Neuro ICU Nurse Tips for Newbies, Part 2: Disease Processes

by | Feb 27, 2018 | Podcasts, Neuro Nursing, New Nurse | 0 comments

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Who You’ll Hear

Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Melissa Stafford, BSN RN CCRN SCRN – highly experienced and currently practicing nationally certified neurocritical care nurse.

Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center.

What You’ll Learn:

  • Subdural hematoma
  • Epidural hematoma
  • Seizure
  • Brain Tumors
  • CPM
  • Diffuse axonal injury


This episode discusses a few disease 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!

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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, an incision is made through the nares
  • Coughing/sneezing precautions
  • Usually benign
  • 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

More resources

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Picture of Kati Kleber, founder of FRESHRN

Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.

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