend parameters for close monitoring.
The respiratory therapist, who was monitoring his forced vital capacity (FVC), maximum inspiratory pressure (MIP), pulse oximetry, and arterial blood gas values (ABGs), reported a progressive deterioration in all the values.
A diagnosis of Guillain-Barré syndrome was recorded in the patient's chart.
Interpret this ABG: on 2 L/min NC: pH 7.29 HCO₃⁻ 23 mEq/L PaCO₂ 53 mm Hg PaO₂ 86 mm Hg SaO₂ 96%
Recommend an intervention.
The respiratory therapist called the attending physician and reported his assessment of acute ventilatory failure.
The doctor transferred the patient to the intensive care unit (ICU), intubated him, and placed him on a mechanical ventilator.
The initial ventilator settings were as follows: synchronized intermittent mandatory ventilation (SIMV) mode, 12 breaths/min, tidal volume 550 mL, and FIO2 0.50.
About 15 minutes after the patient was committed to the ventilator, he appeared comfortable.
No spontaneous breaths were noted between the 12 set breaths per minute.
His vital signs were as follows: blood pressure 126/82 and heart rate 68 beats/min.
He was afebrile.
A portable chest radiograph confirmed that the endotracheal (ET) tube was in a good position and the lungs were adequately aerated.
Normal vesicular breath sounds were auscultated over both lung fields.
His ABGs were as follows:
Interpret this ABG: pH 7.51, PaCO₂ 29 mm Hg, HCO₃⁻ 22 mEq/L, PaO₂ 204 mm Hg, SaO₂ 98%.
8. Evaluate the ventilation and recommend a change, if any:
