You are working at a skilled nursing
You are working at a skilled nursing facility that cares for patients on ventilators. G. W. is your first patient with Guillain-Barré syndrome. G. W. is a divorced, self-supporting 56-year old woman from a small town who developed a URI after caring for her grandson who had the same. Three weeks later she developed weakness, numbness, and tingling in her feet that progressed up her body. Her physician recognized the seriousness of her condition and transferred her to a tertiary referral center. Within days she became totally paralyzed; she was trached and placed on mechanical ventilation. She spent 1 month in the neuro critical care unit and several months on the floor before being transferred to your facility. Her only in hospital complication was pneumonia, which has totally resolved. The physicians don’t know how long the paralysis will last. 1. What adaptations would you or your family have to make if you were paralyzed and unable to perform your normal responsibilities? 2. How would you feel if you were totally dependent on others for your simplest needs? 3. How would you feel if you were totally dependent on others for daily care, financial issues such as who would pay the rent/house note, groceries, utilities, mounting medical bills; social issues such as who would care for your children, see to their education, meet their emotional needs; self-perception? 4. Is G. W.’s case typical? 5. Why does potentially fatal respiratory function occur? 6. Describe a plan for pulmonary hygiene for G. W. 7. How do you anticipate that G. W.’s nutritional needs are being met? 8. Describe nursing interventions to manage bladder and bowel elimination for G. W. 9. What are some things you can do to decrease G. W.’s fear and anxiety? 10. You are using your expert nursing skills to avoid complications. List 4 potential complications 11. What measures can be taken to prevent pressure ulcers? An additional 3 weeks have passed. G. W. has recovered gross movement of her arms and some respiratory effort. She is still on a ventilator but she has gone from controlled to assisted breathing. This morning G. W. receives a letter from her health insurance company informing her that she has exceeded her lifetime limit and has been dropped from her plan. She is crying hysterically and is choking because of the increased mucous production in her sinuses. Remember that she cannot wipe her eyes or blow her nose to clear it. 12. What can be done for her? It took G. W. almost 11 months to recover enough to be discharged to home with assistance of a home health aide.
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