Olga Lupascu

Current Job role/function as a Neurosurgery/Hospitalist/SURGICAL FISRT ASSISTANT Nurse Practitioner.

I assist the neurosurgery attendings in the OR as needed.

• I receive patient updates and full sign out on the entire patient list that varies between 30 and 60 patients on average in the morning from night shift resident at 05:30.
• Round on all inpatient patients daily.
• I am assigned the first call pager and start receiving pages at 05:30. All pages are addressed immediately.
• I carry the consult pager on assigned days. I see new consults and staff with the attending in a timely manner.
• I complete every single plan/assignment/task for each patient that the residents send out in teams from the attendings
• I review patient’s labs, reconcile home medications, adjust or add new medications according to patient’s situations. Transition patients off IV infusions. Make sure all orders are accurate and appropriate. I replete all needed electrolytes. If patients need blood transfusions, they are transfused accordingly and monitored to ensure that they remain stable.
• I review all vital signs to ensure all patients are hemodinamically stable.
• I monitor patients with Foley catheters and central lines to make sure they are discontinued as soon as medically indicated to prevent infections.
• I review images and discuss the results with the team and convey the results to the patients.
• I order, review, and monitor specific labs and tests for infectious workup to ensure that the patients receive appropriate and fast necessary treatments.
• I lead the morning huddle for all neurosurgery patients at 8AM with the Neuroscience ICU team, PT/OT/SLP, dietitian, case management/social workers. During this meeting we coordinate which patients are stable to be downgraded to general floor or ready for discharge. I prioritize discharging patients before 9 AM.
• I provide patient education in person about incision/surgical wound care at home along with general safety discharge instructions.
• I talk to the patients and their families, answer all their questions about plan of care, imaging/biopsy results, and postoperative care.
• I coordinate care with other providers. I refer patients to other providers in the outpatient setting after discharge for further care.
• I set up scheduled procedures with Interventional radiology per attending physician instructions.
• I post patients for operative procedures, I preop and consent them as instructed by the team.
• I respond to all calls to bedside and lead tiger teams, call appropriate consults and upgrade the patient to the ICU and collaborate further care with the ICU team.
• I add all the postop patients and direct admits to the neurosurgery daily working patient list and keep it updated in teams throughout the day so that the entire neurosurgery team access the most accurate and updated patient information.
• I give sign out to the resident before I leave at 15:30 with all the completed plans, patient updates, recommendations from the consulting teams.
• When short staffed, i stay after hours to complete all the tasks for the day.
• If a patient's condition declines right before my shift ends and needs my attention I do stay after hours and make sure the patient is taken care of. It can involve emergent surgical interventions, or transfer to the ICU, order stat images and review those images. Update the chief resident and the attending about the changes made and follow their instructions. I call and update the family of the situation.
• For ICU patients I manage high intracranial pressures; I recognize vasospasms, and other acute neurological changes and address them accordingly with the attending providers.
• I place as well as remove lumbar drains, EVD’s, and all other types of surgical drains. I remove all cranial and spine-incision sutures and staples. I clean and monitor the incisions.
• I perform all other procedures such as VP shunt valve adjustments, VP shunt taps, place and remove prevenas. I administer intrathecal tPA. I perform fluid collection taps at bedside. I collect and send off CSF from lumbar drains and EVDs. Access Ommaya reservoirs and administer intrathecal medications.
• I reinforce, troubleshoot, and replace wound vacs, ventriculostomy drains, subdural drains, and lumbar drains.
• I update all patients and their families about changes in plans throughout the day.
• I call all consulting teams that the patients need, and coordinate care to provide comprehensive care for all active medical issues while the patient is hospitalized, such as: hypertension, hyperglycemia, hospital acquired pneumonia; urinary tract infections; acute cardiac issues that occurred spontaneously and the patient requires a cardiology consult and further cardiac intervention and management; ileus, constipation/diarrhea; bowel obstruction, pressure injuries; falls in the hospital; new onset seizures; new strokes; DVTs/pulmonary embolism with need for anticoagulation or IVC filter placement after a recent surgical intervention; postop hemorrhage detection and management; postop/hospital acquired infections; uncontrolled pain; substance abuse/withdrawal; delirium; acute kidney and liver injuries; postop anemia; thrombocytopenia from reactions to medications such as antibiotics; dysphagia and handling the discussion with patients and families about the need for a permanent feeding tube placement; paralysis and weakness postop; weaning off the ventilator; recognizing when it is appropriate to downsize trachs and decannulate the patients when they are stable and ready; recognizing and managing abnormal electrolytes, abnormal EKG’s, X-rays, CT/MRI, manage new onset urinary retention, hematuria, GI bleeds, COPD/Asthma exacerbations, heart failure, acute flare-ups of chronic conditions, new anxiety/depression/psychosis/ suicidal or homicidal ideations while hospitalized.
• I respond to all tiger teams and code blue emergencies for all neurosurgery patients.
• I frequently contact the following consulting providers: intensivists, cardiology, pulmonary, endocrine, general and stroke neurology, PMR, ophthalmology, general/thoracic/cardio thoracic, and vascular surgery, hematology-oncology, radiation-oncology, urology, geriatrics, psychiatry, internal medicine, rheumatology, GI, infectious disease, interventional radiology, epilepsy monitoring unit (EMU).
• I contact all primary providers for the patients that neurosurgery is consulted on and touch base about our new recommendations and plans.
• I also see new consults in the ED or throughout the hospital when the residents are in the operating room or otherwise unavailable for other reasons such as mandatory didactics, conferences or clinic.
• I see patients in clinic if I am asked to by my team.
• I perform nursing bedside procedures that the nurses are unsuccessful with such as: placing NG tubes, placing IV’s or drawing blood for a patient that is declining or otherwise necessary.
• I perform peer to peer conversations/reviews with insurance companies when patient hospital stay coverage is denied.
• I complete FMLA paperwork for patients and their family members.
• I contact companies such as Medtronic and Abbot regarding deep brain stimulators and pacemakers interrogation, identify if they are working properly, if they are MRI compatible, turn them off, or set in MRI mode to preserve battery integrity.
• I call surgical reps to request various surgical supplies needed by attendings in OR.
• I respond and handle all concerns brought up by the patient experience staff regarding negative patient situations.
• I manage pharmacological and non-pharmacological treatments to treat underlying causes and relieve symptoms.
• I learn and adapt quickly to new technology and software applications

• Assessed patients to determine individual needs and develop care plans in coordination with multidisciplinary healthcare professionals
• Discussed care plans with patients and explained test results and therapy purposes
• Conducted screenings, diagnostic treatment and rehabilitative services on primary health care team
• Ordered and interpreted diagnostic tests to develop and implement treatment plans
• Provided medical services and care to patients with chronic and acute conditions
• Educated patients on treatment options, medical needs and non-medical options for treatments and therapy
• Adhered to hospital procedures, policies and protocols to support patient safety
• Completed supervised bedside procedures such as establishing arterial and central venous access, intubations, and ultrasonography.

• Provide exceptional care to critically ill patients in the ICU
• Assisted physicians with intubations, defibrillations, chest tubes, and placement of central venous and arterial lines
• Titrate pressors, anti-arrhythmics, sedatives, narcotics, and paralytics
• Monitor telemetry and respond to calls and emergent, life-saving situations
• Follow physician orders and report changes in condition
• Educate patients and families and provide caring support
• Discharge patients and help in patient transfer
• Collect and plan the care for patients using the nursing model of assessment, planning, intervention, and evaluation
• Adhered to legal and patient safety requirements of nursing care in area of practice
• Setting up and maintained arterial CVP lines, and chest tubes
• Maintain advanced airways
• Assessed and prepared patients for procedures, performing initial and ongoing patient assessments
• Exhibited professionalism and leadership to peers by participating in professional activities and continuing education
• Promoted safe and calm environment for complex patients by keeping services, supplies and necessary equipment on hand
• Specialized in nursing care for patients requiring continuous and comprehensive observation and acute trauma patients with multitudes of injuries
• Confirmed proper functioning of life support equipment such as ventilators and feeding tubes.

• Progressive Care Unit
• Efficiently and knowledgeably provide RN care for all PCU patients
• Assisted with bedside procedures, administered blood products, high-risk medication, IV starts and maintenance
• Maintained open and clear communication with physicians to coordinate effective patient care
• Conducted patient assessments and diagnostic tests to provide physician with important patient health information
• Completed daily assessments and documented information in electronic medical records
• Helped team manage patient flow by promoting timely placements for admissions, discharges and transfers
• Conducted continuous cardiac monitoring on patients stepping down from ICU care
• Assessed and coordinated patient discharge planning needs with multidisciplinary healthcare team
• Supported timely diagnostic and ongoing testing by collecting samples
• Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.