Evaluation Of An Increased Intracranial Pressure New Admission Patient

Nearing the end of my shift in the Emergency Department, I was requested to accompany a patient while the nurse readied the discharge papers. Upon entering the bay, I met a very small and fragile patient who was anxious to go home. Conflicted between my primary duties and responsibilities to complete training for two inexperienced volunteers, I decided to put forth my interests in teaching by demonstrating compassionate care to my trainees. Although the patient repeatedly refused my assistance, I gave my best effort to calm her as I cloaked a warm blanket around her. As I listened to her confide in me of all of her hospital anxieties, I was shocked from the lack of quality care she had received which made her feel more sick after the first

During my clinical rotation during my last semester of nursing school, I was able to work one on one with a BSN degree nurse named Judy in the ICU. Judy had three years of experience in the ICU setting. She had been a medical surgical nurse prior to her ICU transfer. The ICU at this hospital consisted of two associate degree level nurses and two BSN level nurses on my shift. I rotated three days in this particular ICU. I worked with Judy all three days of my rotation. I was excited about being placed with her for she seemed knowledgeable and skilled. We were given a male post trauma patient to work with all three days. This patient was a 30 year old male admitted for trauma related injuries and was considered unstable and was to be monitored in ICU. This patient had been involved in a motor vehicle accident and

Meanwhile, elsewhere in Habersham County, Tom was feeling slightly nervous as he exited the staff lounge and entered the hustle and bustle of County Hospital’s ER to begin his first shift as an RN. The first few hours of his shift passed slowly as Tom mostly checked vital signs and listened to patients complain about various aches, pains, coughs, and sniffles. He realized that the attending physician, Dr. Greene, who was rather “old school” in general about how he interacted with nursing staff, wanted to start him out slowly. Tom knew, though, that the paramedics could bring in a trauma patient at any time.

The situation happened during the author’s last day of orientation as a new medical-surgical nurse. The author was passing medications and administered aspirin to a patient as ordered. As the author approached the nurses’ station, she stopped in disbelief as the charge nurse started yelling at her, saying, “Why are you not checking your orders? Why did you give aspirin when there was an order for no anticoagulants? Do you know the patient is having a procedure tomorrow? New grads.” Several physicians and nurse practitioners, along with the author’s coworkers, witnessed

We arrived at Clearview at 2231 Hrs. and took the patient to room 14. I went back outside and began to put our unit back together when Supervisor Carlock approached me and in a very agitated voice said: “WHY DID YOU PULL OFF?” Surprised, I said “What are you talking about?” He said loudly, “I TOLD YOU TO STOP AND YOU DIDN’T!” I replied, “Jeff was telling me not to stop because we had a pulse back.” He said “I DON’T CARE WHAT JEFF SAID, I’M YOUR SUPERVISOR AND I TOLD YOU TO STOP!” I said “Dennis, I think you’re talking to the wrong person, you need to be talking to Jeff, I was doing what he told me to do.” He replied “WHO’S YOUR SUPERVISOR, WHO’S YOUR SUPERVISOR, I AM, NOT JEFF, YOU DO WHAT I SAY!” I said ”yes, you are the supervisor, but at that moment I was doing what the Paramedic in charge of patient care was telling me to do, and what I felt was best for the Pt., since we had a 41 Y/O patient who had a pulse.” He said “I DON’T CARE, YOU DO WHAT I SAY!

I had my first two night shift this week on Sunday 9/13 and Wednesday 9/16. I am on 7 West at Sharp Memorial Hospital and the unit is PCU unit with tele monitoring. The unit had a high census this week, but proper staffing and no codes lead to the nights being relatively calm. I was working with Laura who is not my regular preceptor. She stepped in to work with me for this week while Elle, my regular preceptor, was on vacation. I had a wide variety of patients on my two shifts. The first shift I had a patient that was suffering from an exacerbation of COPD with a history of CHF and a patient that had polycystic kidney disease, which had progressed to end stage renal failure. The second shift I had four patients; one patient had been admitted to the hospital multiple times in the past month for GI bleeds, another patient with a history of diabetes and hypertension was admitted for fever and chills and was later diagnosed with sepsis, the next patient had a history of schizophrenia and was found on the ground in her home and was expected to have been there for over 24 hours resulting in deep tissue injury, and my final patient was suspected to have a history of alcoholism and presented to the hospital with shortness of breath and an oxygen saturation of 89%. The first clinical shift I was shadowing my nurse for a majority of the shift. I was being orientated to the unit and learning where to find supplies on the unit. The second shift I took a

It was a very busy night on M10, call bells ringing non-stop for pain medication, or toileting needs, IV pumps alarming, concerned family members coming to the nursing station, numerous patient admissions from urgent care and PACU. I received nursing handoff on all my patients from the day shift, gave handoff to my patient care technicians, and we had our nightly nursing huddle in the station. After hearing everyones concerns about their high risk patients, I wanted to get out on the floor as early as possible to complete my assessments, and administer my medications to leave time for the many uncertainties that my gut instinct warned me would occur. I was able to finish all my patient assessments, and pass my medications earlier than usual, and when this occurs, I always do my best to help my co-workers if they have fallen behind. I went around asking everyone if they needed assistance, and indeed one of my fellow RN’s needed help moving one of my former patients closer to the station, because she had been hypotensive. I greeted Ms. T and her face lit up like a Christmas tree, I asked her how she was feeling and the smile she had on her face immediately turned into a grimace. I assured her, that we would do our best to make her more comfortable once we settled into the new room.

I was working PRN at my local skilled nursing facility. Not having worked for a few weeks this elderly man I was receiving report on was new to me. I was told in report he had slept all night and was doing well. After getting my patients organized for the day I was called into my elderly man room. He was lying in bed having shortness of breath and was very pale in the face. After assessing him I notice blood in his brief. His blood pressure was low, heart rate was rapid and oxygen saturation was low. After speaking with the physician we decided to send him to the emergency. I called 911 and gave them a brief assessment of his condition. When I got off the phone I went back into the room to comfort the wife and daughter. I then explain to them what to expect when they arrive at the hospital. When the emergency responder arrive I gave them report of his condition. I went over his vital signs, current medication list, recent lab work, current diagnosis, and what he was doing prior to his change of condition. After he was transported to the hospital I called and spoke with the nurse in the emergency room that would be taken him. I gave her a detail report of his current health conditions. After a few hours I called to speak with the nurse to check his condition and at that time he was stable and was being admitted to the hospital. After a few days in the hospital he returned to the skilled nursing facility and is still doing well. As a registered nurse I was able to use my scope and standards of practice to recognize there was a change with him and was able to get him assessed quickly and transported to

The simulation exercise presented a complex situation when Charge Nurse Janice didn’t have enough nurses in her unit and the VP of Support Services called and her about the scheduled meeting. At the start of the shift, she responded unprofessionally to the situation by giving directions to the staff while on a personal call and reacting negatively to any patient update provided by the staff. Janice also created a bad impression to Elise, the new nurse, when she asked about her assignment. Janice addressed the patients’ names with the procedures they had. Knowing that there was a situational problem, Janice should have communicated properly and emphasized to the staff about teamwork to facilitate the workflow in the unit. Elise is new and inexperienced, but Janice could have utilized her help with basic tasks as long as she had been directed and coached properly.

Then I received a new admit with telemetry I had to give that patient away to get this new telemetry patient. This patient was from skilled nursing facility (SNF). The patient was being admitted with pneumonia and sepsis. When received patient from the emergency room, who had multiple wounds to whole body. Literally it took me and certified nurse’s aides one hour take pictures, due to patient being confused and combative with us. It was fourteen hundred (1400) not gone to lunch. The charge nurse could not help me or watch my patients, was busy with transferring patients to another facility. And we did not have a break relief nurse. Hospital was already short staff of nurses. They called nurses come in, but unfortunately no one came. With having high acuity patients’, not enough nursing staff, and having exposure to this stress over time leads to nursing burnout. With the Affordable Care Act the health care has experienced an increase in the number of new patients’ in the emergency room. Some of these patients that are coming into the emergency rooms have chronic illnesses that were ignored and now require more care. Due to increase in patients the wait times and patient loads have also increased for nurses and

Most weekend nights in the Intensive Care Unit are busy, but this particular Sunday night in July was more intense than any other. Working as a weekend night ICU manager, I do not normally care for patients one on one. I make rounds with each nurse on their patient on a nightly basis and oversee everything that is happening. I am also in charge of the staffing for my shift and the upcoming shift. On this specific night, we had one ICU bed available, but no staff on call. Every patient in the unit was a high acuity, therefore; the nurses were very busy, with no time to spare. The Emergency Department called with an admit that would be a one nurse to one patient ratio. I knew that our facility highly disliked turning patients away to

Intra cranial pressure (ICP) measurements are taken via invasive procedures in clinical settings. These procedures require sensors to penetrate the skull or are performed by a lumbar puncture. All invasive procedures come with a risk of infection, bleeding, damage and structural herniation of brain tissue(2).Therefore the development of a proven non-invasive method of measuring ICP is highly desired. At the University of California in San Diego (UCSD) lab researches have begun tests using a non-invasive technique to measure ICP through the use of a cerebral and cochlear fluid pressure (CCFP) analyser (the MMS-12 developed by Marchbanks measurement systems). The CCFP can measure ICP via calculating fluctuations of the perilymphatic fluid

During my Cath lab rotation, I followed the Cath Lab personnel to the ED after a cardiac code was called. We transferred the patient with a ST-Elevation Myocardial Infarction (STEMI) to the Cath Lab to perform an angioplasty in which it had to be done within 90 min to prevent any more complications such as cardiac arrest. The patient arrived via ambulance and he did not have any family with him. Once we arrived to the Cath Lab I observed the procedure and the team at work. There were a lot of consequences during the surgery he was close to coding and required to be intubated and ventilated. The physician inserted a PICC line due to his decreased perfusion. After,

A disoriented patient, aged 25 years, suspected with cerebral malaria was admitted to the emergency department of my medical college. Upon administrating quinine with dextrose, the general practitioner shifted him to the intensive care unit. Within a short span of time while monitoring the patient in the ICU, a catastrophic event occurred; he sustained ventricular tachycardia with hemodynamic instability. Following this, the resident on call proceeded with the cardioversion immediately. In the meantime, the doctor assigned me to deliver cardiopulmonary resuscitation in between the events. Fortunately, our efforts to reverse him back to sinus rhythm proved effective and the patient responded. Before the incident, the patient had multiple episodes of vomiting. Vomiting depleted his potassium levels in the blood and hypokalemia contributed to quinine toxicity which was the primary cause of this debacle. Being able to bring back patient’s life was an exhilarating moment; collective team effort was the key reason behind this unique feat. From that moment during the internship, I was never the same person again. I realized if I had to handle the patients without supervision I would not have been able to revive the patient. I appreciated that there is much more to learn than the mere 5 years in medical school and good grades. The circumstances behind the patient’s condition further enlightened me to think logically. A good doctor needs to be alert and updated all the time about

Intracranial hypertension is the term that is mostly used for all forms of high intracranial pressure. There is one form of intracranial pressure that in the 1890’s a German physician Heinrich Quincke named “pseudotumor cerebri” which describes a neurological disorder that has all the symptoms of a brain tumor but without the presence of an actual brain tumor. This condition is now known as idiopathic intracranial hypertension. Idiopathic intracranial hypertension is a condition that occurs when the pressure inside the skull increases for no obvious reason. It seems to occur out of nowhere and without warning which is where we get the word idiopathic which means “relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown.” Symptoms of Idiopathic intracranial hypertension includes a severe headache behind the