I have a question for those of you who specialize in neurology and neurosurgery.

My 82 year old mother, who had taken a fall this Monday and seen in the ER, was admitted to the hospital and now that all of the tests/scans have been run and analyzed, the neurosurgeon updated me this morning that she has what they first suspected in the ER, a Meningioma, but unfortunately it's a big, nasty aggressive one that covers pretty much the entire frontal lobe of her brain.

There are really only two options, and they are bad or worse. The bad is proceeding with surgery to remove the tumor, which they feel confident they can do because of the location, but at best it is iffy and despite of course wishing for the best possible outcome for quality of life, there are the definite risks of infection, bleeding, and left-side weakness (her dominant side is the left). 

Worse is doing nothing and following the natural progression of end of life. 

I am devastated to hear this. I had suspected for some time that there was something wrong with my mom, but she absolutely refused to have any testing done. I never would have suspected this.

Now my 3 siblings and I are meeting tomorrow by Zoom to discuss everything. I am so conflicted. (Just for more information, I am the HCP and POA). She has told me over and over in the past that she NEVER wants to be in a facility and I am afraid if we proceed with the surgery that this could happen.

Also, for more background, I asked the neurosurgeon if my mother has decision-making capabilities, and he let me know he does not think so based on her presentation.

I don't know what to do : (   

I have a year's experience on a neuro step-down unit, and studied about a month. The resources I used were:

-Comprehensive Review For Stroke Nursing: this is the review book from AANN. It is very detailed, there are some charts but it's mostly text. Looking back, this book has a lot of info that wasn't on my exam, however the details do help in understanding.

-Fast Facts for Stroke Care Nursing: this is a quick small review book that covers the essentials to know about caring for stroke patients. It covers a lot of what is on the exam, so I went thru it after I did the Comprehensive Review. It includes a lot of tips that are helpful, and helps you make sense of the details from the Comprehensive Review.

-Stroke Chapters in Clinical Practice of Neurological and Neurosurgical Nursing: I looked thru the cerebrovascular anatomy (definitely need to know this), ischemic, ICH, aneurysm, and AVM chapters. Doesn't cover everything on the exam, but good overviews, and has a good chart on stroke syndrome symptoms by vessel, which you need to know.

-Stroke Certification Study Guide for Nurses: Q&A Review: this is by the same author as Fast Facts. It's a 300 question review book, covering each section of the SCRN exam, and the number of questions in each section is based on the percentages from the exam blueprint. Good practice, and great rationales.

-SCRN Practice Test: I also bought the 75 question practice test from AANN. The only downside to these questions is there are no rationales. Also, once you submit, you can go back and review the questions, but you can't do them all over again (you'll only see your answer choice, as well as the correct one if you got it wrong).

If you can get these used or from the library, I'd definitely recommend each resource if you like to study on your own. I personally don't like to sit in review classes, however you may find that useful if that's your style.

As far as the test, it was pretty straightforward. I didn't feel like they were trying to trick you, and I didn't have that uncertain feeling like I had during the NCLEX. If you reviewed with these resources, and reflect on your evidence-based clinical experience, it's honestly pretty easy and straightforward. There were maybe 2-3 questions out of the 170 that I just didn't remember ever covering (like a random medication I never heard of), and the ones I figured I got wrong still sounded vaguely familiar. You're allowed to bring a basic calculator, and the only calculation you might have to do would be related to tPA dosage.

Hope that helps, and good luck

3 other (all MedSurg unit) roles are:

• Acute Spine
• Neuroscience
• Telemetry

I've been trying to read up about what the nurse roles in each of these units looks like from the multiple posts in each forum.

What I'm really interested in though is which of these will I do the most in? What I really mean by that is which one has the most variety of hands-on skills? I ask this because that is what I am most lacking in (being a new grad with no prior healthcare experience) and want to go into a place where I will be busy all day and doing a lot of skills, and getting better at them.

I totally get that patient education, communication etc are very very important and I intend to get better at that as well - but I would love to work in a specialty where I am doing more patient care.

I hope I am conveying what I want well ? but if not please do ask more questions.

Thank You
Arvind

I plan on becoming stroke certified by the end of the year. I was wondering, what is a realistic timeframe to study and successfully pass the exam? What were your strategies?

I plan on studying for about 6-8 weeks.

Any advice would help ❤️ thank you.

Understanding how to do a neuro assessment can seem overwhelming to a nurse who is unfamiliar with it. Many nurses feel that neurology is a difficult specialty to understand and that only specially trained nurses can complete this type of assessment. However, it is important not to allow these feelings to prevent providing thorough care to your patients. Neurologic events can happen anywhere, and the best way to recognize them is by including this type of assessment in your basic care.

Early detection of neurologic changes can lead to the identification and treatment of stroke more quickly, allowing for the best possible recovery. The more time passes between the onset and treatment of stroke, the more brain is affected and the lower the chances of improvement in the stroke symptoms. The sooner symptoms are recognized, and treatment is initiated, the better the treatment can benefit the patient.

The best way to recognize neurological changes in a patient is to have a good baseline assessment. This does not have to be complicated or take a long time. Many of these assessments can be done informally while you are conversing with the patient or engaging in your assessment of other body systems.

Neuro Patient Assessment

• The first step is evaluating whether they are alert and oriented. Do they arouse or awaken easily? Do they answer simple questions correctly when you speak to them? 
• The next step is examining their speech. Are their words clear and easy to understand? Do they seem to have difficulty finding the right words to say? Along with their speech, watch their face while they are talking and note if there seems to be symmetry or if one side of the face is drooping. 
• Another step is assessing the patient's movement. If they are responsive, ask them to raise their arms, then their legs. Do they raise and lower them equally, or is one side weaker or unable to move at all? If they are ambulatory, you can observe their gait and see if one side appears to be stronger or if there is limited movement. If they are not responsive, a simple reflex test can be done by pressing on the patient's nailbeds and observing their movement. Does the patient respond to this painful stimulus equally on both sides of the body?
• A final basic assessment step is done by examining the patient's pupils' response to light. A small flashlight or the light on a smartphone can be used for this. Check to see if the pupils are the same size and if both react by constricting as the light is being shone into the eye. It may be helpful to do this in a dark room in order to see the light reaction more clearly.

Once you have completed each of these steps, you now have a baseline neurologic assessment. As you continue to encounter the patient, you can consider if the patient's response is different than their baseline. Any change in alertness, confusion, difficulty speaking, inability to move one side of the body or pupils that are unequal or do not react to light is cause for concern. 

There are many more components to a complete neurological exam, some of which can be quite complex. However, these basic steps can be done by any nurse and can be pivotal in getting patients the care that they need. Your patients will thank you for it!

References/Resources

Simplifying neurologic assessment: Nursing Made Incredibly Easy!

Neurologic Exam: National Library of Medicine

Guidelines For The Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: American Stroke Association / American Heart Association, Inc.

I'm looking for input from acute care/neuro nurses who have Stroke Champions on their floor. This is a very new role to me and is essentially being built from the bottom up. I'd love to know what you do in your role as a stroke champion. Did you receive a raise for this role? How much time do you dedicate to this role? If you aren't a stroke champion, what do you look for from the nurses that is the champion on your unit? I'm not finding much online related to this role. Any ideas, input, advice, all would be appreciated! 

The National Institute on Aging defines Dementia as "The loss of cognitive functioning-thinking, remembering, and reasoning- to such an extent that it interferes with a person's daily life and activities.” It is unimaginable how harsh this disease affects a person, and each person will exhibit signs differently. Some things one may see if the obvious memory loss and confusion. These patients may also find it difficult to express themselves, repeat questions, act very impulsively, and may even find themselves lost in their own neighborhood.

In the following article, we will look at some easy ways to possibly cut down on our chances of developing this condition that takes away crucial parts of human beings.

Are there any ways I can possibly prevent Dementia from developing?

It is known, at this time, that there is no cure for Dementia. However, what if there was something that maybe could lower your risk of developing it? If there was, and even if the idea was opposed by a bunch of naysayers, would you do those activities just to possibly lower that risk of developing dementia?

The American Academy of Neurology released a study where it found that if a person did certain things, they may lower their risk of developing this condition. The types of activities were things that one could argue takes care of the body as a whole. The participants of the study did regular things like performing household chores and daily exercise. They also had regular visits with family and friends. The study showed a lower risk of developing dementia when they were frequently performing those activities than compared to those who did not. You can see how important it is to keep the mind healthy with the stimulation of not only the familiarity of family but also a general sense of accomplishment that one gets from having a purpose when doing chores. We know that physical activity is important as well, but what else can we do to possibly prevent the disease?

Is diet really an important factor?

There have been many people who will constantly say how diet is such an important factor in life. Eating vegetables and fruits and skipping high sugary drinks is the staple of such claims. Can diet affect our chances of developing Dementia? Another study released by the American Academy of Neurology has found an association that individuals who eat high amounts of what they call ultra-processed foods are at a higher risk of developing dementia. These types of foods are those that are higher in salt, sugars, and fats. They are typically lower in healthy things like fiber and protein. These foods are generally those that are deemed as convenient and include soft drinks, ice cream, fried chicken, packaged loaves of bread, and cereals that are flavored, just to name a few. These foods have also been shown to have certain molecules that have emitted from the packaging or have come about from heating. These elements, the study says, have been shown to cause ill effects on a person's ability to think and effected their memory, as evidenced by the results of other previous studies.

Could it be possible that if a person simply reduces their intake of ultra-processed foods, they could, in turn, reduce their risk of getting dementia? Would it be so terrible to cut out those convenient elements of our diets? This study has supportive data to suggest that outcome. The researchers found that individuals could reduce their risk by 19% simply by cutting out little bits of ultra-processed foods and replacing them with things like fresh fruits, veggies, and legumes! The participants of the study only cut out a small percentage of the ultra-processed and had convincing results. This may take a bit of planning on the individual's part, but it would be a better reward in the end to retain memory than enjoy the moment of bliss on your taste buds.

What is the bottom line?

If you are on the side of things where it is important to have data presented to you in order to visualize the results, then check out these two studies. All too often, we hear from medical staff that we need to take care of our bodies by doing exercise and eating healthy. Here we have good evidence that it is true. In both studies, the researchers followed these patients over the course of many years, and they have shown us that by exercising not only the body with physical exercise but also by keeping our diets clear of processed foods and the mind sharp with social interactions, we can at minimum help to reduce the risk of developing dementia.

References

Eating More Ultra-processed Foods Associated with Increased Risk of Dementia

Study: Chores, Exercise, and Social Visits Linked to Lower Risk of Dementia

What Is Dementia? Symptoms, Types, and Diagnosis

I'm wondering what type of route to take to bevome a neuro nurse. Is the pay good? Do you enjoy your work in general? Is it tough to get a job in this department?

Thanks in advance for sharing your experiences.

History and Background

James Parkinson was a British physician who published "An Essay on the Shaking Palsy" in 1817 after closely observing and interviewing six men on the streets of London. These individuals shared symptoms such as tremors, slowness, stiffness and walking hunched forward. His work opened up the idea that this collection of symptoms related to progressive stages of "the same slow-moving disease". April is now established as National Parkinson's Month in honor of Dr. James Parkinson whose birthday was April 11th.

Biology Lesson

Of the extensive research and studies carried out on patients with PD, the main finding in brains of affected patients is loss of dopaminergic neurons in the area of the brain known as the substantia nigra. This is where we produce most of the dopamine our brains use. Dopamine is the chemical messenger that transmits messages between nerves that control movements, as well as those involved in the brain's pleasure and reward centers. In normal aging, these cells begin to die off at a slow rate. In PD patients this process happens at a faster and more profound rate. When over half the cells are gone, the symptoms of PD begin to arise.

PD patients also lose another neurotransmitter known as norepinephrine, a chemical required in the sympathetic nervous system. This system controls autonomic functions in the body such as heart rate, blood pressure, digestion and breathing. With loss of norepinephrine, PD patients experience some non-movement related symptoms such as low blood pressure, fatigue, constipation and anxiety.

Possible Causes

There appears to be no one definitive cause of PD but various theories point to genetic, environmental and lifestyle factors playing a part. It is unclear why some people exposed to these examples develop the disease and some do not.

Genetic : Ted Dawson, MD., Ph.D., director for Cell Engineering at John Hopkins points out that about 15 percent of people with PD have a family history of the condition which can be the result of specific genetic mutations. However the interaction between genetic changes and a person's risk of developing the disease is not fully understood.

Environmental : Another theory is the belief that exposures in the environment such as pesticides, heavy metals, detergents and solvents contribute to the development of the disease.

Lifestyle : Repeated blows to the head such as in boxing and other contact sports where head injuries are common are thought to increase the risk of developing PD. Further studies are required to solidify this theory.

Symptoms

Tremor : Often starting in the hands or fingers a tremor can be present even at rest. Patients may rub their thumb and forefinger back and forth (pill-rolling).

Slowed Movement (Bradykinesia) : Walking becomes slow and steps may be shorter. It may be difficult rising from a chair and feet may drag.

Muscle Rigidity : Stiffness can occur in any part of the body and muscles can be painful with limited range of motion.

Impaired Posture and Balance : Patients often become stooped and have balance issues.

Loss of Automatic Movements : There may be a reduced ability to perform unconscious movements such as blinking and smiling. Arms tend to hang by the side rather than swing during walking, and the face can take on a mask-like appearance.

Speech Changes : Speech may become softer and patients may slur words or hesitate before beginning to speak. A monotone speech style may be apparent.

Writing Changes : Handwriting may appear small and become increasingly difficult to manage.

As Parkinson's progress, complications often arise such as cognitive difficulties, depression, swallowing problems, sleep disturbances, bladder control and constipation.

Some Lesser Known Symptoms

Swallowing Trouble : PD patients often lose weight without actively trying. This is due to the trouble they have chewing, eating and swallowing. They may also cough and choke during eating.

Exhaustion : Patients may nod off during the day and feel generally fatigued possibly due to the added stress on muscles during tremor and contractions.

Losing the Sense of Smell : Compared to the other symptoms mentioned, this may seem like a trivial one, but it can affect the quality of life of the patient already struggling with food intake which can in turn reduce their enjoyment of it.

Orthostatic Hypotension : Some people may experience a drop in blood pressure when changing from sitting to standing position. This lightheadedness can lead to risk of falls.

Stages

According to the Hoehn and Yahr Scale (named after its authors), there are 5 stages of Parkinson's which get worse as the disease progresses through mild to moderate and lastly advanced stages.

1. Symptoms at this stage will mostly be mild and are often missed if they are not interfering with daily life. Tremors or movement challenges may be noticed on one side of the body.
2. The disease enters the moderate stage where symptoms such as trembling, stiffness and changes in facial expressions become more obvious. Symptoms begin to spread to both sides of the body. This progression may take months or years and patients progress at differing rates.
3. Patients begin to experience a decrease in reflexes and loss of balance. Movement becomes slower and risk of falls higher. Activities of daily life begin to get compromised and additional help may be required.
4. By now most patients are unable to live independently and may require a walker or wheelchair to get around.
5. This is the most advanced stage where patients need to be closely monitored to prevent falls. Confusion, hallucinations and delusions may be experienced among some and dementia may be a consideration too. At this stage the side effects of medication outweigh the benefits.

The earlier PD is detected, the sooner treatment such as medication, physiotherapy and occupational therapy can be implemented so it is important not to ignore the early warning signs. 

Common Medications

Levodopa (L-dopa) is the most commonly prescribed drug for Parkinson's and is best for controlling the common motor symptoms previously discussed. Simply put, L-dopa works when the brain cells turn it into dopamine.

Sinemet is a mix of levodopa and another drug called Carbidopa (a medication which makes levodopa work better so less is needed). This helps with the common side effects such as nausea, vomiting and irregular heart rhythms.

Dopamine Agonists eg. Pramipexole (Mirapex) and Rotigotine (Neupro) are drugs which act like dopamine in the brain. They can be taken on their own or alongside Sinemet depending on the patient's symptoms and are often the first choice of treatment for Parkinson's.

Outlook

• Medication together with lifestyle changes can help patients cope with their symptoms of PD and have the best quality of life available to them. 
• Homes can be adapted and there are many therapies available (Physio, Occupational Therapy) which can help patients with their activities of daily living. In the early stages, just after diagnosis, patients may wish to alter their home so they are prepared for when their independence is compromised. 
• Patients are advised to keep active when they can and try new exercises such as Tai-Chi or regular walks in the park. 
• Parkinson's Disease does not directly cause people to die, but the condition can place great strain on the body and in turn increase the risk of complications. The somewhat good news is that with advances in treatment, many people with PD can still lead active lives and have a near-normal life expectancy.

Personal 

Unfortunately for my mum, even walking for her is now a challenge, thanks to a fall resulting in a broken hip! She experiences pain when mobilizing but at least she is still able to do it. Gone are the days when she could take up aerobics or brisk walking. One thing she has not yet lost is her creative talent. She has crocheted baby blankets for years and to this day is still managing to keep those needles going. Her finished work is impeccable - I wish I could be half as creative! As long as she's able, she will still crochet her beautiful legendary blankets and this is something solely for her - my dad isn't helping in that department! Good on you Mum!

References

Mayo Clinic: Parkinson's Disease

National Today: Parkinson's Awareness Month - April 2022

American Parkinson Disease Association

NIH: The History of Parkinson's Disease: Early Clinical Descriptions and Neurological Therapies

Parkinsons.org: Parkinson's Disease Information

Johns Hopkins Medicine: Parkinson's Disease Overview

Parkinson.org: Understanding Parkinson's/Statistics

Cleveland Clinic: Parkinson's Disease

ActiveBeat: Most Common Symptoms of Parkinson's Disease

Parkinson'sDisease.net

WebMD: Your Guide to Parkinson's Disease

About stroke

Just like every organ in the body, the brain needs blood to function properly.  A stroke occurs when blood flow to the brain is blocked because of either a ruptured blood vessel or a clot.  This lack of blood flow causes brain cells to start dying very quickly.  A stroke is also known as a "cerebrovascular accident (CVA)” or a "brain attack".   

3 Common Types of Stroke 

Hemorrhagic Stroke 

When a blood vessel ruptures causing an interruption of blood supply to the brain and pressure on brain cells.  Uncontrolled blood pressure and aneurysms are the leading causes of hemorrhagic strokes.

Ischemic Stroke 

Occurs when there is disruption of blood flow to the brain due to blockage of a blood vessel by either plaque or a clot. It is the most common type of stroke.  An ischemic stroke can also turn into a hemorrhagic stroke.

Transient ischemic Attack (TIA)

Known as a mini-stroke, is a temporary blockage of blood flow to the brain that resolves on its own before there is any permanent damage to the brain.  TIAs tend to be of short duration, lasting a few minutes to one hour, but they are an important warning sign of a possible future and more serious stroke; and it is crucial to seek medical care immediately.

Is it a Stroke? BE-FAST

The American Stroke Association (ASA) reports that for every minute that stroke treatment is delayed, 1.9 million brain cells die.  Use the acronym BE-FAST to recall the warning signs of a stroke:

B – Balance 
Is there sudden unsteady gait, lack of balance, or dizziness? 

E – Eyes 
Are there sudden visual disturbances, loss of or blurred vision, either in one or both eyes?

F – Face 
Is there sudden numbness, or weakness of the face?  Is the face drooping on one side or is uneven when the person smiles?

A – Arms 
Is there sudden numbness, weakness, and/or drifting of one arm when the person holds his or her arms outstretched with palms up and eyes closed (the pronator drift test)?

S - Speech 
Is there sudden confusion, difficulty speaking, slurred speech, or trouble understanding speech?

T - Time 
If any of the above signs are present, it's time! Call 9-1-1 immediately.

Another warning sign of stroke is a sudden onset of intense headache that comes out of nowhere.

Who's at risk of a stroke?

According to Mayo Clinic, any of the following modifiable risk factors (factors that can be changed or treated) increase a person's risk of having a stroke:

• Having high blood pressure.
• Being overweight or obese.
• Leading a sedentary lifestyle.
• Using birth control pills or hormone replacement therapy.
• Having diabetes.
• Having heart disease, especially those that can form blood clots like atrial fibrillation.
• Having an elevated low-density lipoproteins (LDL) cholesterol, known as the bad cholesterol.
• Being under high levels of stress or anxiety.
• Having obstructive sleep apnea.
• Being a smoker or having exposure to second-hand smoking.
• Having a brain aneurysm or arteriovenous malformations (AVMs).
• Having a viral infection, like COVID-19, or an illness that causes inflammation.
• Using illicit drugs such as cocaine.
• Drinking alcohol excessively.
• Having a suboptimal diet.

The following risk factors for stroke are non-modifiable risk factors (factors that can't be changed):

• Being age 55 or older (the risk of stroke increases with age). 
• Being of African American, Hispanic, or American Indian descent.
• Being a male (men are more likely to have a stroke than women).
• Having sickle cell disease. 
• Having a family history of stroke, TIA, and/or heart disease.
• Having had a previous stroke or TIA.

The ASA reports that 80% of strokes are preventable.  The modifiable risk factors listed above can be managed and treated through lifestyle changes, medical treatments, stroke risk screenings, and education.  Stroke care begins with prevention! 

The Nurse's Role in Stroke Care: A Brief Overview  

Stroke is an emergency and stroke care is complex.  Nurses and healthcare providers have a key responsibility to improve outcomes and decrease disability and mortality in stroke patients by timely recognition of the signs and symptoms of stroke and early intervention.  In the acute care setting, competent nursing management in all phases of care, from arrival to the emergency room through discharge, is vital; and nurses must have a full understanding of their role: 

Please note that the succession of events, steps, and responsibilities listed below are not all-inclusive and will vary based on the facility.  It is strongly recommended that institutional policies and protocols are reviewed and adhered to.

In the Emergency Room

• When a stroke is suspected at presentation to the emergency room, remember the principle "Time is Brain".  The triage nurse's role is to promptly screen the patient using an institution-designated stroke screening tool.  The National Institutes of Health Stroke Scale (NIHSS) is a commonly used tool that uses a scoring system to determine the severity of strokes.
• Many institutions have established a Stroke Alert process – which mimics the concept of a Code Blue – that is used to notify a pre-designated team of providers of an acute stroke and to quickly activate the stroke response system.  Usually, the triage/emergency room nurse will activate the Stroke Alert.
• A 60-minute or less protocol, developed by the ASA, lists specific medical interventions that must be performed at set intervals within the first 60 minutes of the patient's arrival in the emergency room to optimize outcomes.  In most facilities, the emergency room nurse is responsible to document the arrival time of a stroke patient and, if possible, document the patient's last known normal (LKN).  This is used to mark the start of the 60-minute timer for tracking of time-sensitive interventions. 
• A non-contrast CT scan of the head must be performed within 25 minutes of the patient's arrival.  In most facilities, the emergency room nurse accompanies the patient to the CT scan department and ensures patient safety.    
• Based on the CT scan results – and if an ischemic stroke – treatment with tissue plasminogen activator (tPA), also known as alteplase or Activase, is initiated.  This intravenous medication is usually given within 3 hours of the onset of symptoms and can be given up to 4.5 hours in certain cases.  This is done to dissolve the clot and restore blood supply to the brain.   Among other duties, the nurse administers the treatment and closely monitors the patient for complications. 
• In the case of a hemorrhagic stroke, the primary focus of care is to control the bleeding and blood pressure, as needed, using medication.  Surgery to repair the ruptured blood vessel may be indicated.  The nurse closely monitors the patient for any concerns or changes in status.

In the ICU

• At this point, the patient may be transferred to the intensive care unit (ICU), and the emergency department nurse accompanies the patient to the ICU and ensures a safe transition of care. 
• For eligible patients with an ischemic stroke, a mechanical thrombectomy may be indicated.  This surgical procedure is done to remove the clot via catheterization and is typically performed within 6 hours of the onset of stroke symptoms and can be done up to 24 hours from onset.  Among many other responsibilities, the ICU nurse's role is to monitor for postoperative complications, condition deterioration, perform neurologic assessments, titration of medications, and other system monitoring per practice guidelines and institution protocol. 
• In some severe stroke cases, the patient may need to be intubated.  The ICU nurse is responsible to monitor for airway patency per hospital guidelines. 

On the Floor

When the patient is stable and ready for transfer, the floor nurse's responsibilities include, among countless others:  

• Continuing to closely monitor for and prevent complications, including the possibility of a second stroke.
• Helping with improvement of patient's mobility.
• Assisting the patient with managing and coping with disability such as sensory and/or communication deficits.
• Collaborating with the multidisciplinary team to include Physical Therapy, Speech Therapy, Occupational Therapy.
• Assessing the patient for depression, as needed, and addressing accordingly.
• Preparing the patient for discharge whether to home or to a rehabilitation facility.
• Providing education on the risk of recurrent strokes and prevention methods. 

A stroke is a life-threatening and life-changing event.  Early action is vital during stroke care.  The nurse's role, as the patient transitions across care environments, is very diverse and complex and includes effectively meeting the patient's various care needs, collaborating, providing education and support, promoting recovery, contributing to positive patient and family outcomes, and more.  It is of utmost importance for nurses to stay abreast of proper stroke care and advancements in treatment modalities, become familiar with their facilities' stroke protocols, and take an active role in advocating for and educating the public about stroke signs and symptoms, prevention methods and the management of risk factors. 

References

About Stroke | American Stroke Association

Characteristics of the stroke alert process in a general Hospital - PMC (nih.gov)

Prevention | American Stroke Association

Role of the nurse in acute stroke care - PubMed (nih.gov)

Stroke - Symptoms and causes - Mayo Clinic

Stroke Facts | CDC.gov

Update: Stroke guidelines: Nursing Management (lww.com)

Updated guidance confirms crucial role of nurses for patients with acute ischemic stroke | American Heart Association

I'm an experienced nurse looking at various Neuro jobs at Duke Hospital in the Raleigh/Durham area of NC. I was hoping someone would be able to explain the various Neuro units, specifically 4100 Neuro Stepdown, Neuro Trauma Stepdown, and 8W Neuro Stepdown. Beyond these units (which I see have openings via the duke careers site) are there any other Neuro units in the Duke Hospital system? I have a background of a few years in the ED and most recently have been working inpatient Psych focusing on neurocognitive/neurodegenerative disorders (dementia, Alzheimers, Parkinson's, MS, rare congenital diseases, etc) I'm very interested in finding a Neuro unit that focuses more on the neurocognitive and degenerative disorders. Any advice or insight would be greatly appreciated. Thank you!!

Please can you tell me what materials did you use and where did you get your NIHSS Certification? I would like to get certified since I work in a Neuro Rehab floor. I really appreciated it.

Stay safe! God bless!

.

The ANA (American Nurses Association) describes nursing as a highly specialized profession that is the adhesive that supports the entire healthcare journey of an individual, as a science which employs critical thinking, and as an art that demonstrates intuition for patient’s needs and respect for human dignity (nursingworld.org, n.d.). This definition attempts to broadly classify nursing in the midst of the other healthcare professions and is certainly not meant to encompass 100% of what nurses do. The profession of nursing is ever-evolving and what is true of the roles of nurses today may no longer be true a decade from now. What will likely never change is the nursing process. Nurses will always assess physiological, economic, social, and spiritual factors, attentively and cautiously form a diagnosis, plan for patient outcomes by setting realistic goals, implement care plans, and evaluate or analyze patient outcomes (nursingworld.org, n.d.). The definition of nursing is a multifaceted description that has various interpretations based on individual experience; it involves considering the evolving nature of the profession, and the space that it occupies in healthcare.

What is a Neurology Nurse’s Role?

Neurology nursing is a specialty of nursing that incorporates all the established nursing responsibilities, but additionally incorporates a new subset of functions that impact patient outcomes. The following is a list that attempts to broadly categorize the roles of neurology nurses in order that the public can better understand the complexity and indispensability of their role.

1. As the very foundation of neurological nursing, nurses must understand physiology behind all neurological conditions and diseases. Only with this background do the physical signs and symptoms begin to be understood within the greater context of what is occurring internally. (Lewis et al., 2017).
2. Neurological nurses indirectly assist neurologists in diagnosing conditions based on their assessments. For this reason, it is so important for nurses to provide accurate assessments and reports to physicians when they round. (Lewis et al., 2017).
3. Neurological nurses provide the patient with the therapeutic interventions laid out in the care plan. (Lewis et al., 2017).
4. Neurological nurses provide information to the family about the interventions, disease process and signs and symptoms. Physicians explain to family what is transpiring; however, nurses are often the ones that are asked clarifying questions once the physician has left. For this reason, it is important for nurses to identify themselves as educators and be prepared to speak to patients and family with confidence about disease process, progression, and teach about different treatment modalities.
5. Through the interview process, nurses could uncover a piece of history about the patient that could explain or direct a course of treatment. (Walleck, 1982).
6. Neurological nurses must be attentive to vital signs, and neurological changes through the use of critical thinking and assessment tools. To provide an in-depth analysis of all the assessments carried out could take an entire book.

The following briefly summarizes some of the most common assessment techniques that RNs carry out that go unnoticed by the general public.

Common Assessment Techniques that Go Unnoticed

1. Before anything else, the fundamental principal in neurological examinations is change. If a patient experiences a baseline change, no matter how subtle, it could be significant. This implies that there must be an excellent assessment to provide an accurate baseline. This is easier when a patient is alert and awake. However, when the patient is unconscious due to a head injury, alcohol, or drugs, a strong stimulus must be provided to bypass the effects of one or all three of those factors. The first test is to simply ask the patient in a soft voice to follow a command. After this you ask in a loud tone of voice. Subsequently, a strong stimulus must be created using one of the following: squeezing the trapezius muscle, applying supraorbital pressure, applying mandibular pressure, and lastly applying a sternal rub. If the patient responds to one of the painful stimuli forms, this means that their brain is responding, not a spinal or reflex response. If the patient doesn’t respond to any of the forms of painful stimuli within 15-30 seconds, it is time to desist. (Lower, 2002).
2. Level of consciousness is another key aspect a nurse is always attentive to. When the patient opens their eyes spontaneously in response to voice or pain, that is an indicator of a functional wakefulness center located in the brain stem. Awareness is also tested through the use of four components: orientation, memory, calculation, and fund of knowledge. In patients who begin to exhibit disorientation, the first level that noticed is time followed by place and then person. Short term memory can be tested with simple questions about remembering three separate words, long term by asking about date of birth. Simple mathematical calculations give an indicator about that portion of the brain. Fund of knowledge involves drawing on something current (president, current news). (Lower, 2002). When dealing with patients who are at risk for ICP there are more subtle signs that nurses look for that may not be obvious to the family. They are changes in LOC, losing details and disorientation, forgetfulness, restlessness, and sudden quietness. The nurse will also assess pupillary, motor, and vital signs changes.
3. The interview process is vital to determine if there are any peculiarities exhibited by the patient’s speech and thought processes. Sometimes this can be an indicator of an underlying process, especially if the family states this is a change from baseline (Walleck, 1982).
4. A description of every cranial nerve will not be provided; however, it must be conducted as it can be a vital indicator of brain cranial nerve function.

Conclusion

This small article’s goal was to inform the public of a few of the more subtle tasks neurology nurses carry out that are often not perceived by the public. A neurology nurse is always assessing for change from baseline. This is a foundational concept upon which rests a significant portion of the patient’s outcome. As the profession of nursing continues to evolve there will certainly be new tasks required of nurses. Some of those tasks will be visible to the public, some will not. What will remain constant is the need for nurses to continue to critically think and carry out the nursing process in order to provide the best outcome for the patient.

References

1. Lewis, S. M., Bucher, L., Heitkemper, M. M. L., Harding, M., Kwong, J., & Roberts, D. (2017). Medical surgical nursing: assessment and management of clinical problems. St. Louis: Elsevier.
2. Lower, J. (2002). Facing neuro assessment fearlessly. Nursing, 32(2), 58–65. doi: 10.1097/00152193-200202000-00054
3. What is Nursing? (n.d.). Retrieved from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/
4. Walleck, C. A. (1982). A Neurologic Assessment Procedure That Wonʼt Make You Nervous. Nursing, 12(12), 50–59. doi: 10.1097/00152193-198212000-00023

Can someone explain the differences in working as a neuro nurse v. a psych nurse? I understand how they differ on a basic level, but I am curious how the case loads and working envrionments contrast, and which speciality is more rewarding/challenging, etc. I would love to eventually have a career in one of these specialities, as I come from a background in psych. I have a very patient and compassionate heart, which has always lead me to believe that psych is my calling, however, neuro is endlessly fascinating to me.

Any advice, suggestions, opinions, etc., are eagerly welcomed!

Thanks in advance!

The side effects seem so extreme I really don't want to take it, but I am interested in how it works. Can anyone explain this? I figure since I'm discussing it in A&P right now, it may actually make sense to me. I'm really curious how you can inhale a powder in your nose that makes your migraine go away.

Our team works up approximately 2700 strokes a year and about 1300 of these patients are diagnosed with strokes. Our ED activates at least 120 suspected strokes a month, last rolling calendar year we gave tPA 127 times and provided emergent thrombectomy 47 times. Yes, I'm the one keeping track of those numbers. So aside from data collection and implication of quality metrics, let's walk through what I do for our stroke patients who come to our ED.

On arrival to our ED, I greet the patient and provider team. I ensure the patient gets to CT scan within the American heart recommended target time (20 minutes but our facility are a bunch of overachievers so we promote the magic number 10). If the patient is a candidate for tPA I support the nursing staff by mixing tPA, obtaining a second IV access, ensuring adequate blood pressure control, anything I can do as a second set of hands. Again, only 3% of patients in this ED are strokes so even though we have made waves in stroke care – the nurses are still a bit overwhelmed when they do have to give tPA. Let’s say this patient also is a candidate for thrombectomy, I then coordinate transport to the cath lab, support the cath lab staff, and ensure they receive a clear report on these patients deficits. Regardless if the patient received an intervention, I am following all strokes/ stroke mimics until their MRI is negative/positive. I round on these patients and provide them with community resources, support groups, education, and ensure the family is on board and can recognize signs of a stroke. I am tracking these patients in real time to ensure all joint commission and AHA quality metrics are met.

After these patients leave our facility, if they received intervention they get a call from me after their return home from rehab. If they did not receive intervention – I call them within 7 days to ensure they don’t have questions in their discharge plan and to clear up any inaccurate information. During these calls, I gauge their functional outcomes to report improvement. A lot of the people will attend a stroke support group that I host- and it's so rewarding to see the connection from hospital arrival to their discharge out in the community.

When I'm not in the hospital – I am participating in community outreach and promote stroke awareness and prevention. We have 80 ambulance services that feed our ED, and I have made relationships with our top 10 by rounding with them to ensure they are comfortable activating a stroke alert in the pre-hospital setting. I visit with senior centers and school-aged children to ensure that education can be provided to all because TIME IS BRAIN!

So in summary – I am a stoke program nurse coordinator. I promote stroke awareness in the community, concurrently review charts of stroke patients to ensure the best quality of care, round with stroke patients, support the emergency room staff during acute strokes, support our vascular neurologists and our process through evidence-based research. What a mouthful!

I'm currently have two jobs: one full time at a freestanding rehab hospital and the other one is PRN at a Prescribed Pediatric Extended Care (PPEC)

During these two jobs, I've realized I love neuro, and I want to work with pediatric population!

I enjoy working with geriatric patient at the rehab hospital. However, in the future I want to work with pediatric population. Kids just win my heart ?

I am interested in taking CNRN exam. However, it's costly and it will take great effort to pass the exam (yes, I've heard how hard the exam is!), and I will pay out of my pocket. So I want to know if CNRN is appealing for neuro pediatric nurse recruiter? My disadvantage here is no acute care experience and I don't think hospital is interested in hiring nurses without real acute pedi experience? (I have applied once before and still got rejected despite my PRN experience in PPEC)

And as my understanding CNRN is more covering of adults (like dementia, MS, stroke etc), not sure if I'm right. Please correct me if I'm wrong. So I'm not too sure if it's appealing for children hospital.

My question is I'm just wondering if you guys think it's worth the investment if my future goal is neuro pedi unit?

Thank you, lovely nurses ?