A nurse is caring for a client that has been recently diagnosed with Guillian-Barre syndrome. What would the nurse consider to be common risk factors associated with Guillain-Barré syndrome (GB5)? (select all that apply)

Associated with recent vaccination

Associated with tobacco use

Recent surgical experience

Presence of a thymus gland

Associated with exposure to a recent viral infection

Answer and Explanation

Correct Answer : A,C,E

A) Associated with recent vaccination:
Vaccinations, particularly those for influenza and other viral infections, have been linked to an increased risk of GBS in some cases. This association is believed to be due to an immune response that may trigger the autoimmune attack on the peripheral nervous system, leading to GBS.

B) Associated with tobacco use:
While smoking has been associated with various health conditions, including respiratory and cardiovascular diseases, there is no established direct link between tobacco use and the development of GBS. The pathophysiology of GBS is more strongly related to infections and certain immune responses rather than lifestyle factors like smoking.

C) Recent surgical experience:
It is believed that the stress from surgery, particularly in the presence of an infection or immune response, may trigger the development of GBS. Infections, especially bacterial infections like those caused by Campylobacter jejuni, which is a common antecedent of GBS, can sometimes occur after surgery.

D) Presence of a thymus gland:

The thymus is involved in the immune system, particularly in the development of T-cells, but there is no direct correlation between the thymus gland and the onset of GBS. GBS is more closely related to infections (viral or bacterial), recent vaccinations, or surgery rather than anatomical features like the thymus.

E) Associated with exposure to a recent viral infection:
Viral infections such as Zika virus, Epstein-Barr virus, cytomegalovirus (CMV), influenza, and others can trigger an autoimmune response that leads to the development of GBS. Infections are the most common precipitating factor for GBS, and the immune system’s response to the viral infection may cause the body to mistakenly attack its own peripheral nerves, leading to the symptoms of GBS.

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Correct Answer is D

Explanation

A) The time between ventricular depolarization and repolarization (diastole):
This refers to the period between ventricular depolarization and repolarization, which is associated with the QT interval on the EKG, not the P wave. The P wave specifically relates to atrial depolarization, not the ventricular activity. Diastole refers to the relaxation phase of the heart cycle, and it’s not directly linked to the P wave, which represents atrial contraction.

B) Time taken for impulse to spread to the point immediately preceding ventricular contraction:

The P wave represents the depolarization (or contraction) of the atria, not the time taken for the impulse to spread to the ventricles. The time taken for the impulse to spread through the atria, across the AV node, and down to the ventricles is better represented by the PR interval, not the P wave itself.

C) Time taken for depolarization (contraction) of both ventricles (systole):
This describes the QRS complex, which represents the depolarization (contraction) of the ventricles during systole, not the P wave. The QRS complex shows the electrical activity of the ventricles as they contract, while the P wave relates to atrial depolarization, which occurs before ventricular contraction.

D) Passage of electrical impulse through the atrium causing atrial depolarization:
The P wave represents the passage of the electrical impulse through the atria, leading to atrial depolarization. Depolarization of the atria results in the contraction of the atria, pushing blood into the ventricles. The P wave is the first part of the cardiac cycle on the EKG and reflects the electrical activity that causes atrial contraction.

A. Unilateral upper extremity weakness B. Bilateral ascending weakness C. Mask like facial expressions D. Pill rolling actions made by the clients fingers

Correct Answer is B

Explanation

A) Unilateral upper extremity weakness:
Guillain-Barré Syndrome (GBS) typically presents with bilateral weakness, not unilateral. The weakness in GBS typically begins symmetrically in the lower extremities and ascends upward toward the upper body, including the arms, face, and respiratory muscles. Therefore, unilateral weakness is not characteristic of GBS, and its presence should prompt further investigation into other possible causes.

B) Bilateral ascending weakness:
One of the hallmark signs of Guillain-Barré Syndrome is ascending weakness, which means that the weakness usually starts in the lower extremities (legs) and progresses upwards to the upper extremities, face, and potentially the respiratory muscles. This bilateral ascending paralysis is a classic feature of GBS and occurs due to the immune system attacking the myelin sheath of peripheral nerves. The nurse should be vigilant for signs of progressive weakness, as GBS can quickly lead to respiratory failure and requires prompt intervention.

C) Mask-like facial expressions:
Mask-like facial expressions are more commonly associated with Parkinson's disease, not Guillain-Barré Syndrome. Parkinson’s disease is characterized by a reduction in facial expressiveness due to the loss of dopaminergic neurons, leading to a fixed, unblinking, or "masked" appearance. While facial involvement can occur in GBS as the weakness ascends, it is not typically described as a "mask-like" expression.

D) Pill rolling actions made by the client's fingers:
Pill-rolling is a characteristic tremor often associated with Parkinson's disease and involves the repetitive motion of the fingers, as if rolling a pill. It is a resting tremor seen in Parkinson's disease and not in Guillain-Barré Syndrome. GBS primarily presents as weakness and loss of motor function, rather than tremors or other involuntary movements.

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A nurse is caring for a client that has been recently diagnosed with Guillian-Barre syndrome. What would the nurse consider to be common risk factors associated with Guillain-Barré syndrome (GB5)? (select all that apply)

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Correct Answer is D

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