afox

I'm new to the NSICU and I was taught that for GCS-Motor assessment that when we need to use painful stimulus we should use central stimulus such as Trap Squeeze. So the other night I had a patient who was declining (hx: afib, resp failure, multiple cva, CHF). 1900 assessment patient could slightly wiggle fingers/toes by command when alert. 2100: patient not alert but slightly withdrawing to trap squeeze. (Neuro Dr. Notified & says consult medical doctor). 2230: Intubated for resp failure (Given 20 etomidate & 2 of versed). Now patient is sedated. so unable to get a good neuro exam. 0100-0200: still nothing, getting nervous! 0300: Patient opens eyes to voice but eyes appear slightly deviated and is not able to move/command. Only responding on LLE to trap squeeze. Resident finally comes to assess the patient at 0500 and does a Peripheral nerve pinch. There is slight flicker of patients right side. The resident then says "why did you call me down here, there is no change. You said he was withdrawing earlier and he still is". I tried to explain that I was using Central not peripheral stimuli and that his baseline assessment HAD changed (as I was taught that there are receptors in the spinal cord that can react to peripheral pain and so it is not necessarily testing brain function) The patient was also hypotensive (on Esmolol drip for afib that was stopped during intubation d/t lowering bp) and in Trendelenbur so I finally get the Neuro doctor to agree that we should at least start a pressor to get the BP for perfusion, but i must run it by medical doctor. By 0700 patient has not improved and has definite eye deviation. I guess I'm frustrated b/c I feel like the doctor wasn't listening to me & I'm wondering if I'm doing my assessment wrong. Does anyone have any input on how they do their assessment (central/peripheral), how I should have handled it differently, etc??

Featherz-- just curious..... to finish in the 6 months how many hours a week did you devote to school? And did you take your proctored tests online or at an assessment center?

Just curious if you guys have figured out what you are taking first?!

I've had my transcripts evaluated, appealed, and then some of my appeal approved again (looks like I'll have to complete the 2 health assessment classes and BioChem)...... How is it going for everyone else? Has anyone started the online orientation or talked to their mentor yet? So far I am only communicating with the "enrollment counselor" still.

@fgreen I work in Peoria at OSF saint Francis. ( which has a sister hospital st Anthony in Rockford ) we aren't hiring as much as we did last year but there are occasionally some good jobs posted. New grads start at 22.65 which is good for the central il area. They only require you to be in a position 6 months before transferring depts/facilities which is something to consider too. There are also 2 other hospitals in the city ( unity point Methodist and Proctor)

Just curious what part of Illinois you are from? I drive an hour to work and although I didn't have difficulty finding a job, I work with people who did. 1 girl was unemployed 9 months and another lives in Chicago and works 3 hours away. She got an apartment near work and works 6 days in a row then goes back to Chicago to be with her husband/kid on her 8 days off

I originally planned on doing the RN-MSN in Leadership/Management (but now am unsure if maybe the BSN is the way to go) and was talking to my enrollment counselor today and I asked about being awarded a BSN through the program and she replied that the BSN would be awarded at the same time as the MSN after completion. And when I asked if for some unfortunate reason due to lifes events, i were to need a semester off or to unenroll she basically stated that a BSN would not be awarded because transferring credits "gets messy". It is my current impression that the advantages of doing the RN to MSN are that it cuts 2 classes and would allow you to start MSN program classes as soon as you finish the bsn classes, as opposed to having to wait for a new term/pay another semester of tuition. Is this correct? I do plan on earning both but am a little skeptical now on the sequence now just because life can happen ( ex: I have a clean bill of health now but was dx with thyroid cancer in December that d/t multiple surgeries left me out of commission for months) Please share any advice, thoughts, experiences with the programs :)

I'm probably starting 11/1 also. Just waiting for my transcript eval!

Im glad your husband isi back to normal! Mine was basically over night too. I went from probably 20 percent to 90 in about a day or two. My voice is a little lower now, but other than that I'm doing well! I'm scared how it will impact any future surgery I may need to have though.

So I'm on a general floor. We care for 5-6 patient's a night. I have a lot of stroke patient's who can be anywhere from a normal person with no residual effects (just watching them/waiting to d/c them) or someone who is absolutely dependent on care. We get a lot of patient's who have seizures. G-tubes are common of my floor because a lot of people have been dysphagic. We get central lines/foleys. We also have patients with spinal cord injuries, spine surgery, brain surgery, MS, Lou Gherigs, meningitis. I've seen a lot of motorcycle accidents where they remove a portion of the skull to allow for swelling. I see a lot of Lumbar puntures done. Confused patients are normal to have. We take general medical overflow patients, too. Basically- i get the more stabilized Neuro patients and the ICU/Intermediate floor gets more critical patients, but then they come to us. Every night is different for me. We do Q4 hour neuro assessments. (Our intermediate floor does Q2 hour checks and have 2-3 patients and our Neuro ICU does Q1 hour assessments and has 1-2 patients.) My friend works in the Neuro ICU and see's a alot of motor cycle accidents and blunt force trauma. Yesterday she had a young guy who shot himself in the head but failed to die right away. So they do a lot of organ donation and dealing with hysterical families. if you can think of any specific questions, ask and i'll try to answer.

What did you take?! Firstly, Neuro isn't for everyone, but while it seems limited, can actually be very broad. I myself would have taken the Neuro-Tele position at the Comprehensive stroke center. (In fact, I work at a comprehensive stroke center at a Level 1 trauma Center and it's pretty awesome) It feels good to be part of a neuro department that is the "best of the best", as we recently along with help of our ED had a door to TPA time of 5 minutes. Most of our stroke patients are on tele, but we get all neurological ailments from Seizures to MS to ALS to spinal chord injuries to Craniotomies and spinal surgery. I'm on the general unit so we have 5-6 patients and some nights they are all neuro, some nights I have all medical overflow, so it all depends. I get a lot of pneumonia, sepsis, I've had a mom 1 day post partum because she was having seizuress, pancreatitis, psych issues, etc... I feel like this floor, while is specialized in neuro, has a wide array of patients many who different comorbidities and allows me to stay relevant to other issues.

goodstudentnowRN, Do you mind me asking how much time you spent (on average) per week on your studies?

Thank you for the posts, everyone. I never got a notification of the replies! I was thinking worst case maybe going back and doing medical transcription so it looks like you guys were on the same page with dictation type stuff. Fortunately, my ENT was hopeful and wanted to give me more time to recover and it did happen after almost 3 months! I still have limited movement of one chord, so I'm not back to how I used to be, but I have gotten most of my voice back, rarely choke and have been able to resume my old job!

One thing for sure- I definitely recommend getting an RN job after graduation. (you don't want to seem like you've lost skills since you wont be a "new grad" anymore, PLUS some areas are hard to find jobs in) My suggestion is, that maybe only try for a part time one that would allow you to have a social life/continue with your BSN. It really depends on the area you live in though. I work in a larger magnet facility in central IL that probably hires 100-200 new grads per year. Because of the economy and the fact that we do hire new grads, we get nurses from all across the state that come here to work for a couple years of experience. Most of our nurses are in their 20's and many of them have roomates that are other nurses, and a lot of them still "party" since they are still young. As long as you don't do anything illegal your job isn't in jeopardy.

Background: I'm 26 and I've been employed on a Neuro Med Surg floor since passing boards in July 12, but in December I had a thyroidectomy for thyroid cancer and unfortunately since then have been SOB with any type of exertion or speaking more than a sentence (my voice is no louder than a whisper) and I'm also dysphagic on thin liquids. Today, I finally saw an ENT and they did a scope to see how my vocal chords are moving and they are paralyzed in an almost closed position. The ENT was surprised that I'm even functioning at all without a trach. Ive been referred to the best of the best (supposedly) and I was advised to take it easy to avoid respiratory distress. So my question is does anyone have any ideas on types of nursing jobs (or really any type of job) that I could do that requires very little speaking (and that I'd be understood at a whisper) and doesn't require much movement, as I'm SOB with any exertion. I have my appointment this Friday with the Big Shot ENT, but I'm so worried about employment. I have bills to pay and 30K in student loans. I don't see myself being able to return to a traditional nursing roll unless this is reversed. Any ideas/advise is appreciated! (sorry it's so long)