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6 Guillain-Barre Syndrome Nursing Care Plans

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By Paul Martin, BSN, R.N.
Guillain-Barre Syndrome Nursing Care Plans
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Guillain-Barre syndrome (GBS) also known as infectious polyneuritis is an autoimmune disease in which there is an acute inflammation of the spinal and cranial nerves manifested by motor dysfunction that predominates over sensory dysfunction. The exact cause is unknown, but it is associated with a previously existing viral infection or immunizations.  Classical clinical manifestation may include ascending and symmetrical motor weakness and absent or diminished reflexes.

The severity of the disease ranges from mild to severe with the course of the disease dependent on the extent of paralysis present at the peak of the condition. Recovery is usually complete and may take weeks or months. The disease most commonly occurs in children between 4 and 10 years of age. Treatment is symptom-dependent with hospitalization required in the acute phase of the disease to observe and intervene for respiratory or swallowing complications.

Nursing Care Plans

Nursing care planning goals for a pediatric client with Guillain-Barre syndrome include improved respiratory function, promotion of physical mobility, prevention of contractures, decreased anxiety and pain, relief of urinary retention, improvement of parental care and prevention of complications.

Here are six (6) nursing care plans (NCP) and nursing diagnosis (NDx) for Guillain-Barre Syndrome (GBS):

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  1. Ineffective Breathing Pattern
  2. Acute Pain
  3. Impaired Physical Mobility
  4. Impaired Urinary Elimination
  5. Anxiety
  6. Risk for Altered Parenting

5. Anxiety

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Anxiety

Nursing Diagnosis

  • Anxiety

May be related to

  • Change in health status and threat to self-concept.

Possibly evidenced by

  • Increased apprehension as the condition worsens and paralysis spreads
  • Expressed concern and worry about permanent effects of the disease
  • Treatments during hospitalization
  • Expressed feeling of increased helplessness and uncertainty

Desired Outcomes

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  • Parents and child verbalize decreased feelings of anxiety.
Nursing InterventionsRationale
Assess source and level of anxiety,
how anxiety is manifested and need
for information that will relieve it.		Determines the extent of anxiety and need for interventions, sources may include fear and uncertainty about treatment and recovery, guilt about the presence of illness, possible loss of parental role and responsibility during hospitalizations.
Facilitate expression of concerns and an opportunity to ask inquiries regarding the condition and rehabilitation of the ailing child.Provides an opportunity to release feelings, secure information needed to overcome anxiety.
Encourage parents to stay with the child and in the care of the child.Allows for care and support of child instead of increasing anxiety that is caused by absence and lack of knowledge about child’s condition.
Therapeutically communicate with parents and child and answer questions in a calm and honest manner.Promotes an environment of support.
Assist parents and child to recognize improvements resulting from treatments.Promotes a positive attitude and optimistic outlook for recovery.
Allow the child to participate in own care depending on ability and degree of paralysis; allow to make informed choices about ADL as soon as possible.Promotes independence and control and preserves developmental status.
Teach parents and child about disease condition and manifestation.Provides information to relieve anxiety by knowledge of what to expect.
Discuss each procedure or type of may
therapy, effects of any diagnostic tests to parents and child as appropriate to age.		Reduces fear of the unknown which increase anxiety.
Teach parents and child that degree of severity varies but motor weakness and paralysis start with extremities and move upward with the peak reached in 3 weeks and improvement seen by 4 to 8 weeks.Provides information about the usual course of disease and length of illness.
Clarify any information and answer questions in lay terms and utilize visual aids for reinforcement if helpful.Prevents unnecessary anxiety resulting from incorrect knowledge or beliefs or inconsistencies in information.
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5. Anxiety

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

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Other nursing care plans related to neurological disorders:

References and Sources

Recommended references and sources for this fracture nursing care plans:

  1. Auer, R., & Riehl, J. (2017). The incidence of deep vein thrombosis and pulmonary embolism after fracture of the tibia: an analysis of the National Trauma Databank. Journal of clinical orthopaedics and trauma, 8(1), 38-44.
  2. Biz, C., Fantoni, I., Crepaldi, N., Zonta, F., Buffon, L., Corradin, M., … & Ruggieri, P. (2019). Clinical practice and nursing management of pre-operative skin or skeletal traction for hip fractures in elderly patients: a cross-sectional three-institution study. International journal of orthopaedic and trauma nursing, 32, 32-40.
  3. Brent, L., Hommel, A., Maher, A. B., Hertz, K., Meehan, A. J., & Santy-Tomlinson, J. (2018). Nursing care of fragility fracture patients. Injury, 49(8), 1409-1412.
  4. Buckley, J. (2002). Massage and aromatherapy massage: Nursing art and science. International Journal of Palliative Nursing, 8(6), 276-280.
  5. Desnita, O., Noer, R. M., & Agusthia, M. (2021, July). Cold Compresses Effect of on Postoperative Orif Pain in Fracture Patients. In KaPIN Conference (pp. 133-140).
  6. DiFazio, R., & Atkinson, C. C. (2005). Extremity fractures in children: when is it an emergency?. Journal of pediatric nursing, 20(4), 298-304.
  7. Griffioen, M. A., Ziegler, M. L., O’Toole, R. V., Dorsey, S. G., & Renn, C. L. (2019). Change in pain score after administration of analgesics for lower extremity fracture pain during hospitalization. Pain Management Nursing, 20(2), 158-163.
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  11. Maher, A. B., Meehan, A. J., Hertz, K., Hommel, A., MacDonald, V., O’Sullivan, M. P., … & Taylor, A. (2012). Acute nursing care of the older adult with fragility hip fracture: an international perspective (Part 1). International Journal of Orthopaedic and Trauma Nursing, 16(4), 177-194.
  12. McDonald, E., Winters, B., Nicholson, K., Shakked, R., Raikin, S., Pedowitz, D. I., & Daniel, J. N. (2018). Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery. Foot & Ankle International, 39(10), 1135–1140. https://doi.org/10.1177/1071100718782489
  13. McDonald, E., Winters, B., Shakked, R., Pedowitz, D., Raikin, S., & Daniel, J. (2017). Effect of Post-Operative Toradol Administration on Bone Healing After Ankle Fracture Fixation. Foot & Ankle Orthopaedics, 2(3), 2473011417S000288.
  14. Metsemakers, W. J., Kuehl, R., Moriarty, T. F., Richards, R. G., Verhofstad, M. H. J., Borens, O., … & Morgenstern, M. (2018). Infection after fracture fixation: current surgical and microbiological concepts. Injury, 49(3), 511-522.
  15. Neri, E., Maestro, A., Minen, F., Montico, M., Ronfani, L., Zanon, D., … & Barbi, E. (2013). Sublingual ketorolac versus sublingual tramadol for moderate to severe post-traumatic bone pain in children: a double-blind, randomised, controlled trial. Archives of disease in childhood, 98(9), 721-724.
  16. Pan, Y., Mei, J., Wang, L., Shao, M., Zhang, J., Wu, H., & Zhao, J. (2019). Investigation of the incidence of perioperative pulmonary embolism in patients with below-knee deep vein thrombosis after lower extremity fracture and evaluation of retrievable inferior vena cava filter deployment in these patients. Annals of vascular surgery, 60, 45-51.
  17. Patterson, J. T., Tangtiphaiboontana, J., & Pandya, N. K. (2018). Management of pediatric femoral neck fracture. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 26(12), 411-419.
  18. Patzakis, M. J., & Wilkins, J. (1989). Factors influencing infection rate in open fracture wounds. Clinical orthopaedics and related research, (243), 36-40.
  19. Resch, S., Bjärnetoft, B., & Thorngren, K. G. (2005). Preoperative skin traction or pillow nursing in hip fractures: a prospective, randomized study in 123 patients. Disability and rehabilitation, 27(18-19), 1191-1195.
  20. Rothberg, D. L., & Makarewich, C. A. (2019). Fat embolism and fat embolism syndrome. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 27(8), e346-e355.
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Paul Martin, BSN, R.N.
Paul Martin is a registered nurse with a bachelor of science in nursing since 2007. Having worked as a medical-surgical nurse for five years, he handled different kinds of patients and learned how to provide individualized care to them. Now, his experiences working in the hospital is carried over to his writings to help aspiring students achieve their goals. He is currently working as a nursing instructor and have a particular interest in nursing management, emergency care, critical care, infection control, and public health. As a writer at Nurseslabs, his goal is to impart his clinical knowledge and skills to students and nurses helping them become the best version of themselves and ultimately make an impact in uplifting the nursing profession.
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