Help!!!!...pleeeez

  1. hello fellow cyber-nurses....l really need some feedback here....here's the deal....at the hospital where l work we have and er residency program for rn's who want to work in the er but have different specialty backgrounds....i volunteered to do the neuro emergencies portion of the program. now l do have some teaching exp....(medical assisting)...but have not taught a class of my peers yet...i will have 40 minutes to cover this topic...which brings me to my question...[what snippets of advice, pearls of wisdom can you share with me regarding your exp. with neuro emergencies?l sort of have a game plan in mind...actually l took this course a few years ago and one of the things l didn't care for was all the ''nursing 101'' review of stuff l already knew....l wanted to know exactly how what l aready knew related to the er setting...imo...the most common neuro complaint that rolls thru the doors of the er is change in loc....but this is very vague.........so ok....how to put this in a nut shell.......any suggestions?......thanks y'all....lr
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  2. 16 Comments

  3. by   SuperCEN
    A few topics that come to mind: headache analysis--chronic complainers vs. " the worst headache of my life"; Seizure patients and proper precautions for airway and self injury: CVA vs. TIA--important to document symptoms onset and length if resolved; PLEASE teach them to do a neuro assesment and chart it: S/S of increased ICP(N/V, headache, posturing); when to think tox. screen with LOC changes. Documentation is a BIG problem in our ER right now--teach them to LOOK at their pt's and document what they see. Our charts sometimes read "family state blah, blah blah, but it would appear the nurse never even assessed the pt by what she has written.
    Oh and tell them even though the Sz is over to go ahead and start the IV. (Alot easier when they are post-ictal then when they are shakin' and bakin' again!) Hope this helps!
  4. by   Jen911
    Few other things to teach them..little snippets.. Elevate the head of the guerney for the CVA's, (tell 'em if they already have a bleed in there, don't you want to let gravity be your friend?)... Check blood sugar ASAP, hypoglycemia can mimic CVA... Teach proper and COMPLETE neuro assesment...

    My pearle of wisdom for a sz pt... if you get a moment of calmness and you have an IV making you nervous but it's still working.., just put in a 2nd heplock and tape that sucker down....keep using that first one till it's gone... THEN go for your heplock.

    I'll keep thinking.....

    Good luck!

    Jenni
  5. by   l.rae
    Thank you, this helps alot....l've printed these......it will be a challenge to present this in 40 minutes......any other thoughts will be greatly appreciated......the date of presentation is 7-31...LR
  6. by   MPHkatie
    And I'm having trouble thinking of snippets:
    #1- pt's who are really altered, don't use the old hand squeeze as a test- as the hand grip is also a reflex on those pts (They will grab on and squeeze tighter and tighter....) Try asking for two fingers instead, or if you like the squeeze, also ask the pt to let go, they should do so rather than squeezing the life out of your hands, if they are in there.

    #2. Teach them how to administer Dilantin (mixed in a appropriate volume of NS. I got tons of pts with a gram dilantin load mixed in 100 cc of saline, and of course that IV site was shot....

    #3 a good exam, is probably going to be the best because it doesn't matter that the nurse doesn't know whats wrong, it's important that the nurse knows something is not normal in that Neuro exam....if you can tell the neuro res. whats going on by phone, this can get some treatments started a bit earlier sometimes.

    #4. If you facility uses solumedrol gtts for spinal injuries- including a nice dosing card based on your hospitals protocol could also help RN's (I keep mine in my mailbox, use it say 3 times a year, but very nice for the three times.

    Thats about all that I know... I feel as if I should remember lots of little perals, but you know, Not sure I rememeber....perhaps I am altered.
  7. by   teeituptom
    Howdy Yall
    From deep in the heart of texas

    Isnt there a company that sells snippets, you find next door to widgets
  8. by   l.rae
    Originally posted by teeituptom
    Howdy Yall
    From deep in the heart of texas

    Isnt there a company that sells snippets, you find next door to widgets
    Howdy Tom.....I thought they were only avail on Home Shopping Channel.....l hear Texas has the Biggest widgets anywhere...any truth to this???????:roll :roll ,.......LR
  9. by   teeituptom
    Howdy yall
    from deep in the heart of texas

    Well I.rae I will defer that question to george W bush. Isnt that where he got his start. From widgets to the whitehouse, this novel should be appearing this fall
  10. by   l.rae
    Originally posted by teeituptom
    Howdy yall
    from deep in the heart of texas

    Well I.rae I will defer that question to george W bush. Isnt that where he got his start. From widgets to the whitehouse, this novel should be appearing this fall

    :roll And l hear Gore's novel..From Whitehouse to Snippets...will be making the scene also:roll ....LR
  11. by   teeituptom
    Howdy yall
    from deep in the heart of texas

    Republican
  12. by   l.rae
    originally posted by teeituptom
    howdy yall
    from deep in the heart of texas

    republican



    .....declaration or acusation?... :d :roll
  13. by   teeituptom
    Howdy Yall
    deom deep in the heart of texas

    Seing as Im the lone democrat in this state, It must be an accusation..........
  14. by   l.rae
    Tom... l had something earlier that l tried to scan and post here for u but l'm having bad luck with that tonight,,,,,,keep your eyes open....someday l might be successful.....looked up your profile thinking l might end up e-mailing it.....7 little golfers huh.?....busy man u are but not so bad for a democrat.....from deep in the heart of the Midwest and standin' in the tall grass up to my a$$.....LR

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