Any advice - Neuro ICU Clinical

canigraduate · Jul 2, 2015

If you are interested and can afford it, go on Amazon and get the Neuro Notes flip book. It has a wealth of relevant info.

In the Neuro ICU, you will be seeing mostly CVA/head trauma, strokes, aneurysms, brain tumors, seizures, some ETOH withdrawal when it's really bad, hemorrhages, and some eclampsia.

You will need to know about your pain and sedation drips. You will need to know your pressors. You will need to know ICP measurements, what they mean, and what you need to do to fix them.

You will need to know the s/sx of stroke and it will help to be familiar with the NIHSS. You can actually get certified online for this one, as it is a fairly straight forward assessment.

You will need to remember to keep it quiet around patients with ventrics so you don't raise their ICP. Keep turning, bathing, ADLS, light, noise, and all stimulation to a minimum.

What else.....?

Keep your sense of humor and don't get too involved. These can be some of the saddest cases, especially when it's a young victim.

Here.I.Stand, BSN, RN · Jul 6, 2015

We use quite a bit of prn labetalol & hydralazine, and Nicardipine gtts when the prns don't work to keep the BP down.

We give lots of hypertonic saline--mostly 2% or 3%, sometimes 5%, and a fair amount of 23%. 23% is given as a one time dose over 15 min. for ICPs >20.

Neurogenic fevers happen a fair amount. Kind of related is Tylenol related hypotension...every once in a while you may see a neuro pt whose BP tanks after receiving Tylenol.

Neurogenic shock will be important if it's a trauma center and see those high SCIs.

I'd do some reading on the neuromuscular blockers. In my ICU (surg/trauma/neuro), most of our medically paralyzed pts are due to ICPs unresponsive to less drastic measures.

As canigraduate said, if the pt has ICP issues they need stimulation kept to a minimum. Families may need to be reminded of this. I've had dysfunctional family situations playing out in pt rooms, such as divorced parents of a young adult who have trouble being civil. I have had to say, "your son and his brain need a calm, quiet environment. If you need to fight, you need to do it outside of the unit." I've also had the very well-meaning loved ones who constantly want to rub the pt's feet or hands, talk to them, stimulate them...once I had to explain several times why this was not helpful--ICPs were in the high 10s and would go into the high 20s/low 30s with any stimulation. The friend was really very sweet, but was on the slow side. He kept saying, "But they say you're supposed to talk to someone in a coma." After a few explanations he seemed to understand, but initially he was convinced that his friend needed the stimulation.

Some of these cases are heartbreaking. Families often need nursing care too; unlike a chronic illness, or something like a CA dx where they likely got the news in clinic and were then admitted to the hospital, lots of neuro ICU pts have been suddenly stricken (e.g. strokes, TBIs, high SCIs). They are devastated--when someone will never be the same it is a loss--uncertain about the future, and can be overwhelmed by the ICU environment.

When the pt does well though, it's like witnessing a miracle.

canigraduate · Jul 6, 2015

Ah, geez, I can't believe I left out the SCIs (spinal cord injuries).

Had one kid who was thrown from a horse and ended up a quad. Sad.

Here.I.Stand, BSN, RN · Jul 6, 2015

That's very sad. I rode as a kid, never did many competitions but did that type of English style in lessons. I quit soon before Christopher Reeve's accident. My mom was very relieved.