A client with GBS reports increasing weakness with bedside vital capacity (VC) dropping from 22 to 14 mL/kg over 4 hours. Which interventions should the nurse anticipate? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Impending neuromuscular respiratory failure in GBS: VC under 15-20 mL/kg, NIF less negative than -25 to -30 cm H2O, single breath count under 20, weakening cough or bulbar dysfunction. ELECTIVE intubation prevents emergent crash airway with aspiration. IVIG (0.4 g/kg/day × 5 days) or plasmapheresis are equivalent disease-modifying therapies; STEROIDS do NOT help. NIV is generally avoided in GBS with bulbar weakness because of aspiration risk and progressive failure — definitive intubation preferred. Autonomic dysautonomia (BP swings, dysrhythmia, ileus) requires continuous monitoring. DVT prophylaxis (SCDs plus heparin) is essential because of immobility.
Memorize 20/30/40: VC under 20, NIF less negative than -30, MIP not adequate, indicates intubation. Weakening single breath count is rapid bedside trend.
NIF -22 cm H2O. Single breath count 12. SpO2 95 percent on room air. Bulbar weakness with weak cough.
vital capacity — Maximum exhaled volume after deepest inhalation; declines in neuromuscular failure.