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bellehill

bellehill RN

Neuro Critical Care
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bellehill has 9 years experience as a RN and specializes in Neuro Critical Care.

bellehill's Latest Activity

  1. bellehill

    Pupillometer guideline

    We obtain a pupillometer reading on admission for all our neuro patients. Our protocol is to call the MD for: NPi CV %change >1mm difference between pupils We also trend the NPi and if there is a difference between R/L pupils of >0.7 or if the NPi has decreased by 0.7 the MD is to be called. We use the pupillometer Q4h for GCS
  2. bellehill

    TIA PRESENTATION

    We treat any stroke symptoms the same with the standard benchmark goals. Door to doc in 10 minutes, door to CT in 20 minutes, door to CT read in 45 minutes and door to TPA in 60 minutes if applicable. Our hospital uses a "stroke alert". The important thing to remember is a TIA is a warning that a larger stroke is going to happen. A lot of patients and physicians will ignore the symptoms and that is a big mistake. TIA patients still need to be admitted and evaluated.
  3. bellehill

    Neuroscience - I need some help in Cerebral Circulation

    Grab a textbook, preferably by Hickey and look at it then draw it. I always learned better when I drew the subject (like the Circle of Willis). I think I drew the COW a million times when I was studying for the CNRN. If you can draw it you can visualize and then when you need to discuss it just picture the circulation pattern in your head.
  4. bellehill

    Flotrac for Triple H therapy

    An update: we are seeing great success using the Flotrac. Our goal is SVV40 and CVP>8 for non-vented and >12 for vented patients. If two of the three parameters are not in range we bolus the patient. No more swans...YEAH! Just recently had a patient who spasmed for the full 21 days, several trips for IA Verapamil and she walked in to visit us completely intact. Really makes you feel good about what you do!
  5. bellehill

    Unit Staffing?

    We have a 20 bed ICU we staff with 9-10 RNs, 1 charge nurse (who may have patients), 1 unit secretary and 2 techs. Our goal is 11 nurses plus charge but that doesn't always happen.
  6. bellehill

    Pupils and Brain

    Depends on the location of the hemorrhage and the size. The pupils could be completely equal or unequal. Remember that Cranial Nerve 3 controls pupil dilation so follow the nerve path. Also, increased ICP will affect pupil dilation by compressing the nerve pathway.
  7. bellehill

    cnrn test

    You can purchase the AANN core curriculum to study from but otherwise, there is very little material. I studied from AANN core curriculum and I read the Hickey textbook to prepare. Good luck.
  8. bellehill

    Anyone apply to the OSU Medical Center Residency?

    Why don't you check out the Ohio Health Critical Care Fellowship. I know they were accepting applications last week, not sure how long.
  9. bellehill

    Levophed shortage

    We have a Neo shortage as well, anyone else? We have been using Dopamine and Epinephrine.
  10. bellehill

    Problems with shift to shift report

    Have you tried a bedside report? If you are having trouble remembering what happened during the day go in the room and talk about the patient. Chances are you will remember and the patient will appreciate knowing how thorough you were with report (if they are awake). Just a thought. Other thoughts, I go system by system. Head to toe and SBAR is always useful. Have the chart in front of you so you can go over orders, that will help to spark memory too. Your educator is right, it will get better.
  11. bellehill

    Shared Governance

    Our unit has a shared governance with 4 different quadrants: customer service, quality of worklife, practice and research, and education. Each quadrant has a chair and co-chair as well as the chair and co-chair of the shared governance. Ours meets once a month for 2 hours. We have bylaws and a mission statement. The basic reason for shared governance is to bring decision making to the bedside, especially when it affects the bedside nurse. Some topics we have covered; weekend on-call for staffing, new education topics, social events for staff gatherings, signage for our visitor waiting room, new protocols for patient care. You really have to have a 100% commitment from the chairs and co-chairs for it to work. You also have to have a manager who believes in the process and is willing to let the council make decisions. Ideally, the chairs and co-chairs of each quadrant would engage the staff to be involved. All decisions are taken to the staff and decided by a vote so even if someone can't make it to the meeting their voice is heard. There are several great resources on-line regarding shared governance. It is very slow to develop but once you can get a strong base it will be worth it.
  12. bellehill

    Need some Precedex advise

    In our neuro patients it seems to work very sporadically. We were just inserviced on Precedex and it is not to be used for the patient when they are wild. Ideally, you would get the patient calm with Ativan/Haldol/Versed and start the Precedex drip while those are wearing off. Our rep recommended this especially for patients who are at risk of alcohol withdrawal. Start the drip BEFORE the patient becomes uncontrollable, not once they are. Personally, I like Precedex but it isn't for everyone. I like that the respiratory drive is not affected so I can use it on my non-vented patients and still do a good neuro assessment. Maybe your docs need to talk to the drug rep. Hospira makes it, just call them.
  13. bellehill

    "One Born Every Minute"

    Is anyone watching "One Born Every Minute" on Lifetime? It was taped at Riverside Methodist Hospital in Columbus. I work there (not L&D) and I love to see the exposure. Even if you don't work at Riverside, what a great opportunity for Central Ohio. It is on Tuesday nights. Check it out!
  14. bellehill

    Pregnant in Neuro ICU?

    I worked in a busy Neuro ICU my entire pregnancy. I was supposed to work the night I had my child. It is like any nursing job. You take normal precautions just like you would with any patient, even if you aren't pregnant. If you want to try neuro then do it. The worst part? All the sadness with those extra hormones in your body!
  15. bellehill

    Flotrac for Triple H therapy

    Thanks. We are going to be looking at the SVV, SVI and CVP. If 2 of the 3 numbers are below the parameters the patient will be bolused. This has worked well so far!
  16. bellehill

    cscc or mount carmel

    I agree with birdie22, go with the BSN and work as a tech. Nursing jobs are very competitive in Columbus.