About
Autoimmune disorder causing mobility weakness and paralysis, usually with recovery after a long period of time.
Assess
Illness within previous couple of months, ascending or descending paralysis, numbness and tingling, diminished reflexes, pain, difficulty in breathing, arrhythmias, difficulty speaking, visual changes, respiratory failure
Complications
Mechanical ventilation
Impaired mobility; ineffective coping; quadriparesis
Diagnosis
- Impaired breathing pattern related to respiratory muscle weakness and/or paralysis
- Impaired mobility related to muscle weakness and paralysis
- Self care deficit related to inability to perform usual activities of daily living
Goals
- The client will maintain a patent airway and effective respirations.
- The client will maintain mobility and accommodate for impaired mobility.
- The client will state a decrease in pain.
Interventions
- Monitor pain level, respiratory status, vital signs, pulse oximetry frequently.
- Have endotracheal equipment at the bedside in case of respiratory emergency.
- Encourage coughing and deep breathing techniques.
- If shunt present for plasmapharesis, monitor for bruit, patency, bruising, or bleeding.
- Assist client with ambulation, repositioning every two hours, range of motion exercises.
- Apply antiembolism compression stocking on client and monitor for changes in circulation.
- Encourage active participation in activities of daily living, use of assistive devices.
- Monitor for signs/ symptoms of complications.
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