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EXPLANATION
✔Correct answer:
Providing information, offering positive feedback, and promoting relaxation techniques. Guillain-Barré syndrome (GBS) can be a frightening experience for patients due to the rapid onset of paralysis and potential for respiratory compromise. Providing information about the condition, its expected course, and the plan of care can help reduce anxiety and promote a sense of control. Offering positive feedback on any progress, however small, reinforces the patient's efforts and boosts morale. Promoting relaxation techniques, such as deep breathing exercises, guided imagery, or music therapy, can help manage anxiety, promote comfort, and improve sleep. Given that the patient is on mechanical ventilation, communication and emotional support are paramount.
GBS is an autoimmune disorder affecting the peripheral nerves, leading to demyelination and/or axonal damage. This disrupts nerve impulse transmission, causing muscle weakness, which can progress to paralysis. The ascending pattern of paralysis can affect respiratory muscles, necessitating mechanical ventilation. The rapid progression and potential severity of the condition can cause significant psychological distress, including anxiety, fear, and depression.
Imagine being suddenly unable to move your body and relying on a machine to breathe. This would be incredibly scary and overwhelming. Providing clear information, offering encouragement, and teaching relaxation techniques are like giving someone a map, a compass, and a first-aid kit during a difficult journey. It helps them understand what’s happening, gives them tools to cope, and reassures them that they are not alone.
Psychosocial support is a crucial component of GBS care.
- Provide clear and concise information about GBS, its expected course, and the treatment plan.
- Offer positive reinforcement and encouragement for any progress made, no matter how small.
- Teach and encourage the use of relaxation techniques, such as deep breathing, guided imagery, and progressive muscle relaxation.
- Facilitate communication using alternative methods if the patient is unable to speak due to intubation (e.g., communication boards, eye-tracking devices).
- Encourage family involvement and provide emotional support to both the patient and their family.
✘Incorrect answer options:
Allowing the patient full control over care decisions and limiting visitors. While patient autonomy is important, giving full control over complex medical decisions when the patient is in a vulnerable state and potentially experiencing cognitive or emotional distress is not appropriate. Limiting visitors can further isolate the patient and deprive them of crucial social support.
Offering positive feedback and encouraging active range-of-motion exercises. While positive feedback is helpful, active range-of-motion exercises are contraindicated during the acute phase of paralysis as they can cause muscle strain and fatigue. Passive range-of-motion exercises are more appropriate during this phase to maintain joint mobility and prevent contractures.
Administering IV sedatives, minimizing distractions, and restricting visitors. While minimizing distractions can be helpful, routinely administering IV sedatives can mask neurological changes and hinder assessment. Restricting visitors can increase feelings of isolation and anxiety. Sedation should be used judiciously and only when clinically indicated for agitation or anxiety that cannot be managed with other methods.
References
- Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. (9th ed.). Elsevier.
- Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., Roberts, D., & Hagler, D. (2017). Medical-surgical nursing: Assessment and management of clinical problems (10th ed.). Mosby Elsevier.