PICU Nursing Expectations
Name the monitoring equipment that must be present at each bedside at all times
-X3
-calbes: pulse ox, adult BP, EKG + 5lead & 12lead
-CO2 extension
- intellibridge
What is a normal ICP
0-15mm Hg
does not require leveling
How often should you level and zero your ventric
At the beginning of your shift and whenever the pt changes position
Which of the following patients would most likely need neurosurgery?
A- a patient with basilar skull fracture
B- a patient with bacterial meningitis
C - a patient with a subdural hematoma
D - a patient with metabolic encephalopathy
C - subdural hematoma
***others require medical management***
Your patient must have this present on 2 different limbs:
ID band
What personnel is allowed to change the EVD dressing
neurosurgeon or designee
When should the monitor be zero'd
At the beginning of the shift and when ever you question the reading
Where is the ventriculostomy tray kept?
on the westside in the storage room
A pt presents with c/o the "worst headache I have ever had" and was diagnosed with a grade I aneurysm. Which answer describes a grade I aneurysm.
A - decebrate posturing and coma
B - mild to sever hemiparesis and stuporous
C - minimal neurological deficits with a mild to serve headache
D - minimal headache, no neurological deficits
D - minimal headache no neurological deficits
***other symptoms describe higher grade aneurysm***
How often must you document your patients pain score
-Q1 or Q2 with VS and before & after any pain medications
What disinfecting agent can be used on the EVD
betadyne only
When is the reference number obtained and where is it kept
prior to the catheter being inserted and on a sticker placed on codman monitor
How often should the ventric drainage bag be changed
when it is full
What of the following statements are TRUE?
a - the patient who develops delirium will have an increased risk of mortality
b - delirium is a permanent condition
c- most patients with delirium exhibit agitation
d - a patient with dementia cannot develop delirium
a - patient who develops delirium will have an increased risk of mortality
24 hours
Which anatomical location is used to zero and level an EVD
Tragus of the ear
the white "zero patient monitor" button
How can you troubleshoot a ventric that is not draining
re-level, re-zero, make sure it is open correctly to drain, lastly - drop it slowly below the tragus to see if you have movement of fluid
Which of following nursing interventions would be appropriate for a pt with increased intracranial pressure (ICP) after receiving a basilar skull fracture.
a - feeding them via an OG tube
b- administer D5W at 100cc/hr
c - keeping pts HOB flat
d - maintaining a slightly elevated PaCO2
a - feeding them via an OG tube
Name 2 patient population groups where it is contraindicated to obtain a rectal temperature.
low platelets, GI bleeding, neutropenic, transplant, heme/onc
Name 4 things that can be done with the EVD
- monitor
-drain
-sample fluid
-administer medications
When would you need to use the reference number
Only if the catheter is disconnected for the monitor cable
What steps would you take if your ventric became dislodged
1- assess pt neuro status
2-no PICU/neuro surgery to develop plan of care
3- incident report
Which of the following interventions would the nurse consider to be inappropriate for the patient with increased ICP?
a - maintaining the PaCO2 level at 35mmHg
b- feed the patient via a feeding tube
c- log roll when turning
d- administering D5W @ 83cc/hr
d - administering D5W