Among four clients, which should the nurse assess first based on recent report of a Guillain‑Barré syndrome patient who has begun plasmapheresis?

• A. The client with Guillain‑Barré syndrome undergoing plasmapheresis
• B. A stable postoperative patient
• C. A well patient with controlled diabetes
• D. A patient admitted for observation only

Answer: (A)

Plasmapheresis in a Guillain-Barré patient is a high-risk situation that requires close, ongoing assessment as the most urgent priority. This therapy can cause rapid shifts in fluid, electrolytes, and hemodynamics, and patients with Guillain-Barré often have autonomic dysfunction that can lead to sudden changes in heart rate and blood pressure. The combination of a procedure that removes plasma and the potential citrate anticoagulant used during the exchange can produce hypotension and citrate toxicity, the latter presenting as perioral numbness, tingling, cramps, or even seizures if not addressed. Because these issues can develop quickly and jeopardize airway or circulation, the nurse must monitor the patient receiving plasmapheresis first to detect and respond to any adverse effects promptly.

The other clients are comparatively stable or not in the middle of a high-risk procedure, so while they still require routine monitoring, they do not present an immediate threat to life at this moment. Prioritizing the actively treated Guillain-Barré patient aligns with the need to protect airway, breathing, and circulation and to manage potential procedure-related complications as they arise.