Guillain-Barré syndrome case study

Guillain-Barre syndrome (GBS) is the most common cause of rapidly acquired paralysis in the United States today and it affects one to two people in every 100,000. The disorder first received public attention when people who received the 1976 Swine Flu vaccine developed GBS. Today, it continues to afflict new victims each year; and, it does not discriminate as it may afflict any person, at any age, regardless of one's gender or ethnic background ("About GBS," n.d.).

In patient's with GBS, the body's immune system attacks part of the peripheral nervous system. Initially, symptoms include weakness or tingling sensations in the legs; and, oftentimes, the weakness and abnormal sensations may spread to the arms and the upper body. In some cases, the symptoms may increase to the point where the patient's muscles cannot be used at all causing the patient to be in a paralyzed state. In such cases, GBS is life threatening and the patient may require the use of a respirator to assist with breathing. Fortunately, however, the majority of patients with GBS recover from even a severe onset of the syndrome ("NINDS Guillain-Barre," 2009).

This particular paper shall address the needs related to Frank Sinatra, a forty-five-year-old, married man who drives a truck for a living. Mr. Sinatra was recently admitted to our facility with Guillain-Barre syndrome. We recognize that in many people, GBS leads to significant lifestyle changes such as the need to change jobs, the loss of activities, failure to associate with social networks, family strain and anxiety; and, that many of these issues last longer than the period of rehabilitation (Forsberg, 2005). We understand the potential for significant intrusion upon one's life with the onset of GBS and we do not underestimate it and while there is no known cure to date and while some studies suggest a significant portion of individuals have difficulty returning to a normal life. However, it is our goal that upon discharge that through proper discharge planning and long-term care consisting of medical treatment, follow-up care, therapeutical interventions, and familial support that Mr. Sinatra will be able to return home and lead a productive and full life.

Impact of the Disease on the Patient/Family

Fortunately for Mr. Sinatra, he sought admittance to the hospital and has responded well to the treatments received as an inpatient to date. Mr. Sinatra's recovery may take 3 to 6 months. In some cases, recovery may last up to 18 months. As part of his recovery plan, based upon an assessment of his functioning as well as the needs of his condition, Mr. Sinatra will receive occupational therapy, ongoing physical therapy, and behavioral therapy/counseling in order to help him learn how to live with GBS ("WebMd Treatment"). Furthermore, a regular sleep pattern needs to be established since it is a critical component in keeping the symptoms of GBS at bay (Sutton, 2001). In addition, family support as well as the support from networks of friends is critical in fostering a healthy recovery and keeping Mr. Sinatra from relapsing (Sutton, 2001).

The following information is provided to you as you begin preparing for Mr. Sinatra's discharge and his home health rehabilitation plan.

Health Perception and Health Management

Prior to hospitalization, Mr. Sinatra's overall health perception and health management was poor. As the sole provider for his family, he spent many hours working (sometimes being away from home for weeks at a time). He had not seen a doctor in over six years and only came to the emergency room because he had been experiencing acute pain. While in the hospital, he has been amenable to treatment and suggestions for his future medical regimen. It is critical that in the future, he attend regular examinations and follow a daily health care medical regimen.

Mr. Sinatra also has profound sleep disturbance. Oftentimes, he may go days without sleeping more than a few hours. An establishment of a regular sleep pattern will help him tremendously.

It is anticipated that his wife may need a support system to help her with the implementation of Mr. Sinatra's health care regimen so as to avoid caregiver strain and additional stress on the family.

Activity and Exercise

Prior to hospitalization, Mr. Sinatra led a sedentary lifestyle. He reported that he often would become winded walking up a flight of stairs and had difficulty keeping up with his toddler. He expressed interest in having a physical therapy consult to help him learn how to exercise correctly as well as ongoing physical therapy during his home rehabilitation. He also stated that he used to take walks, but because of his work schedule he is either driving his truck or sleeping/trying to sleep and there is little time for walking. His wife is very supportive of helping her husband incorporate exercise back into his life. They have a pool in the backyard which may provide an outlet to exercise without putting added strain on his muscles.

Self-Perception and Self-Concept

Mr. Sinatra appears to be happier and more balanced than the data on his questionnaires and his interviews with the psych consult and occupational therapist indicate. He presents as an articulate and composed individual. At all times, he appears alert and provides appropriate communicative responses. His tone of voice his steady and it appears that his responses to my questions are genuine. However, a review of his chart reveals that he either has a tendency to underestimate his complaints or he has made significant progress since being admitted three weeks ago.

Overall, subjectively, he describes himself as hard-working and a good provider for his family. As a husband, however, he oftentimes feels inadequate because his wife takes care of all of the household duties as well as taking care of their son. When he is home, he says that he isn't a very good husband or a father because he is generally to tired to do anything or to want to do anything. A review of the psychological data in his chart from the current hospitalization reveals that most of the time he "does not feel so good" about himself. He is upset with himself for gaining over thirty pounds in the past ten years. He used to be a competitive swimmer and now he won't even put on a swimsuit.

Presently, he fears that now with the onset of Guillain-Barre that he will gain even more weight. It appears that he struggles with mild to moderate depression along with feelings of low self-worth and body-image. Ever since he has gained weight, he says that he has become more sullen and more withdrawn. It will be critical for Mr. Sinatra to have follow-up care which entails physical therapy for assistance with establishing an exercise regimen and occupational therapy consults for assistance with daily living activities at home in which he can reasonable participate and instruction in accommodation of those activities.

Roles and Relationships

Mr. Sinatra lives with his wife and his five-year-old son in a two-story home. As the sole provider, he works approximately sixty hours each week so that his wife can stay at home with their son. His job as a truck driver oftentimes takes him away from his family for a week at a time. Recently, they have been having difficulty paying for their mortgage due to an increase in their interest rate. Mr. Sinatra admits that even when he has time to sleep, he oftentimes can't because he lays awake worrying about losing their home. Mr. Sinatra has a tendency to underestimate his complaints because he knows how much his family relies on him.

The Sinatra's have a supportive social network. Mrs. Sinatra is active in their local church and Mr. Sinatra is a member of the local Lion's club. However, Mr. Sinatra has not been able to participate in many community activities in the past few years due to his schedule. Mrs. Sinatra's family lives in the area and her mother oftentimes helps her out with childcare.

Throughout his stay here, Mr. Sinatra has received numerous visits from his wife as well as from his wife's family whom live in the area. In general, he appears to be supported by people who genuinely care about his well-being and rehabilitation. Mr. Sinatra will benefit from counseling services to help him release some of the stress and anxiety that causes sleep disturbance. Mrs. Sinatra will be referred to a local health group that has monthly support groups for caregivers of individuals recovering and coping with GBS.

Coping and Stress Tolerance

Mr. Sinatra does not have any present systems in place to help him relieve stress and anxiety in a positive manner. His familial history reveals that his father had hypertension and his mother was an alcoholic. Approximately two years ago, his mother passed away and he talks to his father about once a week. He admits that without his wife, he does not think he would have made it through the loss of his mother and he still appears to be grieving. He denies any alcohol abuse; however, he does admit to taking different non-prescribed medications in order to stay alert when he drives long distances. He denies taking these meds for any other reason but to be able to stay awake at work. He also admits that he is not in the position he thought he would be in at this age in his life. Approximately five years ago, he was laid off as the manager of a local distributing company. Since that time (which is also the time of his son's birth), he feels that he has become increasingly stressed as well as disappointed in himself. He used to go to church, but he has not been since his mother died. He believes that going to church helps him feel more grounded and at ease. It is recommended that Mr. Sinatra learn to release his stress in positive manners such as exercising in the pool, walking, and stretching, attending counseling, and going to church.

Values and Beliefs

Mr. Sinatra and his family are members of the local Episcopalian church. Mr. Sinatra has a strong belief system which he says oftentimes gives him the strength to carry on when he begins to despair. In fact, Mr. Sinatra used to volunteer at the local homeless shelter as a cook. He says it is selfish on his part because he always wanted to be a chef and he takes away more than he gives. Since his mother's death, he worked more and has not volunteered. It is recommended that one of his occupational therapy consults be geared toward the kitchen. While Mr. Sinatra is nervous about finances and time off from work, he does seem to be amenable and open to using the time to connect with the people and things that used to bring him happiness. He has a strong work ethic and a strong dedication to his family.