As a Neuro ICU nurse, expect frequent patient assessments and monitoring. Neurological assessments are to be done anywhere from every 15 minutes to every 2 hours because changes in status with a neuro patient are often not shown in vital signs until it is too late.
These frequent neuro assessments are necessary—the first sign of a neuro change often is seen in level of consciousness/orientation. Neurological assessments can often be very subjective—is the patient just tired of being woken every hour and not wanting to participate? Did he or she recently have a procedure done that might be causing numbness or tingling? Is there an external stimulus causing their ICP to raise?
In addition to neuro checks, many neuro patients have extra ventricular drains (EVDS) that must be monitored hourly for output and ICP (intracranial pressure) levels. Any stark increase in the output or ICP level needs to be communicated quickly to the advanced providers. Honing your skills with neuro assessments does take time and practice but once you have mastered it, there is no better feeling than catching a neuro change early on before it becomes detrimental.
The 4 most common medications used in the Neuro ICU are:
- 3% Hypertonic Saline-aids in decreasing cerebral edema after stroke or head trauma, also helpful in cases of hyponatremia
- Mannitol- also aids in decreasing cerebral edema and therefore decreasing ICP
- Propofol-sedation of choice for neuro patients due to its quick onset/offset (typically only a few minutes) in order to obtain a quick neuro assessment
- Vasopressors-norepinephrine (Levo), phenylephrine (Neo), vasopressin are the three most common for increasing blood pressures
A “Typical” Day
A Neuro ICU nurse must be calm under high-pressure situations. You will be required to assess and address neuro changes quickly, travel patients to CT and MRI scans frequently, assist with EVD placements, ICP monitoring drain placements, and lumbar drain placements on an almost daily basis, monitor for signs of brain death and herniation, understand reflexive movement and be able to educate families well on their loved one’s condition.
Every person reacts differently to their neurological disorder—two patients can have the same stroke and one could be relatively fine while the other could be suffering major side effects so it’s important to maintain open communication with families as these patient’s recoveries are often rollercoasters.
Pros of being a Neuro ICU Nurse
Working in a Neuro ICU can be extremely rewarding. Watching and facilitating patients recovery from large strokes and head injuries to one day come back for a visit to thank you is one of the most uplifting and fulfilling experiences a person can have.
Cons of being a Neuro ICU Nurse
On the other hand, neurological trauma is often very debilitating and can frequently lead to death. As a Neuro ICU nurse, having an understanding of the brain death process and organ donation criteria, as well as withdrawal of life sustaining treatment protocols are paramount to your understanding of caring for these patients as these cases do happen often.
Treating the Whole Person
Neuro ICU patients do not just have neurological issues. They still have all the other organs to monitor as well so there is no shortage of ventilator use, CRRT (continuous renal replacement therapy), and cardiac output monitoring to be done. Many of the trauma patients also have ortho needs to be addressed. General surgery is often involved due to internal traumas. Just because a patient is in the Neuro ICU does not mean you will never get to see a procedure or treatment involving another organ—that is one of the best reasons to work there, you get to see a little bit of everything due to the complexity of these patients.
Making a Difference
Many of your patients will recover from these debilitating issues and as a Neuro ICU nurse, you have the opportunity to work with so many interdisciplinary teams: physical and occupational therapy, speech therapy, music and pet therapy, neurologists, neurosurgeons, critical care, etc…you get to really experience a lot of knowledge and learn from so many types of professionals.
About the Author
As a registered nurse with over 5 years of critical care experience and 1 year of travel nursing, Shannon Hardy has a great understanding of how much work is put onto the backs of every healthcare professional each day. She loves finding inefficiencies in how things are currently done and speaking with those who actually deal with it to find solutions. With this in mind, Shannon sought out her MSN in Clinical Informatics and joined Kamana after graduation. She sees Kamana as the answer for how to reduce some of that daily stress, especially when it comes to the important things (like licenses) that help you stay working!
In her spare time, you may find her hiking with her dog and husband, traveling somewhere new, spending time with friends, or trying her hand at recipes seen on cooking shows.