Discharge planning and recovery support for a Guillain-Barré syndrome patient

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.

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.

Based upon all that he has to live for as well as his spirituality, work ethic, and dedication to family, it seems that with the proper follow-up care and support for his family and himself, Mr. Sinatra has a good prognosis for regaining a healthy and positive quality of life.

Nutritional-Metabolic

Mr. Sinatra's diet generally consists of fast food when he is on the road. A typical daily food intake might be a donut/Danish for breakfast, snacks throughout the day (e.g., potato chips, candy bars, licorice), and then a fast food meal for dinner (oftentimes eaten after 8-9pm). Additionally, Mr. Sinatra drinks approximately six-ten sodas per day as well as approximately 4-6 cups of coffee per day. He rarely drinks water and he does not take vitamins or supplements.

He presents as 5'11" and 265 pounds with a significant amount of his weight carried in his abdomen. In the past five years, he has gained approximately thirty pounds, but he denies a significant difference in his eating habits. The major life change is that he switched jobs from one in which he was walking quite a bit to one which is completely sedentary. Additionally, he went from living at home and eating relatively healthy home-cooked meals at regular intervals to living a life on the road and eating a significant amount of fatty foods devoid of nutritional content. He denies skin problems, but admits to needing to see a dentist. It is anticipated that a return to home cooking and eating regular portions at regular intervals will greatly assist Mr. Sinatra in his weight management and overall health. Accordingly, we will order a nutritional consult with follow-up care to ensure that Mr. Sinatra and his family receive adequate support with regard to healthy lifestyle changes.