Advice regarding student in Neuro ICU

DustinRN · Apr 22, 2004, 09:41 PM

First of all thank you for the tips. Keep them coming! :chuckle I will make sure to implement all of these tips that I received from everyone.

NeuroICURN, the unit I'll be going to is Neuro/Trauma ICU. This is possibly the unit I will work on when I graduate on May 11th. The nurse manager has two positions open and I believe she is holding them for a classmate and me. I just want to make a good impression during my preceptor experience.

These are just a few things I plan on reviewing before I start on Saturday.

1. I'm going to read the whole neuro chapter in my med-surg book.
2. Make a couple of 3 by 5 index cards regarding ICP and GCS
3. Record all the normal values for ICP, CPP, MAP, PAWP, and PAP. I can't really thing of any other values off the top of my head right now.
4. I'm going to try and review ventilators in my textbook

Those are just a few things that I'm going to look before I go in on Saturday. If there is anything that you think I should focus more on I'm all ears! :chuckle

Do you think this is enough to review, or do you think I need to review different material?

Again, I have recorded all of the tips that everyone has provided and I thank you.

*Tweety* · Apr 22, 2004, 10:04 PM

Dustin, you'll do great, don't feel you have to know it all. Perhaps you might want to bone up on the common neuro meds like pentobarb, dilantin, decadron and sedatives like fetanyl, norcuron (sp?), etc. The other guys can tell you what they've used, as when I floated to neuro ICU from the intermediate unit (my home for three years) I took more stable patients.

Good luck. Let us know what you think after Saturday.

gwenith · Apr 22, 2004, 10:04 PM

I have started a sticky thread in this forum for people to add books and articles that they find useful - if you can add to that please go ahead!!!

DustinRN · Apr 23, 2004, 09:43 AM

Originally Posted by gwenith

I have started a sticky thread in this forum for people to add books and articles that they find useful - if you can add to that please go ahead!!!

Thanks for the websites gwenith! I copied and pasted some of the charts on them to print onto my 3 by 5 index cards.

3rdshiftguy, I'll make it a priority to look up those meds that you noted earlier.

I'll let you guys/gals know how it went after I get off on Saturday.

DustinRN · Apr 24, 2004, 08:02 PM

Today wasn't that bad. We had one pt with a subdural hematoma (resolved) going through DT's from alcohol withdrawal. He was a combative little thing. The other guy being on "floor status." We had a new admit that was hit in the head with a 25lb anchor. He was a site for sore eyes :chuckle (pun intended) Periorbital hematoma like crazy. Nice 3 inch laceration across his brow too. Oh man I have so much to share and so little time to do it in. This was my first time eve working a 12hr shift and it was tiresome. There is one thing I know for sure and that is I'll be buying new shoes before I start work after graduation. My legs are killing me!! Anyways, I had a great day and learned a ton. I can't wait to go back tomorrow. I will share more in the next day or too as soon as I catch up on some sleep. Going in again at 7am Sunday, so I'm hitting the sack. I've got to learn how to be a pro at this 12hr shift thing. I'm just fixing to pass out now as it is typing while lying in my bed. I'm really loving the unit so far...........zzzzzzzzzzzzzzzzzz

*suzanne4* · Apr 24, 2004, 09:19 PM

Glad to hear that you had such a good day, and rewarding at that..............
Keep up the good work.................

and please keep us posted.

gwenith · Apr 24, 2004, 10:55 PM

Peri-orbital haematoma eh??? Look up the term "racoon eyes" it has special significance and a whole slew of special "Do not's"

Racoon eyes (Bilateral periorbital haematoma) and Battle's sign ( Bruising over the mastoid) may be signs of base of skull fracture. If you notice either sign you should look for CSF leaks from nose or ears. Especially be on the look out for halo's sign.

NEURO DO NOT's for base of skull fracture

Do not ever put anything up the patients nose or in thier ears

Monitor for infection

Do NOT put anything up the patients nose or in their ears

Do not allow them to blow thier nose - especially if there is evidence of a leak

Put NOTHING in the patients nose or ears

Monitor pupils and vision very carefully as the fracture may impact on the optic nerve

When I say don't put anything up the nose or ears that includes suction catheters ear wicks and nasogastric tubes

Monitor functioning of the 3,4 and 6th nerve

Did I mention about not putting anything up the patient's nose or in thier ears??

I was going to post a picture of a CT which shows the brain intubated by a nasogastric tube but I can't find the picture - which is probably just as well as it is rather shocking.

*perfectbluebuildings* · Apr 24, 2004, 11:58 PM

this is really interesting to me to hear all these tips! I am a third year out of four years nursing student, and just recently found out I will be working on a neuro unit this summer (an externship) and am eager to learn as much about neuro nursing as I can! It is not an area of nursing I really have any experience with at all, except for a little with family members. I am not sure at all what to expect! It is not an ICU, but a general neurology unit with a focus on epilepsy. Thanks for all the tips and keep them coming!! I will have to keep you all posted on how my externship goes (it starts June 7). Thanks again!!

NeuroICURN · Apr 25, 2004, 10:21 AM

Gwenith.....

EXCELLENT advice! You took the words right out of my mouth!

pokey sn · Apr 25, 2004, 09:15 PM

I'm just a student as well but I just precepted in two of the ICU's at the largest hospital in the state three days ago. My preceptors were excellent!! They wanted me to remember: Make sure the MAP (mean arterial pressure) stays above 60, DOCUMENT DOCUMENT DOCUMENT, and stay organized. Good luck!