Which assessment priority is most appropriate for a client admitted with Guillain‑Barré syndrome who has begun plasmapheresis?

• A. Monitor respiratory status and neuromuscular function
• B. Monitor only heart rate
• C. Focus solely on wound care
• D. Schedule routine labs without specific monitoring

Answer: (A)

Airway and breathing status, together with ongoing neuromuscular assessment, is the top priority because Guillain-Barré syndrome can progress rapidly to weakness of the respiratory muscles. When plasmapheresis has begun, the risk of respiratory compromise increases, so the nurse must continuously track how well the patient is ventilating and how their muscle strength is changing. Look for signs such as changes in respiratory rate and effort, use of accessory muscles, decreasing tidal volumes, and declining oxygen saturation, along with objective checks of motor strength and the ability to swallow or cough. Early detection of respiratory decline allows timely intervention, which is lifesaving in this condition. While monitoring for hemodynamic shifts or electrolyte disturbances during plasmapheresis is important, those concerns do not outweigh the need to ensure adequate ventilation and neuromuscular function.