Unit 82 Neurosurgical Intensive Care

Description of Unit 

The NeuroIntensive Care Unit is a 30-bed inpatient unit located on the eighth floor in the Patient Services Building.  The unit consists of thirty private rooms with monitoring capabilities at each bedside. There are three isolation rooms available. All bed spaces are equipped with hard-wiring at the bedside and remote alarm capability (monitor and ventilator) to the central nursing station and nursing alcoves. Monitoring capabilities include continuous 5-lead electrocardiogram, pulse oximetry, capnography, invasive and non-invasive hemodynamics, 2-lead electroencephalogram, full channel (16) digital electroencephalogram  with remote capability as clinically indicated. The patients are not segregated to an area based on ICU or IMC level of care. Care is provided 24 hours per day, 7 days per week. Average bed occupancy is 27.4 patients.

Description of Patient Populations

Patients are admitted to the NeuroIntensive Care (NSICU) from the Operating Room, Emergency Department, and/or general floor for continued cardiovascular, respiratory, or neurological monitoring, postoperatively following moderate to complex neurosurgical procedures, from the Emergency Department, as a neurosurgical or neurological referral from another hospital, or preoperatively for evaluation and treatment. Patients admitted to NSICU require monitoring and/or interventional therapy at intervals ranging between 1 to 2 hours. The neurosurgical population includes patients status post craniotomy and/or interventional radiological procedures and include diagnoses such as aneurysms, arterio-venous malformations, central nervous system neoplasms, traumatic brain injury, spinal cord injury and hemorrhagic stroke. The neurological population includes patients diagnosed with ischemic stroke and/or status epilepticus. Adolescents of greater than 40 kilograms, young, middle, and older adults are admitted to the unit. The average length of stay index is 0.59.

Nursing Care

Nursing care is focused on the assessment, diagnosis, planning, treatment and evaluation of patients requiring intensive and intermediate care. Nursing activities include hemodynamic (arterial, central venous pressure, intracranial pressures, pulmonary artery pressures, intraabdominal pressures, arterial/venous oxygenation, and capnography) monitoring, fluid and electrolyte monitoring, vasoactive and inotropic therapy, respiratory management in both the mechanically-ventilated and spontaneously-breathing patient, neurological monitoring and treatment (including two-channel electroencephalogram setup and basic rhythm interpretation, bispectral index, burst suppression with barbiturate coma, and peripheral nerve stimulation for neuromuscular blockade), postoperative recovery, specialized wound care, nutritional therapy, medication management, and comfort/sedation measures as indicated. Patient and family education and emotional support related to the patient’s condition and treatment is an essential element in the nursing care provided.

Health Care Team

The co-medical directors of NeuroIntensive Care Unit are from Neurosurgery and Critical Care medicine. The Neurosurgery medical director is board-certified in Neurosurgery. The Critical Care Medicine medical director is board certified in anesthesia/critical care medicine. The Critical Care Medicine faculty, fellows, and residents in conjunction with the patient’s Neurosurgical Service faculty, fellows, and residents provide 24-hour care, 7 days per week for the NSICU surgical patient. The Neurology Service faculty and residents provide 24-hour care, 7 days per week for the NSICU neurological patient. Multidisciplinary, comprehensive care of these patients and families is provided by medicine, nursing, respiratory therapy, pharmacy, social work services, case management, pastoral care, food & nutritional services, rehab services, and other health care providers as indicated by the patient’s health status and identified needs.

Nursing management for the unit includes registered nurses in the positions of Nurse Manager and two Clinical Leaders. Unit staff includes registered nurses and support technicians.

Registered nurses on NSICU meet the basic requirements for Registered Nurse staff and function in accordance with the unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for registered nurses include a positive attitude toward family-centered care and open visitation, and the ability, willingness, and interest to work with the age-appropriate needs of patients.

Support techs meet the basic requirements for their positions and function in accordance with their unit-based job description, as described in the Hospital Plan for Nursing Care. Additional unit requirements for the support techs include having a positive attitude toward family-centered care.

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