Nursing Mnemonics 09

MNEMONICS FOR NURSES 09 HYPERNATREMIA FRIED SALT F - Fever (low), flushed skin R - Restless (irritable) I - Increased fluid retention & increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth SALT S - Skin flushed A - Agitation L - Low-grade fever T - Thirst HYPERKALEMIA - Signs & Symptoms MURDER M - Muscle weakness U - Urine, oliguria, anuria R - Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid) HYPERKALEMIA - Causes MACHINE M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism/ hemolysis I - Intake - Excessive N - Nephrons, renal failure E - Excretion - Impaired HYPOCALCEMIA CATS C - Convulsions A - Arrhythmias T - Tetany S - Spasms and stridor BLEEDING - S/Sx BEEP B - Bleeding gums E - Ecchymoses (bruises)

E - Epistaxis (nosebleed) P - Petechiae (tiny purplish spots) RESPIRATORY DEPRESSION - inducing drugs STOP breathing S - Sedatives and hypnotics T - Trimethoprim O - Opiates P - Polymyxins PNEUMOTHORAX - S/Sx P-THORAX P - Pleuretic pain T - Trachea deviation H - Hyperresonance O - Onset sudden R - Reduced breath sounds (& dypsnea) A - Absent fremitus X - X-ray shows collapse PNEUMONIA - risk factors INSPIRATION I - Immunosuppression N - Neoplasia S - Secretion retention P - Pulmonary oedema I - Impaired alveolar macrophages R - RTI (prior) A - Antibiotics & cytotoxics T - Tracheal instrumentation I - IV dug abuse O - Other (general debility, immobility) N - Neurologic impairment of cough reflex, (eg NMJ disorders) CROUP - S/Sx SSS S - Stridor S - Subglottic swelling S - Seal-bark cough SHORTNESS OF BREATH - Causes AAAA PPPP A - Airway obstruction A - Angina A - Anxiety A - Asthma P - Pneumonia P - Pneumothorax

P - Pulmonary Edema P - Pulmonary Embolus CARDIAC VALVES "TRI before you BI": Tricuspid valve is located in left heart and Bicuspid valve is located in right heart. Blood flows through the tricuspid before bicuspid. FEMORAL HERNIA FEMoral hernias are more common in FEMales. "TRY PULLING MY AORTA": Tricuspid Pulmonary Mitral Aorta PLACENTA-CROSSING SUBSTANCES "Want My Hot Dog": Wastes Antibodies Nutrients Teratogens Microorganisms Hormones/ HIV Drugs EMERGENCY MEDICINE

ACTIVATED CHARCOAL: CONTRAINDICATIONS CHEMICAL CamP: Cyanide Hydrocarbons Ethanol Metals Iron Caustics Airway unprotected Lithium CAMphor Potassium IPECAC: CONTRAINDICATIONS 4 C's: Comatose Convulsing Corrosive hydroCarbon ATRIAL FIBRILLATION: CAUSES OF NEW ONSET THE ATRIAL FIBS: Thyroid Hypothermia Embolism (P.E.) Alcohol

Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct Bad valves (mitral stenosis) Stimulants (cocaine, theo, amphet, caffeine) ENDOTRACHEAL TUBE DELIVERABLE DRUGS O NAVEL: Oxygen Naloxone Atropine Ventolin (albuterol) Epinephrine Lidocaine MALARIA: COMPLICATIONS OF FALCIPARUM MALARIA CHAPLIN: Cerebral malaria/ Coma Hypoglycemia Anaemia Pulmonary edema

Lactic acidosis Infections Necrois of renal tubules (ATN) MI: IMMEDIATE TREATMENT DOGASH: Diamorphine Oxygen GTN spray Asprin 300mg Streptokinase Heparin PAIN HISTORY CHECKLIST OLDER SAAB: Onset Location Description (what does it feel like) Exacerbating factors Radiation Severity Associated symptoms Alleviating factors Before (ever experience this before)

SHOCK: SIGNS AND SYMPTOMS TV SPARC CUBE: Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank SUBARACHNOID HEMORRHAGE (SAH) CAUSES BATS: Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease Trauma (eg being struck with baseball bat) Stroke VENTRICULAR FIBRILLATION: TREATMENT "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock": Shock= Defibrillate

Everybody= Epinephine Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Pocainamide VFIB/VTACH DRUGS USED ACCORDING TO ACLS "Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium Magsulfate Procainamide DIABETIC KETOACIDOSIS MANAGEMENT KING UFC: K+ (potassium) Insulin (5u/hour. Note: sliding scale no longer recommended in the UK) Nasogastic tube (if patient comatose) Glucose (once serum levels drop to 12) Urea (check it) Fluids (crytalloids) Creatinine (check it)/ Catheterize NEUROLOGICAL FOCAL DEFICITS

10 S's: Sugar (hypo, hyper) Stroke Seizure (Todd's paralysis) Subdural hematoma Subarachnoid hemorrhage Space occupying lesion (tumor, avm, aneurysm, abscess) Spinal cord syndromes Somatoform (conversion reaction) Sclerosis (MS) Some migraines COMA: CONDITIONS TO EXCLUDE AS CAUSE MIDAS: Meningitis Intoxication Diabetes Air (respiratory failure) Subdural/ Subarachnoid hemorrhage MALIGNANT HYPERTHERMIA TREATMENT "Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia): Stop triggering agents Hyperventilate/ Hundred percent oxygen Dantrolene (2.5mg/kg)

Bicarbonate Glucose and insulin IV Fluids and cooling blanket Fluid output monitoring/ Furosemide/ Fast heart [tachycardia] RESUSCITATION: BASIC STEPS ABCDE: Airway Breathing Circulation Drugs Environment RLQ PAIN: DIFFERENTIAL APPENDICITIS: Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia Diverticulitis Intussusception Crohns Disease/ Cyst (ovarian) IBD Torsion (ovary)

Irritable Bowel Syndrome Stones Acid-base—"ROME" (Respiratory Opposite, Metabolic Equal) Acidosis » Respiratory (opposite): pH Pco2 » Metabolic(equal): pH HCO3 Alkalosis » Respiratory (opposite): pH Pco2 » Metabolic(equal): pH HCO3 Alcohol withdrawal: clinical features—"HITS" Hallucinations (visual, tactile) Increased vital signs and insomnia Tremens delirium tremens (potentially lethal) Shakes/ Sweats/ Seizures/ Stomach pains (nausea, vomiting) Angina: precipitating factors—"4E's" Eating Emotion Exertion (Exercise) Extreme Temperatures (Hot or Cold weather) Anorexia nervosa: clinical features—"ANOREXIC"

Adolescent women/ Amenorrhea NGT alimentation (most severe cases) Obsession with losing weight/ becoming fat though underweight Refusal to eat (5% die) Electrolyte abnormalities (e.g., K+, cardiac arrhythmia) X - ercise Intelligence often above average/ Induced vomiting Cathartic use (and diuretic abuse) Appendicitis: assessment—"PAINS" Pain (RLQ) Anorexia Increased temperature, WBC (15,000–20,000) Nausea Signs (McBurney's, Psoas) Neurovascular Occlusion: symptoms— "6 P's" Pain Pale Pulseless Paresthesia Poikilothermic Paralysis

Blood glucose (rhyme) Symptom Implication Cold and clammy . . . give hard candy Hot and dry . . . glucose is high Blood vessels in umbilical cord—"AVA" (2 arteries and 1 vein) Artery Vein Artery Cholecystitis: risk factors—"5F's" Female Fat Forty Fertile Fair Cleft lip: nursing care plan (postoperative)—"CLEFT LIP" Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair)

Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Position—never on abdomen Cognitive disorders: assessment of difficulties—"JOCAM" Judgment Orientation Confabulation Affect Memory Coma: causes—"A-E-I-O-U TIPS" Alcohol, acidosis (hyperglycemic coma) Epilepsy (also electrolyte abnormality, endocrine problem) Insulin (hypoglycemic shock) Overdose (or poisoning) Uremia and other renal problems Trauma; temperature abnormalities (hypothermia, heat stroke) Infection (e.g., meningitis) Psychogenic ("hysterical coma") Stroke or space-occupying lesions in the cranium Complication of severe preeclampsia—"HELLP" syndrome

Hemolysis Elevated Liver enzymes Low Platelet count Cushing's syndrome: symptoms—"3S's" Sugar (hyperglycemia) Salt (hypernatremia) Sex (excess androgens) Diabetes: signs and symptoms—"3P's," Polydipsia (very thirsty) Polyphagia (very hungry) Polyuria (urinary frequency) Diet: low cholesterol—avoid the "3C's" Cake Cookies Cream (dairy, e.g., milk, ice cream) Dystocia: etiology—"3P's" Power Passageway Passenger

Dystocia: general aspects (maternal)—"3P's" Psych Placenta Position Episiotomy assessment—"REEDA" Redness Edema Ecchymosis Discharge Approximation of skin Eye medications Mydriatic = dilated pupils Miotic = tiny (constricted) pupils Hypertension: complications—"4 C's" CAD (coronary artery disease) CHF (congestive heart failure) CRF (chronic renal failure) CVA (cardiovascular accident; now called brain attack or stroke) Hypertension: nursing care plan— "I-TIRED"

Intake and output (urine) Take blood pressure Ischemia attack, transient (watch for TIAs) Respiration, pulse Electrolytes Daily weight Hypoglycemia: signs and symptoms—"DIRE" Diaphoresis Increased pulse Restless Extra hungry Infections during pregnancy—"TORCH" Toxoplasmosis Other (hepatitis B, syphilis, group B beta strep) Rubella Cytomegalovirus Herpes simplex virus IUD: potential problems with use—"PAINS" Period (menstrual: late, spotting, bleeding) Abdominal pain, dyspareunia

Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing Manipulation: nursing plan—promote the "3C's" Cooperation Compromise Collaboration Medication administration—"six rights" RIGHT medication RIGHT dosage RIGHT route RIGHT time RIGHT client RIGHT technique Melanoma characteristics—"ABCD" Asymmetry Border Color Diameter Mental retardation: nursing care plan—"3R's"

Regularity (provide routine and structure) Reward (positive reinforcement) Redundancy (repeat) Myocardial infarction: treatment—"MONA" Monitor/ Morphine Oxygen Nitroglycerin Aspirin Newborn assessment components—"APGAR" Appearance Pulse Grimace Activity Respiratory effort Obstetric (maternity) history—"GTPAL" Gravida Term Preterm Abortions (SAB, TAB) Living children

Oral contraceptives: signs of potential problems—"ACHES" Abdominal pain (possible liver or gallbladder problem) Chest pain or shortness of breath (possible pulmonary embolus) Headache (possible hypertension, brain attack) Eye problems (possible hypertension or vascular accident) Severe leg pain (possible thromboembolic process) Pain: assessment—"PQRST" What Provokes the pain? What is the Quality of the pain? Does the pain Radiate? What is the Severity of the pain? What is the Timing of the pain? Pain: management—"ABCs" Ask about the pain Believe when clients say they have pain Choices—let clients know their choices Deliver what you can, when you said you would Empower/Enable clients' control over pain Postoperative complications: order—"4W's" Wind (pulmonary)

Wound Water (urinary tract infection) Walk (thrombophlebitis) Preterm infant: anticipated problems—"TRIES" Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP]) Psychotropic medications: common antidepressives (tricyclics) —"VENT" Vivactil Elavil Norpramin Tofranil Schizophrenia: primary symptoms—"4A's" Affect Ambivalence Associative looseness Autism

Sprain: nursing care plan—"RICE" Rest Ice Compression Elevation Stool assessment—"ACCT" Amount Color Consistency Timing Tracheoesophageal fistula: assessment—"3Cs" Coughing Choking Cyanosis Traction: nursing care plan—"TRACTION" Trapeze bar overhead to raise and lower upper body Requires free-hanging weights; body alignment Analgesia for pain, prn Circulation (check color and pulse) Temperature (check extremity)

Infection prevention Output (monitor) Nutrition (alteration related to immobility) Transient ischemic attacks: assessment—"3Ts" Temporary unilateral visual impairment Transient paralysis (one-sided) Tinnitus = vertigo Trauma care: complications—"TRAUMA" Thromboembolism; Tissue perfusion, altered Respiration, altered Anxiety related to pain and prognosis Urinary elimination, altered Mobility impaired Alterations in sensory-perceptual functions and skin integrity (infections) Wernicke-Korsakoff syndrome (alcohol-associated neurological disorder)—"COAT RACK" Wernicke's encephalopathy (acute phase) clinical features: Confusion Ophthalmoplegia

Ataxia Thiamine is an important aspect of Tx Korsakoff's psychosis (chronic phase) characteristic findings: Retrograde amnesia (recall of some old memories) Anterograde amnesia (ability to form new memories) Confabulation Korsakoff's psychosis

SIGNS OF CANCER Change in bowel /bladder habits A sore that doesn’t heal Unusual bleeding/ Discharge Thickening of lump – breast or elsewhere Indigestion/ Dysphagia Obvious change in wart/ mole Nagging cough/ hoarseness Unexplained anemia Sudden weight loss

FOCUS OF PATIENT CARE IN CLIENTS WITH CANCER Chemotherapy Assess body image disturbance (related to alopecia)

Nutritional needs when N/V present Comfort from pain Effective response to Tx? (Evaluate) Rest (for patient and family) Basic MI management - "BOOMAR" Bed rest Oxygen Opiate Monitoring Anticoagulation Reduce clot size To Remember Immunoglobulins - "GAMED" IgG IgA IgM IgE IgD Location of the heart valve from right to left - "A Permanently Temperamental Man" Aortic Pulmonary Tricuspid

Mitral "Cut C4, breathe no more" The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm. Types of Joint movements - "FEEDPIPE CARDSHARP" Flexion Extension Eversion Dorsiflexion Pronation Inversion Plantarflexion Elevation Circumduction Abduction Rotation Depression Supination Hyperextension Adduction Retraction Protraction

Cranial Nerves - "Oh Ohh Ohhh To Try And Fit A Gold Velvet So Heavenly" Olfactory CN I Optic CN II Occulomotor CN III Trochlear CN IV Trigeminal CN V Abducens CN VI Facial CN VII Auditory CN VIII Glasopharyngeal CN IX Vagus CN X Spinal/Accessory CN XI Hypoglossal CN XII "Point and Shoot!" For remembering that Parasympathetics are involved with erection and Sympathetics with ejaculation. Layers of the scalp - "SCALP" Skin Connective tissue Aponeurosis

Loose areolar tissue Pericranium Carpal bones of the hand (lateral to medial) - "She Looks Too Proud, Try To Chase Her" Proximal row: Scaphoid Lunate Triquetrum Pisiform Distal row: Trapezium Trapezoid Capitate Hamate Viruses causing diarrhea - "ACNE CAR" Adeno virus Corana virus Norwak virus Entero virus Calci virus Astro virus

Rota virus The Krebs cycle - "Can I Actually See Some Filipina Mothers" Citrate Isocitrate alpha Ketoglutarate Succinyl CoA Succinate Fumarate Malate Oxaloacetate Stages of mitosis/meiosis including interphase as a phase - "In Philippines, Men Are Talented" Interphase Prophase Metaphase Anaphase Telophase Order of prevalence of White Blood Cells, most prevalent to least "Never Let Monkeys Eat Bananas" Neutrophils Lymphocytes

Monocytes Eosinophils Basophils 10 essential amino acids - "PVT. TIM HALL" Phenylalanine Valine Tryptophan Threonine Isoleucine Metheonine Histidine(semi-essential) Arginine(semi-essential) Leucine Lysine Uses of Chloroquine (other than malaria) - "RED LIP" Rheumatoid arthritis Extra intestinal amoebiasis Discoid lupus erythematosus Lepra reaction Infectious mononucleosis Photogenic reactions

Bronchodilators - "TO A SIS" Terbutaline Orciprenaline Adrenaline Salbutamol Isoprenaline Salmeterol Signs of cor pulmonale - "Please Read His Text" Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence Portal hypertension features - "ABCDE" Ascites Bleeding (hematemesis, piles) Caput medusae Diminished liver Enlarged spleen Key questions needed in an emergency history taking situation "AMPLE"

Allergies Medication Past medical history Last meal Events and environment related to injury Malignancies that metastisize to bone - "Laging Panalo Kung Taga Bulacan" Lung Prostat Kidney Thyroid Breast Six "S" in Scarlet Fever Streptococci causal organism Sorethroat Swollen tonsils Strawberry tongue Sandpaper rash miliarySudamina vesicles over hands, feet, abdomen Signs of anti-cholinergic crisis - "SLUD" Salivation

Lacrimation Urination Defecation Causes of huge spleen - "3M's" Myelofibrosis Malaria Myelogenous leukemia Cardinal Symptoms of Parkinson's Disease - "TRAP" Tremor Rigidity Akinesia and bradykinesia Postural Instability Days of appearance of rashesVaricella(chickenpox) - "Very Sick Patients Must Take Double Exercise" 1st dayScarlet fever 2nd dayPox(smallpox) 3rd dayMumps 4th dayTyphus 5th dayDengue 6th dayEnteric fever(typhoid) |

SHOCK – HYPOTACHYTACHY HYPOTENSION TACHYPNEA TACHYCARDIA

INCREASE ICP – HYPERBRADYBRADY CUSHINGS TRIAD: HYPERTENSION (WIDE PULSE PRESSURE) BRADYCARDIA BRADYPNEA

HYPOGLYCEMIA TREMORS, TACHYCARDIA IRRITABILITY RESTLESSNESS EXTREME DIAPHORESIS

EARLY SIGNS OF HYPOXIA

RESTLESSNESS AGITATION TACHYCARDIA

LATE SIGNS OF HYPOXIA BRADYCARDIA EXTREME RESTLESSNESS DYSPNEA CYANOSIS

CONGESTIVE HEART FAILURE DIGOXIN MORPHINE AMINOPHYLLINE DOPAMINE DIURETICS O2 GASSES – MONITOR (ABG)

MG SO4 TOXICITY

BP DECREASE URINE OUTPUT DECREASE RESPIRATORY RATE DECREASE PATELLAR REFLEX ABSENT

SICKLE CELL DISEASE HYDRATION OXYGENATION PAIN INFECTION AVOID HIGH PLACES

PREGNANCY INDUCED HYPERTENSION HEMOLYSIS ELEVATED LIVER ENZYMES LOW PLATELETS

GI SYMPTOMS AND TOXICITY TO DIGOXIN VOMITTING

ANOREXIA NAUSEA DIARRHEA ABDOMINAL PAIN

FRACTURE PRESSURE REST ICE COMPRESSION ELEVATION

TETRALOGY OF FALLOT DISPLACED AORTA RIGHT VENTRICULAR HYPERTROPHY OPENING INTO THE SEPTUM (VSD) PULMONARY STENOSIS

HYPOKALEMIA

SKELETAL MUSCLE WEAKNESS U-WAVE ON ECG CONSTIPATION TOXICITY TO DIGOXIN IRREGULAR WEAK PULSE OTOSTASIS NUMBNESS PARESTHESIA

PAIN ASSESSMENT PROVOCATION QUALITY RADIATION, RELIEF SEVERITY TIME

NEUROVASCULAR CHECK PAIN PULSELESSNESS PARESTHESIA PARALYSIS PALLOR

VIRCHOW’S TRIAD IN DVT VENUS STASIS DAMAGE TO VESSELS HYPERCOAGUABILITY ABDOMINAL AORTIC ANEURISM (4A) ASSYMPTOMATIC ABDOMINAL MASS ABDOMINAL PULSE ACHES LOW BACK ANTI TB DRUGS AND SIDE EFFECTS RIFAMPICIN – RED-ORANGE URINE ISONIAZID – PERIPHERAL NEURITIS PYRAZINAMIDE – INCREASE URIC ACID ETHAMBUTOL – EYE PROBLEMS STREPTOMYCIN – OTOTOXIC

USE STRAW BECAUSE THESE DRUGS STAIN THE TEETH

L - LUGOL'S SOLUTION I - IRON N - NITROFURANTOIN T - TETRACYCLINE LR6 - LATERAL RECTUS : CN6 SO4 - SUPERIOR OBLIQUE : CN4 ALL3 - ALL THE REST : CN3 RADIATION TX VIA: MUSTARD ESTROGEN NITROGEN STEROIDS ANTIBIOTICS

DILUTE DECREASE OSMOLALITY