Put down the Penlights...Neuro assessment

Changes in behavior are an early sign of neurologic compromise. They are not specific to neurologic problems, but they are the earliest sign. Keep a close eye on the patient for problems with speech and disorientation. Many nurses start assessing neurologic function by pulling out their penlight and checking the patient's pupils. This is very stimulating to your neuro patient and is not the first thing that is going to change.
If your patient is alert and oriented and you are just trying to follow him to see if his condition is getting worse, the first thing that is going to change is his behavior. Behavior is the highest level of function. Next the patient will have changes in his speech. Speech patterns and the ability to perform speech tell you a lot about the patient's neurologic function. The third level down is content of arousability, and this is what is referred to as orientation. The forth level is arousability; whether or not the patient wakes up when you walk into the room or you have to touch him or use painful stimuli.
If your patient is already unconscious, assess systolic blood pressure as an indicator of intracranial pressure. As intracranial pressure increases, systolic pressure has to increase to continue to perfuse the brain. The very lowest level is the pupil reflex. Changes in pupils do not tell you much about the patient. Pupil changes indicate a very small lesion that is right around the optic nerve or a huge lesion that is causing the patient to herniate.
Check speech first. Put down the penlights and watch the patient's behavior changes.
Best wishes,David W. Woodruff, MSN, RN-BC, MSN, CENPresident, Ed4Nurses, Inc.www.Ed4Nurses.com www.dwoodruff.com

Amiodarone Competency~for RN's

You will find in your mailboxes a competency for Amiodarone. Each RN needs to complete the quiz and return it to Vilma's mailbox outside the office and while you are there sign the Attendance sheet posted there also.

AHRQ and You-Evidences Based Best Practice Handbook

You just never know what you find when you are surfing the net these days but looky here a handbook developed from the Agency for Healthcare Research and Quality (AHRQ) for nurses. Sponsored by the Robert Wood Johnson Foundation this is a virtual (literally) treasure trove of best practices from the nurses point of view and get this...researched as best practice, not just "we do it that way because that's how we've always done it" reasons.
The whole book can be accessed.....online-for nothing...and you can order your own 3 volume printed copy or a researchable CD if you so desire but why when this will be updated periodically long before the printed stuff will be available.
http://www.ahrq.gov/qual/nurseshdbk/

What a treat! Take a gander around and see what we can improve on to keep our patients safe and well cared for.
We all have a hand in this so read on McDuff !! :)
Tracy

And they're on their own..

The new grads are off orientation and are all doing great! We also had a great weekend at ACLS and I am happy to say that Susan Plissey passed without a speck of nerves showing, Dorothy, Jen and I all recerted successfully! The next ACLS is December 6 & 7th. The new grads will be scheduled in the spring class(es) once the dates are annouced I'll post them here.

Just a couple pix of the preceptors with their new grads...

Thank you to all who attended the Wound Update on Monday...if you missed it there will be more at the skills fair in November also. Remember the new regs go into effect today so let the providers know if there are any pressure ulcers on your patients so they can assess and document them in their admission work. Thanks for all you do!