Neuromuscular and seizure disorders

This chapter is airway-first neurology: Guillain-Barré and myasthenic crisis kill by failing ventilation; meningitis and seizures demand protection, timing, and escalation. Pediatric seizure and Reye patterns live in Paediatric neurology. Phenytoin, cholinesterase inhibitors, and related drug rules live in Neurologic medications.

Guillain-Barré: ascending paralysis and the airway

Guillain-Barré syndrome is an acute autoimmune attack on peripheral myelin, often after a GI or respiratory infection cue on the stem. Weakness usually starts in the legs and climbs. Sensory paresthesias and areflexia are common, but the exam priority is not walking — it is whether the client can still move air and protect the airway.

Trend respiratory rate, work of breathing, SpO2, and ordered bedside ventilatory measures. Do not wait for cyanosis. Supportive care and ordered therapies (IVIG or plasma exchange patterns as tested) buy time; nursing owns recognition and escalation.

Myasthenia gravis: fatigue versus crisis

Myasthenia gravis is antibody-mediated failure at the neuromuscular junction. Strength falls with repeated use and recovers somewhat with rest. Classic stems show ptosis that worsens through the day, nasal speech after talking, or choking on dinner after chewing. Plan rest before meals, give cholinesterase inhibitors on time so peak effect covers eating, and avoid stacking unnecessary neuromuscular blockers when the stem offers that trap.

1. Assess swallow and voice before oral intake when fatigued.
2. Keep suction and airway equipment ready in crisis risk.
3. Distinguish worsening weakness from cholinergic overdose cues before giving more inhibitor — involve the provider; do not guess the crisis type alone.

Myasthenic crisis presents with severe weakness and respiratory compromise, often after infection, surgery, or missed doses. Cholinergic crisis adds muscarinic excess (diarrhea, salivation, bradycardia, fasciculations). Both can need ventilatory support. Detailed antidote and dosing logic belong with neurologic medications; this chapter owns the recognition that breathing beats the drug debate.

Meningitis and encephalitis (adult cues)

Bacterial meningitis is a time-critical infection of the meninges. Adults present with fever, severe headache, nuchal rigidity, photophobia, and often altered mentation or seizures. Viral patterns may look similar but milder; you still protect yourself and the client until the workup clarifies. Droplet precautions for suspected bacterial meningitis are the usual tested pattern until 24 hours of effective therapy or per facility protocol.

Encephalitis is brain-parenchyma inflammation. Mentation change is earlier and deeper than neck stiffness alone. Same nursing spine: airway, fever control as ordered, seizure precautions, and neuro checks that catch deterioration.

• Kernig/Brudzinski may appear on stems as supporting signs — still treat the whole clinical picture.
• Do not delay ordered antibiotics for a perfect LP story when the stem says sepsis/meningitis pathway is underway.
• Quiet, dim environment reduces photophobia and agitation while workup proceeds.

Seizure first aid and status epilepticus

A seizure is a temporary electrical storm. Your job in the first minutes is injury prevention and observation, not wrestling the client still. Clear hard objects, loosen tight clothing at the neck, guide to the floor if needed, and turn to the side when safe to reduce aspiration. Time the event from onset. Do not put fingers, spoons, or padded tongue blades in the mouth — that breaks teeth and your hand. After the clonic phase, suction if secretions threaten the airway and reorient gently in the postictal period.

Status epilepticus is continuous seizure activity or repeated seizures without full recovery between them. It is an airway and brain emergency: call for help, support oxygenation, and give rescue meds as ordered (benzodiazepine first-line patterns as tested). Document duration, body parts involved, incontinence, cyanosis, and recovery. Triggers on stems include missed antiepileptics, alcohol withdrawal, fever, and metabolic chaos — fix what you can after the airway is safe.

Priority map