The nurse caring for a client in ICU diagnosed with Guillain-Barré syndrome should prioritize monitoring for which potential complication?

Rationale: A. Incorrect because hyperglycemia is not a primary complication of Guillain-Barré syndrome (GBS). Blood glucose should be monitored if the patient has diabetes or is receiving corticosteroids, but it is not the most urgent concern. B. Incorrect because gastrointestinal symptoms like diarrhea are not a hallmark of GBS. The syndrome primarily affects the peripheral nervous system rather than causing direct GI complications. C. Correct because Guillain-Barré syndrome can cause ascending paralysis that may involve the respiratory muscles, including the diaphragm and intercostal muscles. Respiratory compromise can progress rapidly and become life-threatening. Monitoring respiratory rate, tidal volume, oxygen saturation, and signs of increased work of breathing is critical. Early recognition allows timely intervention, such as mechanical ventilation, before complete respiratory failure occurs. D. Incorrect because while autonomic dysfunction can occur in GBS, leading to blood pressure fluctuations, it is not the most immediate or life-threatening complication. Respiratory failure takes priority.