As I’ve said many times before, nursing is all about solving problems. You SEE something, you DO something…it’s so simple. But, at the same time, putting it into practice can be quite complex. The patient problems you start out with at the beginning of your shift, are not always going to be the same problems you’re dealing with a few hours in. As a nurse, your ability to adapt, reprioritize and reevaluate is the MOST ESSENTIAL thing you can do.
In Med/Surg 1, you learn the basics of stroke nursing and how rewarding and challenging it can be to care for these patients. And, because the human brain is an extraordinary thing, the manifestations of stroke and the nursing interventions are enough to make your head spin!
In this podcast episode we talk about the basics of hyponatremia:
- What is hyponatremia?
- Common causes including neuro injury, psych disorder, even just plain ol’ poor judgment
- The signs/symptoms of hyponatremia
- How you treat it a
As usual, this podcast and blog are not intended to replace current evidence-based practice or your institutions policies and procedures. It is intended for educational purposes only.
The first “PodQuiz” was so well-received that we’re continuing it this week with an audio quiz about neuro essentials.
In this PodQuiz, you’ll get a chance to review neuro assessment (including all the cranial nerves), Alzheimers, Parkinsons, MS and Stroke. Not sure what a PodQuiz is? In a nutshell, it’s a way to review and quiz yourself on material using audio…I ask a question, there’s a pause while you answer, then I state the answer. It’s like doing flashcards with your ears!
It’s your first shift of four-in-a-row and little do you know that you are in for a tough stretch! Your shift starts out calmly enough, but at 0200 you take report on a 23-yr old post-surgical trauma patient who came in through the ED due to a pedestrian vs auto incident. The patient was crossing the road on a dark, rainy night when she was struck by a vehicle at approximately 30 mph. Her injuries are:
Taking care of patients with neurological injury means managing their intracranial pressure, or as it’s commonly called, ICP. And when we say neurological injury, keep in mind that we’re not just talking about people getting bonked on the head with a 2 x 4. We’re talking about space-occupying lesions, hydrocephalus, intracranial hemorrhage, subdural/epidural hematoma, even severe hyponatremia…basically anything that’s a key player in (drum roll please….) the Monro-Kellie doctrine.
A few years ago a local radio station had a contest…Hold Your Wee for a Wii. The contest rules dictated that the contestants would drink copious amounts of water and whoever could hold their pee the longest, won a Wii game console. Despite numerous physicians and nurses calling in to the switchboard to tell them how dangerous this was, their pleas were ignored. They undoubtedly thought…”It’s water…what’s the big deal?” Well, the big deal was that the winning contestant went to bed that afternoon and never woke up. It was an enormous tragedy and absolutely beyond heartbreaking. I can’t imagine what her loved ones went through to have someone close to them die from such an avoidable event. Hyponatremia is deadly serious…and here’s what we’re going to do about it.
When I first started in the ICU I was overwhelmed with all the different neuro diagnoses and how the treatments varied based on where the injury is located, what caused it, whether or not they’d had surgery yet…super confusing!
Here’s a handy little guide that briefly outlines the basics of the most common neurological injuries I see. I didn’t go into all the tumors and such because there are a million different kinds and I don’t see them that often. We also don’t do traumas so much (except for the subdural hematoma variety) as people who get into knife fights (and lose) go to one of the lovely trauma centers for specialized care.