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