A nurse is caring for a patient with Guillain-Barré syndrome who is experiencing ascending paralysis. Which nursing intervention should be the highest priority to ensure patient safety?

Key Monitoring Parameters: Assess respiratory rate, depth, and pattern hourly. Monitor forced vital capacity (FVC) and negative inspiratory force (NIF) every 2-4 hours during the progressive phase. A decline in FVC below 20 mL/kg or NIF less than -30 cm H₂O indicates impending respiratory failure and the need for mechanical ventilation.

Early Warning Signs: Watch for dyspnea, shallow breathing, use of accessory muscles, paradoxical abdominal movement, and difficulty speaking in full sentences. Tachycardia, diaphoresis, and anxiety may signal hypoxia or hypercapnia before objective measures decline.

Preparing for Mechanical Ventilation: Have emergency airway equipment at the bedside, including a bag-valve-mask device, suction apparatus, and endotracheal intubation supplies. Notify the respiratory therapy team and ICU early when trends show declining respiratory function.

Nursing Actions: Position the patient with the head of bed elevated 30-45 degrees to optimize diaphragmatic excursion. Avoid sedatives that may depress respiratory drive. Cluster care to minimize fatigue. Provide clear communication strategies for the patient who may have bulbar weakness.