neuro checks question

[justgoofie]

I work in a med/surg icu, that also does small amts of neuro patients. Recently I was the nurse to a male patient who came in status podt cardiac arrest at home.

Currently intubated and comatosed.

EEG's done x3 with no changes, technically not brain dead as he had a little brain activity.

gave report to rn assuming care that pt was posturing but no purposefull motor movement. pupils sluggish in response and about a 4-5 in diameter.

came in next morning and was told pt had strong motor movement upper extremities and moderate motor movement to lower extremities. So of course when i went to do my assessment I expected a improvement in his assessment.

The 4th EEg was scheduled for that morning so family could decide their next step. IE: withdraw support and apply comfort measures, or trach and peg while he slowly recovers.

Needless to say the EEG continued to show no improvement, and when I did my assessment he was still posturing.

Unfortunantly the family was told by the previous nurse that he was responding. so It was like the first day with them again explaining what they were seeing.

When shift change came and the same rn took the patient back I questioned her about her assessment. asking if she had seen something that I wasn't, just to clear up my confusion. I was naive in thinking that maybe i was missing something. (being new to neuro) the Rn became defensive and said I don't bathe the patient so of course i wouldn't see the same things as her. Her feeling was when she lifted his arm up to wash and he tried to keep his arm next to him that was a strong motor movement.

Am I wrong or was that him still posturing?

Needless to say after he was in our icu for 2 weeks the family said enough is enough and withdrew life support and placed him in hospice. and as of yesterday he was still alive, but then again he was only 41. any advice?

[CarpeDiem2004]

From your description of the patient's movements and the scenario, it sounds to me like it was posturing you were seeing. To avoid this sort of problem, I frequently go to see my patient with the nurse I am reporting to or am receiving report from during our report time, to make sure we "are on the same page" about what we are seeing.

[BadBird, BSN, RN]

Just another reason to give bedside report so you can discuss the assessment and come to some type of understanding what the other nurse thinks he/she sees.

[altomga, ADN, BSN, MSN, DNP, RN, APRN]

Bed side reports!! This is the best way to clarify and demonstrate what you see and what the pt is doing or NOT doing. In the ICU (neuro-surg/surg/trauma) we do this frequently so there is no question about what the pt was like when we leave.

[justgoofie]

thank you guys for you insight's. The bad part is we do bedside reports, on all our patients. The unfortunate part is she felt that there was motor movement while doing her bath in the middle of the night, and then the motor movement was gone by morning?