Typical Neuro Day

RainClover157 · Jan 21, 2010

I work nights in a Neuro specialized care unit a step down from ICU and more critical than floor nursing in a large teaching hospital. Typical pts we care for- brain/spinal tumors, traumatic brain injuries and spinal cord injuries, aneurysms- clipping/coiling or ruptured, subarachnoid hemorrhage, subdural hematomas, seizures, stroke- ischemic/hemorrhagic, and neuromuscular disorders.. Also rare things like meningitis and encephalitis.

A few things I can tell you...

Patience is huge- like telling an impulsive pt a million times not to touch something or get up but they aren't aware of any deficits. Also when pts are confused and insisting the year is 1970 and they need to go somewhere.

Communication challenges- like unable to speak, mixing up words or nonsensical speech, it can be frustrating for pts and for nurses.

Neuro pts often have airway management and cardiac issues. We do oral suctioning, crushing meds and for more severe dysphasia- trachs/pegs or NG tubes also a variety of different types of O2. Cardiac gtts and monitoring.

Neuro drains- subdural, extraventricular (sometimes placed at bedside), lumbar, externalized VP shunts.

Some days its physically demanding- lifting totals, restraining aggitated/combative confused pts, ambulating stroke pts and mentally exhausting of course but what nursing isn't, right?

Neuro changes can be very subtle and slow or decline quickly- hindsight is always 20/20. You have to notice the small decline like when something is 'just not right' and you have to appreciate the small improvements which can take so long see- like see someone spontaneously move a finger or squeeze your hand for the first time.

Neuro pts also say/do the funniest things- actually thinking they are driving a car or making ham with beans while sitting in bed, asking the IV pole out on a date, attempting to chew out of restraints!

It's hard work but I love it! It challenges me in more ways than I thought nursing could, I learn something everyday and wouldn't want to work anywhere else. Hope this helps a little!

Ciale · Jan 24, 2010

Wow, thank you for sharing. This sounds like the most interesting unit to work in. Ever since my dad had a stroke a few years ago, I've been curious about working in this unit. He did/said the weirdest/inappropriate things when he was in the hospital after his stroke. One time he told me that the nurses were having a pillow fight in his room.

So, were you totally intimidated at first?

NJNursing, ASN, RN · Jan 26, 2010

I work on an ortho/neuro floor and we have a dedicated stroke unit, but we also get the MS patients, seizures, syncope, change of mental status, etc. Not as intense as above, but we're not like a huge metro hospital either.

It's neuro checks q 2-4 depending on how acute the stroke is and how severe the symptoms. It's a NIHSS q 8 if not q 12. I agree with RainClover, it's really being able to pick up some subtle changes in a patient or having like a 6th sense about patients sometimes. It can be frustrating if there are communication problems depending on what part of the brain the stroke affected. Either they don't understand you or you don't understand them or they don't speak at all or it's so slurred/garbled that it can be hard. It's patients having to suddenly deal with massive physical limitations when they were completely self functioning the day before. It's a LOT of education, sometimes more for the families than the patients themselves. Plus you have to have cardiac knowledge as well because they're on heart monitors and you have to see if there's any weird changes going on there as well.

The rewarding part it to see someone who is improving. Who couldn't move the day before, who had global aphasia who get TPA and gain their functionality back. It's amazing. Or when the brain starts to build collateral circulation and you see improvement. Things like that rock.