What do I need to know before I start precepting Neuro/Stroke ICU?

[nurseguyjosh]

Hi guys! I'm a last semester nursing student and I just landed a preceptorship in the Neuro/Stroke ICU at a relatively large medical center in the area and I start Friday. Unfortunately, I haven't covered everything in class yet about critical care related neuro. I have been exposed to some neuro (basic focused assessment, migraines, Guillan-Barre, ALS, Parkinsonism, MS, myasthenia gravis, trigeminal neuralgia, bell's palsy, muscular dystrophy, and cerebral palsy) but not a lot that requires ICU care.

I will have 2 weeks of precepting before we start covering the rest of the neuro material but in the meantime I don't want to look like a complete fool when I start (trying to make a good impression since this is where I want to work!). So what neuro material would you recommend I look over before I start? If you're a neuro ICU nurse, what drugs and treatments do you see the most? Which labs should I review? What assessments should I look over? What patho should I know? I basically want to know what I need to not be totally lost on my first few days.

Thanks so much!! :)

[iluvgusgus]

I work in a neuro icu and I just finished orientation. I dont think much of what you may have notes on in nursing school is going to prepare you for icu because it is so specialized, you kind of just have to be exposed to it. I would youtube neuro assessment because that is probably going to be the toughest thing to learn since every pt is different and subtle neuro changes are very important, go to the NIHSS website they have videos of stroke assessment and practice quizzes. I would brush up on G tube med administration, NG tube med administration and verifiying placement, trach suctioning and care, ABG analysis, EKG interpretation. Ventriculostomies, increased ICP, A and P of brain and how hypertonic IVFs and hypotonic IVFs affect brain tissue- very important. Maybe look at your drug guide or pharm book for common IV drips we give, we need to know onset, peak, and half lives of them : 2 percent NS, 3 ercent NS, 23 percent NS, mannitol, propofol, versed, fentanyl, phenylephrine, nicardipine, dobutamine, dopamine, labetalol, hydralazine ( IV Push), insulin, vasopressin, norepinephrine, nitroprusside, nitroglycerine, milrinone. icufaqs.org is a great website. A and P of heart- preload, afterload, contractility, and that stroke volume equation for heart is very important to understanding cardiac drips, I hope they cover that in your critical care classes. Good luck.

[nurseguyjosh]

Yeah, I realize a lot of the Neuro ICU stuff is material we probably won't cover in class, but I do want to have a good foundation when I get there so that I don't have such a hard time with the harder concepts. So far the resources you put up (especially the icufaqs.org and drug list) seem great, so thanks so much! I really appreciate it!

[palaviccinim]

The above poster has som great thoughts - for your first couple weeks, it will be most important to familiarize yourself with the anatomy of the brain and the Monroe Kellie doctrine. EVERYTHING WE DO in Neuro ICU revolves around this doctrine. If you know it inside and out - you can walk through the rest with relative ease. Know how to do a neuro assessment on an intubated patient - I am not talking whether or not they can smell peppermint to check cranial nerves - I mean KNOW your Glasgow Coma Scale, we use it daily. Know a good motor assessment and what it means, understand the different types of head bleeds (epidural, subdural, subarachnoid) and what the various treatments may be (watch for evolvement, evacuation, aneurysm coil/clipping).

You are a student, so no one will expect you to be an expert (hell, no one expects anyone to be an expert - brains are tough!) but if you want to be able to really engage in conversations with your preceptor and the doctors/residents around you, having a good handle of GCS and different types of bleeds, etc will be really important. We do see occasional Myasthenia Gravis and seizures and such, but I work in a NSICU in a Level 1 Trauma center, so most of what we get are TBIs and head bleeds. Good luck!!!

[ProgressiveActivist, BSN, RN]

to the OP,

you are not precepting, you are on preceptorship.

The RN is the preceptor, you are the student, she is precepting you. You are not precepting.

Some nurses, and I am one, will impressed if you can use these terms correctly.

[Misskala]

iluvgusgus--thank you! I just started orientation on neuro stepdown unit and all of what you recommended I have seen come into play. Espec. assessments! I got 1:1 training on neuro assessmt with the NP and am focusing on GCS, NIH, LOC 1st. OP, hope your preceptorship is going well!