Advanced Neurological Care and Monitoring
Where is the "zero" level?
What is the tragus. Level of Foramen of Monroe.
If the patient failed dysphagia screening in the ER, is it OK to do a bedside swallow in ICU if ordered by a physician?
What is NO. Once failed, always failed until the patient can be evaluated by speech pathology.
Do you perform a sedation vacation when a patient is a neuromuscular blockade?
No.
What is the time frame we call ARORA when the patient meets clinical triggers?
What is within 1 hour.
Who do you notify in the event of a suspected blood transfusion reaction?
Who is the provider and blood bank.
What is a normal CPP?
What is 60-80. >/= to 70 is desired.
How often is the dysphagia screen documented if "FAIL"?
What is one time and one time only.
How often are TOF performed when initiating the paralytic and with any required titration until reach desired goal?
What is every 15 minutes x 4.
What is at least 2 of the clinical triggers to notify ARORA?
What is Intubated patients with a GCS of 5 or less,
initiation of hypothermia protocol,
Family brings up donation, or
Talk of terminal extubation or deceleration of care
Identify three possible symptoms of a blood transfusion reaction.
What is fever, N/V, SOB, headache, Hypo/hypertension, rapid respirations, rash/hives, flushing of the skin, hypoxemia, shock, wheezing, syncope, etc
Calculate a CPP.
MAP 65
ICP 10
What is 55.
What is TIME ZERO?
When tenectaplase given, arrival to ICU post mechanical thrombectomy.
How often are TOF's performed after reaching desired goal?
What is TOF every 30 minutes, then every 4 hours.
Are we as nurses allowed to approach about donation?
What is NO.
What is the first action to take when a blood transfusion reaction is suspected, not including notifying the provider?
What is stop the blood, disconnect tubing, and hang new tubing with Normal Saline.
How is the ICP fiberoptic line/tubing kept secure?
What is secure in two places, prevent kinking or bending, and avoid tension catheter or cable.
What is the maximum dose of Tenecteplase?
What is 25mg (5mL). (98kg or greater)
BIS monitors for what only?
What is Sedation ONLY.
Does not reflect anything RT to pain control or how paralyzed the patient is.
Where do you document when you have notified ARORA?
What is a progress note ".earlyreferraltoarora".
What form needs to be requested and completed and where does this form come from?
What is a blood reaction form obtained from blood bank and/or with our forms in the unit.
How often are neuro assessments, accurate ICP, and CPP assessed and documented?
What is a minimum of hourly.
How often is NIHSS completed?
What is baseline, every shift, and with new neuro changes.
BIS goal typically is?
What is 40-60.
What is the timeframe we notify ARORA of death for tissue referrals?
What is 1 hour.
Name three items sent to lab?
Order LAB1003 -Draw a purple and pink tube.
Blood product with transfusion set including all attached fluids.
Blood reaction form.