Season 2 Episode 002 Neuro ICU Nurse Tips for Newbies, Part 2: Disease Processes Show Notes

This episode discusses a few diseases processes that are typically seen by the neuro ICU nurse as well as a neuro floor. We chat about subdural hematomas, epidural hematomas, seizures, brain tumors, and diffuse axonal injury.  And as always, this episode is hosted by three neuro ICU nurses!

You can listen to Season 2, Episode 2 here.

Neuro ICU Nurse Tips for Newbies, Part 2:

Your first year as a registered nurse is challenging. This podcast is hosted by Kati Kleber, BSN RN CCRN and Elizabeth Mills, BSN RN CCRN and features experienced nurses from FreshRN.com, who discuss the basics of that first year. From nursing orientation, documentation for nurses, code blues, tricks of the trade, and personal experiences, to time management, delegation, patient deaths, and more.

Download the Season 2, Episode 002 Neuro Nurse Tips for Newbies, Part 2 Show Notes or view them below.

This episode discusses a few diseases processes that are typically seen by the neuro ICU nurse as well as a neuro floor. We chat about subdural hematomas, epidural hematomas, seizures, brain tumors, central pontine myelinolysis, and diffuse axonal injury.

Subdural hematoma

• SHD is not a stroke
• Dura = covering of the brain… blood is under the dura but on top of the brain
• Often a tear in a vein, which results in a slow blood accumulation
• Happens often with elderly; brain atrophies and creates space
• Acute – blood is new, the blood isn’t thin. Quite thick… if it’s large enough they’ll go to the OR for an evacuation
• If it’s older (subacute) 1-2 weeks… but blood thins out and become easier to treat. Some surgeons will do a bedside procedure to remove the clot

Epidural hematoma

• Above the dural layer of the covering the brain
• Typically the result in an artery tear, which results in a very fast accumulation of blood in the epidural space
• Appears quickly, enlarges quickly, and is often a surgical emergency
• Common place is around the temporal bone near the eye… meningeal artery… may not lose consciousness
• Liam Neeson’s wife died of this – here is a short article from Advanced Neurological Associates
• Change in HOB with lots of pressure

Seizure

• Patients with neurological injury are at risk for seizures
• You cannot tell just by looking at a patient that they are having a seizure or not; only the EEG can absolutely confirm that
• Safety and maintaining an airway is of utmost importance
• Must get seizures under control
• Antiepileptic drugs (AED’s)

• • Looks like they’re having a seizure, but when you look at an EEG they are not actually having one
• Status epilepticus

• • Maybe one long seizure, or multiple seizures with minimal breaks
  • Must stop the brain from seizing! Brain electricity is going bananas – rescue drugs and airway protection (intubation) is frequently necessary because they cannot maintain their airway while seizing that frequently
• Subclinical seizures

• Not evident from CT or assessment

Brain tumors

• Many kinds of tumors
• Some are cancer, some are not – must get a biopsy, which is incredibly invasive (craniotomy), to definitively say if it is cancerous or not
• Watch Na+ and for CSF leak (clear fluid out of nose, ear)

• Typically, incision is made through the nares
• Coughing/sneezing precautions
• Usually begning
• Diabetes Insipidus is something to watch for
• Watch urine output closely

Central Pontine Myelinolysis (CPM)

• Medscape article
• Overcorrection of serum sodium – cannot correct too fast (more than 8-10 in 24 hours)
• Must watch closely when administering hypertonic saline
• Essentially, it’s a stripping of the myelin sheath
• Irreversible
• Can be mild, moderate, severe, and fatal
• This is a big deal!
• You won’t get an alert from the lab for overcorrection unless it is over their threshold for hypernatremia.
  • For example, if you correct from 125 to 135 in 24 hours, it won’t alert the lab because technically the 135 is normal. However, this is a HUGE change in 24 hours and concerning for demyelination.

Diffuse axonal injury

• Wikipedia article
• Seen with trauma patients
• The force of traumatic shearing causes this
• Global deficits rather than deficits with a stroke that’s one-sided; most (roughly 90%) never regain consciousness
• Ranges from mild to severe

Need more in-depth neuro info? Check out the Neuro Nurse Crash Course brought to you by FreshRN® where we discuss essential topics like essential neuroanatomy and disease processes, primary and secondary injury, neuro nursing report, meds, time management, mastering the neuro assessment, and more!

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More resources

• Becoming Nursey
  • First Edition
  • Second Edition
• How I Deal With Seeing Patients Die Frequently – YouTube
• Brene brown’s daring greatly
• Secondary trauma