Question

A client is admitted with Guillain-Barré syndrome. The doctor performs a lumbar puncture. What would the nurse expect the CSF to reveal? A. Increased glucose and decreased protein B. Increased protein and normal cell count C. Increased red blood cells and elevated WBCs D. Normal protein with increased WBC count

Short answer

Answer: The nurse should expect the CSF to reveal increased protein levels and a normal cell count in a client admitted with Guillain-Barré syndrome.

Step-by-step solution

Understand Guillain-Barré syndrome

Guillain-Barré syndrome is an autoimmune disorder in which the body's immune system attacks the peripheral nervous system. This condition affects both the axons and the myelin sheaths of nerves, leading to symptoms such as weakness, numbness, tingling, and paralysis. As a result, we can expect alterations in the composition of the cerebrospinal fluid that might be specific to Guillain-Barré syndrome patients.

Analyze option A

Option A states that the CSF will reveal increased glucose and decreased protein levels. However, Guillain-Barré syndrome does not typically affect glucose levels in the CSF, as this condition is primarily related to nerve inflammation. Additionally, rather than decreased, protein levels in the CSF of Guillain-Barré syndrome patients are known to be increased. Therefore, option A is not correct.

Analyze option B

Option B states that the CSF will reveal increased protein levels and a normal cell count. Guillain-Barré syndrome affects the nerve(axon and myelin sheath), and the damaged nerves release protein into the CSF. In Guillain-Barré syndrome patients, the proteins in the CSF increase without significant changes in the cell count, predominantly due to the absence of an infectious process. Thus, option B is correct.

Analyze option C

Option C states that the CSF will reveal increased red blood cells and elevated white blood cells (WBCs) count. However, Guillain-Barré syndrome is not associated with increased red blood cells in the CSF. Also, WBCs may slightly increase, but not significantly. Therefore, option C is not correct.

Analyze option D

Option D states that the CSF will reveal normal protein levels with an increased WBC count. As discussed earlier, Guillain-Barré syndrome is associated with increased protein levels rather than normal levels. Moreover, WBCs count in the CSF may be slightly elevated but not significantly. Hence, option D is not correct.

Conclude the answer

In conclusion, based on the analysis of each option, the nurse should expect the CSF to reveal increased protein levels and a normal cell count in a client admitted with Guillain-Barré syndrome. Therefore, the correct answer is option B.

Key concepts

Lumbar Puncture

A lumbar puncture, also known as a spinal tap, is a medical procedure used to collect cerebrospinal fluid (CSF) from the spinal canal. This procedure is essential for diagnosing and monitoring various conditions affecting the brain and spinal cord, such as infections, bleeding, or inflammatory diseases like Guillain-Barré Syndrome.

During a lumbar puncture, a needle is inserted between two vertebrae in the lower back to access the CSF. The patient typically lies on their side with their knees drawn up to their chest, or they may sit and lean forward on a table.

The needle is carefully placed into the lumbar subarachnoid space to collect CSF for testing. This is generally a safe procedure, but common risks include headaches, back pain, or discomfort at the puncture site.

• Assists in diagnosing central nervous system disorders
• Helps detect abnormalities in CSF composition
• Requires proper post-procedure care to alleviate side effects, such as headaches

Cerebrospinal Fluid Analysis

Cerebrospinal fluid analysis is a crucial diagnostic tool that involves examining the collected CSF for various indicators of health or disease. This fluid serves as a protective cushion for the brain and spine and is essential for maintaining the homeostasis of the central nervous system.

In the case of Guillain-Barré Syndrome, the analysis of CSF can reveal significant insights due to its unique changes in protein levels.

Typically, the CSF analysis will include measurements of:

• Protein Levels: Elevated protein levels, particularly without a corresponding increase in white blood cells, can indicate Guillain-Barré Syndrome.
• White and Red Blood Cell Counts: Normally, the CSF has very few cells.
• Glucose Concentration: Should remain unchanged unless another pathological process is involved.

The testing aims to compare these levels against standard reference ranges to ascertain any deviations that might suggest underlying pathologies.

Autoimmune Disorders

Autoimmune disorders occur when the immune system mistakenly attacks the body's own tissues. In Guillain-Barré Syndrome, this response is directed at the peripheral nervous system, leading to inflammation and damage. The immune system typically acts to protect the body from invaders, such as viruses or bacteria, but in autoimmune disorders, it cannot distinguish between these foreign threats and the body's healthy cells.

Guillain-Barré Syndrome falls into this category, where the immune system attacks the myelin sheaths and axons of peripheral nerves, causing symptoms like muscle weakness, numbness, and even paralysis.

• Often triggered by infections such as respiratory or gastrointestinal infections.
• Symptoms can progress rapidly, requiring swift diagnosis and treatment.
• Treatment focuses on managing symptoms and halting immune system attacks.

Management may include intravenous immunoglobulin therapy or plasma exchange to reduce the immune response and support recovery.

Peripheral Nervous System

The peripheral nervous system (PNS) comprises all the nerves that lie outside the brain and spinal cord. It connects the central nervous system (CNS) to limbs and organs, enabling communication between the brain and body systems. The PNS is essential for transmitting signals related to movement, sensation, and involuntary functions.

Guillain-Barré Syndrome primarily affects the peripheral nerves, causing disruptions in these processes. This damage can lead to rapid-onset muscle weakness, usually starting in the legs and spreading to the upper body and arms.

• Nerve fibers in the PNS are covered by myelin, critical for normal nerve function.
• Damage to myelin from autoimmune attacks can severely impede nerve signal transmission.
• Early intervention is critical to prevent severe outcomes and facilitate recovery.

The condition underscores the importance of a healthy PNS for maintaining bodily functions and responding to environmental changes.