A few Neuro Q's....

[raindrop]

Can you guys tell I have a Neuro test coming up that is either going to make or break me???

1) If you are assesing a comatose Pt, who is a 1 on the Glasgow chart for Eye response, do you open the lid and check the pupil response or not? If yes, is this how u would chart it....Glasgow Eye 1, pupils Pearl...or...if they don't react...Glasgow eye 1, pupils not PERLA? Or maybe u don't even open the eye?

2) How do u chart that u did a Glasgow? Do u write out each test, i.e., Eye 2, Speech 2, Motor 2. Hmmm.

3) What Pt's absolutely can't have a spinal tap?

4) If someone comes into the ER with a suspected neck and/or spinal cord injury, and they have a brace on, the HOB is to be up 30 degrees, right? The only time they are to be flat is if they aren't stabilized, but if they are, the HOB should be up, for both types of injuries?

[nurse lucky]

Can you guys tell I have a Neuro test coming up that is either going to make or break me???

1) If you are assesing a comatose Pt, who is a 1 on the Glasgow chart for Eye response, do you open the lid and check the pupil response or not? If yes, is this how u would chart it....Glasgow Eye 1, pupils Pearl...or...if they don't react...Glasgow eye 1, pupils not PERLA? Or maybe u don't even open the eye?

2) How do u chart that u did a Glasgow? Do u write out each test, i.e., Eye 2, Speech 2, Motor 2. Hmmm.

3) What Pt's absolutely can't have a spinal tap?

4) If someone comes into the ER with a suspected neck and/or spinal cord injury, and they have a brace on, the HOB is to be up 30 degrees, right? The only time they are to be flat is if they aren't stabilized, but if they are, the HOB should be up, for both types of injuries?

People who are on anticoags can't have spinal taps as they may develop a hematoma which could cause paralysis!

No one does well on a neuro test in school, because they texts are outdated as the theorys and care change rapidly. I would probably fail the test as we do things differently than that taught in the book. Thank god it's over! Don't feel bad. You're all done with it and on to the rest!!!

[pedseducator]

For those who have experience with ICP monitoring: Does anyone have a special procedure for securing an ICP bolt/monitor to the patient? We recently had one become dislodged during a linen change and the nurse to whom this happened asked if we could secure the apparatus in a better fasion so that this incident would not happen again. Thanks!!!!

[RoxanRN]

We coil the tubing around the site and then cover it all with a large tegaderm. If needed, we tape another loop to the side (away from the tegaderm). It's not a cure-all, but it helps. Just pay extra special attention to the ventric when moving the patient or changing linens.

For bolts, the physician needs to make sure the bolt is secure in the head and the catheter is secure in the device. Again, if needed, we will coil the tubing and tape securely.