New Neuro Nurse Here!

Here.I.Stand, BSN, RN · Sep 13, 2014

Congratulations on the job! Neuro is probably the specialty I've spent the most time in, between my first floor and ICU jobs, an LTACH that took quite a few brain injury pts for vent weaning, and my current ICU job.

I've said on another thread, but this specialty can be emotionally tough (depending on your personality.) When things go well, it is nothing short of witnessing a miracle. When things don't go well, it can be devastating. Practice good self-care

Be prepared for the pt's status to change quickly. One example from my own practice was a woman in her 40s who had had a stroke...she had been healthy an in fact it happened during a run in the park. It wasn't cocaine related or anything. Anyway, from the start the prognosis wasn't great, but she had been opening her eyes and tracking her family and squeezing their hands. (Side note--more about hand squeezing in a sec) She'd had an EVD placed and her ICPs had been fine, in the low-mid tens. But suddenly her ICPs shot up into the 50s and we lost her neuro exam. She was not even withdrawing to pain. I immediately elevated her HOB and gave her a big dose of fentanyl, called the dr. and gave her Mannitol AND 23% NaCl per his order, and then rushed her downstairs for a stat head CT...she had herniated. This all happened in a span of about 30 minutes--by "all" I mean going from tracking her family members to seeing the herniation on screen in radiology.

That is certainly not a daily occurrence, but just an illustration of how quickly a neuro pt can deteriorate.

It is extremely overwhelming for families to come into the ICU to visit their loved one for the first time. They need nursing care too--it's not only the pt in that bed. Of course family nursing is very different than critical care nursing, but still important. I always explain the gadgets to them, not in over-the-top detail, but the basics--this machine is cooling him to help his brain rest, this one is monitoring the temp and oxygenation in the brain itself, etc. I think knowing what is going on really helps alleviate their fear.

Now about hand squeezing. You may see this done commonly to see if they follow commands--"Squeeze my hand!" I don't mean asking them to squeeze w/ both hands to compare strength, I mean just telling them to squeeze and note if they do it or not. But what I was taught was this response could be a reflex. Kind of like if you put your finger into a newborn's hand, the baby will squeeze. It's better to ask them to give you a thumbs up, or have them squeeze but say "Don't let go until i tell you." Just wanted to mention that because I see it done all the time, and in fact I used to myself.

I feel like I'm missing something, but can't put my finger on it. I'll post tomorrow if I remember what it was.

Again congratulations on the job. Let us know how it goes!

brainfixer · Sep 17, 2014

Good advice on the hand squeeze. The theory is to illicit purposeful/higher brain function responses. I always ask for a "thumbs up". Yeah when I was a new neuro RN I did the hand squeeze thingy too.

Neuro is exciting but as mentioned above there are more down times than up. Usually your patients are going to be less functional when they leave your unit. That just goes with the turf.

Make this your Neuro Bible ... it is an awesome text:

books?id=m0xOAQAAIAAJ&printsec=frontcover&img=1&zoom=1&imgtk=AFLRE73-O0Ey0lQqcRur3wr28Ghv1edpIWBJ57rR8hF6DKqAgz_TK6i85k4xIFvYNjTE8lxelhPuCN_FLaJSj_sAQYnsAnvs6m11l5LTMX9Wr0H5AMDTHt0qyIVZhvzn4ZZEfWAHNAFM

Author:

https://nursing.uth.edu/directory/profile/index.htm?profileinode=438498

This book is awesome stuff!

Good luck !

Bob

cmclrn · Feb 28, 2015

Definitely going to look into that book and any other info that you guys would suggest! I'm a new grad nurse starting a job in Neuro ICU. Any other tips you have for handling stress/grief? I am going to be working nights, so hopefully I'm able to learn a little easier!