Recognizing dysautonomia
On day 5 the client's blood pressure swings between 86/50 and 176/98 mmHg and his heart rate between 48 and 124/min within a few hours. Wide, alternating swings in both directions are the signature of autonomic dysfunction (dysautonomia), which is common in Guillain-Barré syndrome. GBS can damage autonomic as well as motor fibers, producing labile blood pressure, alternating tachycardia and bradycardia, and dysrhythmias. Because these changes can be life-threatening, clients with GBS are placed on continuous cardiac monitoring.
How the stem rules out other causes
The question carefully removes the usual triggers of sympathetic surges. The swings occurred during a 3-hour break when no immunoglobulin was running. He has no pain and no fever, his abdomen is soft, and the bladder scan shows only 90 mL, so urinary retention and bowel distension, which can provoke autonomic surges, are absent. With those causes excluded, the most likely explanation is the disease itself.
Why the distractors do not fit
Each distractor explains only one direction of change.
| Option | Expected pattern | Why it fails here |
|---|
| Dehydration | Low blood pressure with a fast pulse | Does not cause severe hypertension or bradycardia |
| Infusion reaction to IVIG | Fever, headache, chills, or anaphylaxis during infusion | No infusion was running and there is no fever |
| Autonomic instability | Alternating high and low blood pressure and heart rate | Matches the findings |
| Anxiety | High blood pressure and fast pulse | Does not cause hypotension with bradycardia |
Watch out! Do not choose dehydration just because the blood pressure dropped to 86/50. A single cause that explains all of the findings, including hypertension alternating with bradycardia, is the better answer.
Nursing response
The nurse keeps the client on continuous cardiac monitoring, measures blood pressure frequently, and reports extremes rather than treating every swing aggressively, because short-acting agents are preferred when treatment is needed. Positional changes are made slowly, and triggers such as a full bladder, constipation, or suctioning are minimized. Key point! In GBS, labile blood pressure and heart rate without another cause point to autonomic involvement, which calls for continuous cardiac monitoring.