[DustinRN]

I wanted to ask a question to all the ICU nurses out there. If you could teach the preceptor students 1 or 2 things before they arrived to start their preceptorship what would it be and why?

Basically, I want to know if you have any suggestions for me before I start my preceptorship in the Neuro ICU this Saturday.

Thanks Guys

[suzanne4]

1. Never reposition the patient who has a ventriculostomy open to drain, without having your preceptor close the drain first.

That is the most important thing that I can think of right now, that would be different from most of the other ICUs.

Good luck.................

[DustinRN]

Originally Posted by suzanne4

1. Never reposition the patient who has a ventriculostomy open to drain, without having your preceptor close the drain first.

That is the most important thing that I can think of right now, that would be different from most of the other ICUs.

Good luck.................

Thanks for the advice Suzanne! I just want to seem half-way competent when I go there.


Can anyone else think of anything that would be helpful to know before I start?

[gwenith]

Learn how your colleagues use and assess with the GCS - there is huge variance in how people assess using this tool - learn how THEY use it so that you are all on the same playing field.

Pupils are not neccessarily the first things to change with rising ICP

When thinking of those things that increase ICP think of the worst hangover/headache you have ever had - now think of those things that you did not do

i.e. cough/sneeze
strain at stool
twist your neck around
listen to loud music/noises

now still thinking of that headache/hangover imagine if someone dropped some money on the ground in front of you and told you that if you bent over so you were head down you could pick up a keep the money - how much money would we have to drop on the floor before you picked it up????

Get the picture - you never ever place a patient with increased ICP in the head-down position usually 30 degrees head up.

Keep us posted on your progress - if we can't answer your questions there should be someone who can.

[Tweety]

Good advice Gwen. When I worked neuro the nurses seemed to be obessed with the pupils. LOL

I would definately bone up on the signs of increased ICP. Just be a sponge, open minded and ask a lot of questions.

Also try not to judge the nurses. Students have a way of being very judgemental, that's not a slam to students, because I was probably the same way. Just realize there are all kinds of nurses out there from different backgrounds with different ways of doing things. Become the nurse you want to become without worrying about what others are doing, and don't compromise.

I love having students around, because they have such fresh knowledge that I can learn from, I may have the skills, so we can equally benefit.

Good luck!

Again, ask lots of questions.

[DustinRN]

Originally Posted by 3rdShiftGuy

Good advice Gwen. When I worked neuro the nurses seemed to be obessed with the pupils. LOL

I would definately bone up on the signs of increased ICP. Just be a sponge, open minded and ask a lot of questions.

Also try not to judge the nurses. Students have a way of being very judgemental, that's not a slam to students, because I was probably the same way. Just realize there are all kinds of nurses out there from different backgrounds with different ways of doing things. Become the nurse you want to become without worrying about what others are doing, and don't compromise.

I love having students around, because they have such fresh knowledge that I can learn from, I may have the skills, so we can equally benefit.

Good luck!

Again, ask lots of questions.

Gwenn and 3rdshiftguy, those are very helpful tips. I've never thought of all things I try to avoid when I have a migraine. When you spell them out like that it really makes since as to what I should try to avoid so they don't increase their ICP.

3rdshiftguy, I have definitely noticed that all nurses have their particular ways of getting tasks done. At first It would frustrate me, because I was like, "Wait! That's not how the nurse yesterday did it!" Now I realize that everyone has their own specific way of doing things and as long as it doesn't compromise patient safety it's fine. I've actually learned a lot of different techniques for a lot of different procedures.

Thank all of you for the help. Trust me, I'm soaking this stuff up. You can be assured that I will ask numerous questions when my preceptorship starts on Saturday.

[Kudra]

here's from 1 student to another: mouth care, mouth care, mouth care...

i found neuro patients almost always had a distinctive smell about them, usually stemming from their oral cavity... mouth care at least ever 2 hours is a must... it sounds really simple and inconsequential considering all the other things going on with the patient, but seriously, it helps... the family appreciates it...

i second the open drain comment...

and remember, this is an excellent time to perfect your assessment skills... everything i ever learned in my Physical Assessment course, i put into use my first day caring for a neuro patient in the ICU... it was awesome!

beth

[gwenith]

I absolutely totally agree about the mouth care - there is an old nursing saying that the worse the smell from the mouth the worse the head injury.

Hmmmm perhaps we should research that..........

[NeuroICURN]

I HEAR YA ABOUT THEIR BREATH....WE CALL IT "HEAD BREATH"!!! YUK!!

Dustin, what area are you in?

Anyway, as a neuro ICU nurse, there's soooooo much I could tell you, but it would take up the entire page! LOL Most importantly, don't be afraid to ask a question! Neuro is a REALLY intense and specialized place...you can't always tell what's going on just by looking at a monitor, so your assessment skills have to be right on.

First of all...thank you to the person that said not to move the HOB for a patient with an EVD (a venticulostomy). I don't know how many times I've had to run, yelling toward my patient's bed as a supplemental staff member (i.e. speech therapy, OT/PT) started to move it! Most know better, but sometimes you get a new one who doesn't!

Also, yes, pupils are important, but also remember that assymetry of pupils CAN also be normal!!! Go with things like their level of consciousness...are they more lethargic now? are they not as strong on one side as they were before??

Now, write this down...The TRUE test of upper body strength is to test for pronator drift! Have the patient hold their arms up in the air, palms to the sky (as if they're holding a big pizza box), tell them to close their eyes and hold the arms still and not let them move for approximately 5 seconds. Especially in patient's who've had an aneurysm that bled and had one clipped or coiled, that is often one of the FIRST signs you'll see if they're going into vasospasm!!!

Finally, don't be afraid to trust your instincts!!! Some of neuro nursing is listening to your instinct.....there are times when just the slightest little thing may be different from your previous assessment, but if it JUST DOESN'T FEEL RIGHT, sometimes, it's not!

Feel free to personal message me with any further questions you may have! Hope I gave ya a few helpful tips to get ya started.

Take care!

PS...I'd love to hear from all my fellow neuro ICU nurses out there!

[gwenith]

Absolutely agree with Neuroicurn - The pupil thing - I was being nice - so many many people focus on just the pupils - focus on level of consciousness and rousability. One of my "gripes" with the standard glasgow coma scale is that it does not accurately assess rousability beyond the eye opening. One very good article I read when I was researching the GCS recommended "timing" the noxious stimuli you were performing both to get a more accurate assessment of rousability and to prevent people from "overdoing" it.

I hear you too NeuroICURN about hearing from more Neuro nurses in general. I would love this forum to become more active and have tossed around the idea of making it a more general neuro forum.