Tips for new Neuro ICU extern?

Joanne Hickey's book. Sorry I cant remember the whole title but its something like: neurosurgical nursing. Its the bible of neuro. Im a new grad in neuro icu. sooo much to learn good luck!

Hi, I found your Neuro ICU extern comment. I will be externing at Neuro ICU this summer. I am wondering if you could give me some tips about how you survived and how I could prepare well for the extern. I have no ICU clinical experience at school yet, so I would really appreciate if you could let me know. thank you!

I just started in Neuro ICU in a 16 bed busy unit. Congrats on getting an extern in one

Some things I wished I would have known before starting neuro ICU
- How to do a head to toe neuro assessment head to toe systematically
- Ways to stimulate a patient that will not wake up (weather they are tired or increased ICP)
- Signs and symptoms of Increasing Intercranial Pressure (ICP)
- How to manage a ventriculostomy (Keep it equal with tragus of ear, monitor color and amount of CSF, watch ventric site and clamp ventic site if you move the patient at all)
- How to manage basic ventilator skills
- How to manage a patient with ICP issues- (keep head mid line, HOB 30 Degrees)

Diagnosis that will be helpful on knowing and how to manage
- Subarachnoid hemorrhage (We get these all of the time but our docs specialize on these).
- Stroke (difference between hemorrhagic and ischemic, left and right)
- Brain tumors/ cancer (glioblastoma, mennigioma)
- Subdural bleeds
- Traumatic brain injury
- Also too pulmonary edema (For some reason I never dealt with this but in the last week I have had a lot of people with pulmonary edema WIERD)

THE MOST IMPORTANT PART
- Which my preceptor told me never forget the basics. Remember DVT prevention (SCDs and teds), keep linens under the patient (NO WRINKLES), deep breathe and cough and use Incentive spirometry, try to get patients who can up in a chair or walking, bathing (esp Indwelling foley catheter), turn every two hours
I know ICU you want exiting things and to save lives but what quality of a life will a person get if you only want exiting things but in the end without the basics end up with DVTs, PE, skin break down, pneumonia, UTI complications that are really preventable. THAT WAS MY WAKE UP CALL. Also too whatever you do or med you give just try to think of a rational why you are doing this or why is this med being given, or why if a bp goes up (try to figure out how come things happen)

Keep organized, keep up with charting because you never know when your patient will have a complication and will get stuck in there and then get behind on everything.

I hope you really enjoy the ICU. I am loving every second of it.
Sorry if I am all over the place but this is just a few pieces of information that will help you out
kent

Kent,
Thank you sooo much for all the information! I am wondering if there's any book or textbook that would help me survive there. have you bought any for Neurology?

aboville

I wish I could recommend a book for you to succed on practice. I wish I have one , but I feel it comes with experence.

Today for instance we got a patient who came from the floor with respiratory difficulties. With lab work showing a High BNP (which indicated fluid overloaded) so she probibly has pulmonary edema. Crap i never took care of a patient with that.

So later on in the day her o2 sats were down in the 90's when all day it was in the higher ninties. I freaked my preceptor helped me out with the situation. Lets assess her lung sounds, see if she is SOB and tried raising her o2 on her NC.

She still was down so I put the head of her bed up and tried getting her to cough and calm her down to see if she could take deeper breaths. Looked at PRN list and nothing to help her fluid filled lungs (no lasix prn darnit hehe).

So with all of the information knowing she is fluid overloaded, her lungs are diminished/ crackly. My preceptor poined to me that we should call the doc and get a lasix order. We did and I wished I could see the results but it is knowing what to do and never feel afraid to ask someone.

So tonite since I am obviously not too smart with my pulmonary edema I will do some research online for it. Like clinical signs and symptoms, meds for it and pathophysiology. It is interesting but very time comsuming


kent

That's great that your wanting to read up before you get there.

I agree with the above poster. Google SAH, different types of strokes, SDH/ICH, GCS, neuro exam, aneurysms, cranis, ICP management, BP management with stroke pts (high vs low BP & gtts to help with that). Just get a general idea of neuro pts. You won't be able to learn everything by reading a book, but at least you will have some idea.

Really...experience is where you learn everything.

When I first started, I would come home from work & look up things I did (when I didn't have time to at work) and write things down. That would help me.

Being in an ICU you will stumble upon all sorts of things non neuro related. Sometimes all you can do is learn as you go. The pulmonary edema pt you had...next time you will be able to recognize this, maybe tell a doc my pt may be going into this,etc..

I'm learning new things all of the time. Don't overwhelm yourself, no one is perfect in the beginning. You aren't expected to know everything. You'll be ok!

So glad I came across this thread. I am a new grad that will be starting soon in the Neuro ICU (very excited and scared too!!) I have come across some great tips reading the enteries. Thanks so much!!

DLangston