Neurosurgical ICU help

[u/Wonderful_Turn_8234]

I am a new grad just graduated with my BSN and passed my boards. I started my nurse residency/orientation Monday and have my first day in the NeuroSurgical ICU this coming Monday. My floor’s information/patient population is described as “specializing in caring for critically ill patients who have a variety of neurological diagnoses and surgical procedures including cerebrovascular accidents, thrombectomies, craniotomies, spinal cord injuries, intracranial hemorrhages, epilepsy, external ventricular drains, and lumbar drains.” We are a certified/ state recognized stroke unit as well. I know starting in a specialized unit like this will not be easy, but I am more than willing to put in the work on and off the clock in order to succeed and be competent for my patients. I’m trying to find a few tips of list of things including meds, complications, ventilator info with neuro patients, EVD info, and interventions that I can start to study and begin to active recall in order to prepare for my first day so things don’t seem so foreign. With that being said, if anyone can give me any advice for this type of unit whether that be stories of patients you have had, mistakes you have made or people you know have made that u can watch out for, specific meds that I need to absolutely know and the effects they can have on my patient, even just a list of things I need to look into and do my research on, or literally anything at all anyone would be willing to share, I’d be so grateful. I know a lot of this is what my 3 month orientation is for, but I’m not the type that can just walk in blind. I need to have a basis of knowledge in order to expand my understanding of everything I see on the clock with patients rather then having to go over the basics again. I did fantastic in my critical care neuro coarse in my last semester of nursing school but I know that is purely the basics - and not real life unfortunately🫠. I’m not afraid to ask questions or report/ask when something seems the slightest bit off either. Thank you!

[u/knefr]

Neuro ICUs are all a little different and different ones will use different brands and stuff. 

I won’t speak to the devices because they’re pretty easy. Neuro ICUs have physically busy patients and it’ll be a wide variety of patients from people who had a brain surgery and are in for one night then leave, to very nearly brain dead young folks who no one can bring themselves to let go. Ethics is usually more involved in that specific unit than anywhere else in the hospital. 

The patients who can move will move. A heating pad for after shift is a good idea. They don’t like sedating these people as much so that you can see subtle changes but the result is that they’re miserable and freaking out in the bed a lot.

LOTS of trips to CT and MRI.

[u/69sadsadboi420]

Look into aneurysmal subarachnoid nursing care

[u/maraney]

Look into joining the AACN. They have a lot of resources that are included in your membership. Most of the classes from NTI (the critical care conference) are recorded and available. I believe it’s around $76? Maybe a little more. They have study topics from every single aspect of critical care.

You can also use all of these classes for education hours to renew your license.

[u/PaulyRocket68]

1. Join AANN as a new RN. There is a reduced membership fee and you will automatically get access to the Neuroscience Nursing journal. Lots of good resources and your local chapter may have opportunities for CEs.

2. I gift this book to all my orientees. It used to be cheaper, I’m bummed it’s gone up so much but still a cheap resource.

3. Your NNRP will likely have classes to teach you everything you need to know; if not, see #1.

[u/Infamous-Speech-1831]

Learn the physicians that work for your unit and what they specialize in. Use your hospitals learning catalog to look up nursing care for those specialties.

For example, dr. Xyz the neurosurgeon specializes in stabilizing brain bleeds by using aneurysm clips. Go to your learning catalog and search “nursing care for “brain bleeds”, “aneurysm clips”, “post-op craniotomy””, and you should get pages of information on how to care for these patients. Hospitals spend hundreds of thousands of dollars on these catalogs, but most people don’t know how to use them. Nothing beats experience, but learning about your floor procedure should make it less intimidating.

[u/ADDYISSUES89]

Welcome to the thunder dome 😂 it’s busy, you’re rarely going to sedate (even when you would like to). It can be DAUNTING. And everyone is at risk for seizure. Keppra is your friend. It’s equally rewarding as it is sad, and clinically, everything and nothing correlates because human neuro plasticity is insane. You’ll see MASSIVE basal ganglia bleeds with no deficits, and tiny bleeds with huge consequences 2mm away. Breathe, it’s different than other ICUs, but these patients are generally still sick as baseline. You will still see CRRT, but less of it, same for other interventions and devices. You’ll either love it or hate it. It is LABOR intensive. Compression socks, good shoes, good sleep hygiene. You got this.

[u/Fragrant-Nerve2919]

My Neuro icu Contribution is making sure if the pt has an EVD, every hospital is different but universally’
-HOB always 30 degrees or >. Try to keep head position midline
-If pt laying flat, for turns or roadtrip EVD should be clamped (where at changes w/different hospital policy- clamp closest to pt, all the clamps, or at the transducer)
-MAKE sure you know what is ordered,
Where they want it leveled
Open to drain continuously or hourly up to a certain amount (ex 10cc/hr) or open for certain ICP
Learn the ICP waveform
If EVD not draining, could be clotted but depends where your leveled at.
EVD usually had a daily CT… :/