Neuro
What parts of the body would you test sensation on?
Face and limbs
(Typically upper and lower parts of each)
Before inoculation, this must be removed and the septum disinfected with 70% isopropyl alcohol, then allowed to air dry.
What is the plastic flip cap on the blood culture bottle?
Can you name 3 occasions when you would perform an NIHSS?
•Prior to TNK
•Within 12 hours of arrival (for non tNK)
•When ordered by the MD
•-At RN handoff
•-When there is an acute change in neuro status
According to guidelines, this must be administered within one hour of sepsis recognition.
What are broad-spectrum antibiotics?
How often do you need to perform a neuro assessment on a hemorrhagic stroke pt?
Every hour
What are the 3 types of aphasia to assess for?
Receptive, Expressive, Global
In cases of difficult venipuncture, this blood culture bottle should be prioritized for collection.
What is the aerobic bottle? (green)
Are arms tested together or separate to assess motor on the NIHSS?
Each one is tested separately
This lab test must be repeated by hour 3 and is used to assess tissue perfusion.
What is Lactate?
In the context of sepsis, this term refers to a state where hypotension continues despite adequate fluid resuscitation, often requiring vasopressors to maintain a mean arterial pressure (MAP) of ≥65 mmHg.
What is persistent hypotension?
What 5 things make up a neurological assessment?
GCS, Pupils, Strength, Sensation, Speech
The amount of time a blood culture venipuncture site should be scrubbed?
What is 30 seconds?
Can you complete a NIHSS without any supplies?
No, The cards are required
•Pictures, objects, and sentences test comprehension in the language section
•Tongue twister words are used for scoring dysarthria
This bedside test involves elevating the legs to assess fluid responsiveness in septic patients.
What is the Passive Leg Raise (PLR) Test?
True or False
A patient has to say the correct number of the finger you’re holding up in the visual fields section
False
The test is checking to see if they can see in that quadrant, not say the right word
Ask them when it wiggles helps with aphasic or confused patients
How do you test for strength?
Hand grasps and foot pushes
This action must be avoided after skin disinfection to prevent contamination of the blood culture.
What is repalpating the venipuncture site?
What 3 sections can be documented as “untestable”
•Motor if there is an amputation
•Ataxia if there is an amputation
•Dysarthria if they are intubated
A creatinine level greater than this value is considered evidence of acute kidney injury in severe sepsis.
What is 2 mg/dL?
When prepping a venipuncture site, this must occur after applying disinfectants like chlorhexidine in 70% isopropyl alcohol or povidone-iodine before the site is considered sterile.
What is allowing the disinfectant to fully dry (or evaporate)?
When you do an NIHSS, what part of a full neurological assessment is NOT performed
Pupils!
The NIHSS allows you to gather the information for all other parts of the neuro
This disinfectant is used for neonates during blood culture collection.
What is povidone-iodine?
What are the 2 sections that are scored as normal when the patient won’t follow commands?
Ataxia and Inattention
Score only if you see it
A patient with severe sepsis and a lactate level greater than 4 mmol/L despite adequate fluid resuscitation meets this condition.
What is Septic Shock?
When a patient is confused or aphasic, how could you test gaze?
If the patient follows you/someone around the room with their eyes, they score as no vision loss