Ascending Abe — Guillain-Barré Syndrome: Weakness That Climbs Toward the Lungs
His tingling toes became weak legs, then a weak chest — the paralysis is climbing, and the only question that matters is his breathing
Abe had diarrhea two weeks ago. Yesterday his legs felt heavy; today he cannot lift them, and the nurse is measuring his vital capacity every few hours.
Abe's immune system attacked his peripheral nerves after a GI infection. Guillain-Barré causes an ASCENDING, symmetric weakness with absent deep tendon reflexes, usually starting in the feet and rising over days to weeks. The single greatest danger is respiratory failure when the weakness reaches the diaphragm — nurses track forced vital capacity and negative inspiratory force, not just strength. CSF shows high protein with normal cells, and treatment is IVIG or plasmapheresis. Pain and autonomic swings (labile blood pressure, dysrhythmias) are common; most clients recover over months.
Read Ascending Abe's full story →The story arc
The setup
Two weeks after a stomach bug, Abe notices tingling in his toes and legs that feel like wet cement.
The turn
His knee and ankle reflexes are gone, his walking is unsteady, and the weakness is climbing toward his trunk.
The crisis
Abe's voice is softer and his cough is weak. His forced vital capacity is falling — the weakness is reaching the muscles of breathing.
The save
Abe starts IVIG, his breathing is monitored on a schedule, and rehabilitation begins early while his nerves slowly remyelinate.
NCLEX study section — Guillain-Barré Syndrome: Weakness That Climbs Toward the Lungs
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Neurological
Take this chapter into practice questions on the same topic.