experience –
First RN jobRating: (votes: 0) My first hospital job was on a neuro floor....Blown pupils are a late sign-- trust your gut if you see any changes in behavior, orientation, or agitation....everybody always talks about the pupils... find out from your preceptor what the general preferences are for the docs about when they want to be notified about suspected ICP changes.Seizure patients don't always have incontinence, loss of consciousness (even with temporal lobe- it can be a partial loss- depends on where the focus is). I've heard nurses call patients fakes because they didn't pee.... don't use that as a measuring stick. Some simple partial seizures are just little twitches, a funky smell, or hearing changes. If a patient has compromised LOC, have suction set up and ready to go... better to waste a suction catheter/Yank than deal with aspiration. If someone comes in with new TIAs or a possible CVA, be sure to check that Speech (or whoever) does their swallow study before giving them anything to drink/eat... patients can't always feel changes. Note drooling (as well as the good old facial droop- but that's not a sure indicator). Decadron IV can cause genital heat sensation that freaks patients out, and they don't want to tell you, but will get a weird look on their face (I'd warn them ahead of time that it's a possibility, and isn't anything to worry about). Decadron can also cause hiccups (to the point of pain)... not sure if they still use a very low dose Thorazine, but it used to work wonders. So much more-- soak up all you can from the preceptors-- ask all sorts of questions. Check out any neuro reference books for nurses...online sources are good. Just be open, and ask questions It's a hard floor, but can be a great place to work. I loved neuro, though a year or two of general med-surg would be good- don't forget the lungs, heart, kidneys, skin, etc just because you're specializing- it's easy to do when you're new....plan on feeling a bit dumb now and then- it's normal |
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