N U RSI
KN E M O N I C S
1 0 0 +
Memory
T ricks
to Crush the N ursing School
T rigger Y
our N
ursing Memor
M a r i a Y outman
M S N BS N R
Copy r i g h t ©
2 0 1 9 by M A R I A Y O U
T M A N . All R i g h t R e s e r v e d .
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result from the use of information contained within herein.
F or M o r e Nu r s i n g R e s o u r c e s Ch e c ko u t here:
Contents
AB O U T TH E AU TH O R
I N T RO D U CT
IO
N
N u r s i n g He a l t h A s s e s s m e n t M n e m o n i c s
I s o l a t i o n /P r e c a u t i o n s M n e m o n i c s
Cardiovascular N ursing Mnemonics
P h a r m a c o l o g y N u r s i n g M n e m o n i c s & Ti p s
M a t e r n a l a n d Ch i l d H e a l t h N u r s i n g M n e m o n i c s
& Ti p s
Anaesthesia N ursing M nem onic s
B e h a v i o r a l s c i e n c e P s y chiatric N
ursing
Mnemonics
Endocrine N ursing Knemonics
Anatomy Mnemonics
Miscellaneous
O n e last thing
ABO U T TH E AU TH O R
Maria Y outman M S N
BSN
R
W ords are very powerful. They can either inspire you to
greatness or make you feel like crap. This is why it’ s best to
choose the words you hear and the principles you believe.
After all, we are all given a choice ever day: to wallow in
self-pity or push ourselves to achieve great things despite
our imperfections.
“Maria Y outman, MSN, B SN, RN, earned her bachelor of
science degree fro m Penn U niversity, and her Master of
Science in Nursing from J ohns Hopkins U niversity. She has
1 0 years of nursing experience and 6 years of experience
as a clinical nurse specialist. F or the past Three years,
she’ s overseen nursing care in writing medical articles,
books, and more.
Maria had a three years of private clinical education and
writing through various websites, she intended to move on
one step to have a web community source, whatever she
inspired, write, and edit, one place can gather all the eff orts
made.
Nurses are no exception. One’ s success in the nursing
profession is not determined by how much theoretical
knowledge a nurse possesses, but how resilient you are to
apply everything you’ ve learned–and that includes the
principle of caring.
IN T
RODU
CT
IO
N
There are a ton of terms that need to be read and
memorized to help you at your nursing school, a s well
before you take the NCLEX -RN Exam.
I t m ay get pretty hard to remember all of those concepts
right off hand. One good way to help you to remember
certain terms and concepts is to use Mnemonics.
Everyone has their own way of remembering information
and that’ s why NCLEX -RN mnemonics are so helpful.
Mnemonics is the study and development of systems for
improving and assisting the memory.
U sing mnemonics is an excellent way to keep things straight
while also relating them to something less stressful.
Mnemonics improve your memory by using the technique of
association.
At this Book, you get the most helpful mnemonics for the
NCLEX -RN exam that you should include in your study
sessions.
T E R M I N A L O BJ ECT I V E S :
Mnemonics are popular study aids to help trigger your
memory of a group of things. I t is similar to memorizing a
phone number. I nstead of memorizing each individual
number – you remember a group of 3 numerals (area code),
3 numbers and a group of 4 numbers. This is called
“chunking” . W hen one thinks of a mnemonic, you usually
think of a list of vertical letters that spell a word with words
going off the stem horizontally.
F or example: What you should quickly do with an acute
myocardial infarction (MI / heart attack)
M – morphine sulfate
O – oxygen
N – nitroglycerine
A – A S A (acetylsalicyclic acid)
I n this instance, remembe ring the word “M O N ” = MI , Acan
help you remember all the nursing actions one should
anticipate.
Mnemonics are not always words however. They can really
be any words, pictures, diagrams, lyrics/ songs, a rhyme, or
something that forms a relationship to help you remember.
Sometimes even the process of creating or thinking up a
mnemonic can help you learn the underlying concept. M y
brain often likes to draw diagrams or models. F lowcharts or
hierarchies can help m e understand how things work
together.
Personally, mnemonics to m e have been helpful for some
concepts but not all. I don’ t really learn well with tons of
mnemonics; I j ust have a couple for things that are really
hard for m e to remember.
Sometimes it seems like it is j ust as much work to learn the
mnemonic as it would be j ust to memorize the information.
That is why the actual process of trying to think of a
drawing, picture, diagram, or acronym can actually be more
useful than j ust using someone else’ s mnemonic.
R e c o g n i z e T h e Fo l l o w i n g E x a m p l e : The American
Cancer
Society uses “C A U TI O N ” to
describe
cancer warning signs: C – change in bowel or
bladder habits
A – a sore that does not heal
U– unusual bleeding or discharge
T– thickening or lump
I – indigestion or diffi culty swallowing
O – obvious change in size of a wart or mole
N – nagging cough or hoarseness W h a t a re d e p r e s s a n t
d ru
g st ?s “ Barbiturates, Alcohol, and Tranquilizers Y ou ca
“
Ba
n
draw a picture of a limp bat to help you remember this
one
SOAP Note
S – Subj ective
O – Obj ective
A – Assessment
P – Plan There are even now some diagnoses that are
acronyms/ mnemonics. An example is “HELLP Syndrome
which stands for H emolysis, Elevated Liver enzymes and
Low Platelets or H ELLP. HELLP syndrome is a lifethreatening obstetric complication considered to be a
complication of pre-eclampsia. The only treatment is
delivery of the baby.
Mnemonics can even be how you take notes. Most people
think of notes as an outline where you try to scribble a s fast
as the teacher talks. However, you can take notes a couple
of diff erent ways that can help you remember the
information, rather than writing down all the words.
I f your teachers provide printed outlines: then
draw pictures or diagrams of what they are talking
about in the margin. This helps you use both sides
of your brain and associate concepts.
Y ou can fold 1 / 3 of your page vertically and make
a crease. On the left side of the crease you can
write a question that you think of while they are
talking. This is called the cue column. Literally
m a ke the concept into a test question. On the
right side of the crease – right the answers or key
ideas. At the bottom of the page, summarize the
whole idea or concept in your own sentence. Later
when you look back through your notes to study,
you can fold the paper and “hide” the answers
fro m yourself. I t is a lot easier to keep track of
then notecards.
This is called the Cornell System of notetaking. Y ou
can usually even find notepaper formatted this way to
make it easy in offi ce supply stores.
N ursing H ealth A s s e s s m e n t
Mnemonics
Lev el of C o n s c i o u s n e s s A s s e s s m e n t : “ A V P
The AVPU scale is a system where you can measure and
record a patient’ s responsiveness to indicate their level of
consciousness. I t is a simplification of the G lasgow Coma
Scale, which ass es se s a patient response in three measures:
eyes, voice, and motor skills. The AVPU
scale should be
assessed during these three identifiable traits, looking for
the best response for each. I t has four possible outcomes for
recording and the nurse should always work from best (A) to
worst (U ) to avoid unnecessary tests on patients who are
clearly conscious. On the other hand, it should not be used
for long-term follow up of neurological status.
A
V
P
U
Alert
Response to Verbal Stimuli
Response to Pain
U nresponsive
talking" a n d thought?
H ave y ou
heard, " T
h e p a t i e n t is
u n c o n sci o us ,
b re a t h i n g ,
and
T h e AVPU scal e — a tool u s e d t o a s s e s s the patient'
s brain perf u s i o n a n d f unction —
describes a
patient' s level of c o n s c i o u s n e s s .
A = the patient is A w a ke V = the patient responds to
a Verbal stimulus P =
the patient responds to a
P ain stimulus U
=
the patient is U n r e s p o n s i v e to
stimulus The distinction between ' A' and ' V' frequently
causes confusion.
Y o u a re a w a k e o n AVPU scale I f you are reading this, you
are ' A' on AVPU . Y ou might be awake and confused, awake
and disoriented, awake and lethargic, or awake and
oriented.
Awake patients are always awake and some adj ective that
describes their mental status of being awake.
N o t A w a k e i s u n c o n s c i o u s A patient that is not awake si
unconscious, V, P, or U .
A patient that is ' V' responds to a verbal stimulus provided
by responders.
Have you ever yelled, " D U D E, wake up! " to an intoxicated
patient (or friend) and they raised their eyes, looked at you,
or somehow responded to your voice? They are responding
to a verbal stimulus.
I f the patient responds, " W
" thepatient is ' A.
hy are you yelling at me?
A patient that is ' V' cannot be alert, answer history
questions, or describe their chief complaint.
I n t e rp re ti n g a p a i n s t i m u l u s
I f the patient doesn' t respond to a verbal stimulus attempt a
pain stimulus with a pinch, squeeze or sternum rub.
A sternum rub is the application of painful stimulus with the
knuckles of closed fist to the center chest of a patient who is
not alert and does not respond to verbal stimuli. The
sternum rub is the most common painful stimulus practiced
in the field by EMTs and paramedics. However, it is possible
to misinterpret the patient’ s response to the stimuli
depending on the duration the pressure is applied.
H e a l t h H istory
Assessment: “ SAMPLE
I n general, do not obtain a detailed history until lifethreatening inj uries have been identified and therapy has
been initiated. The secondary survey is essentially a headto-toe assessment of progress, vital signs, etc. S AMP LE is
often useful as a mnemonic for remembering key elements
of the patient’ s health history.
S
Symptoms
A
Allergy
M
Medications
P
Past Medical History
L
Last Oral I ntake
E
Events leading up to the illness
or inj ury
allergic to
S:
S y mptoms:
Patient
chie
complain.
Q uestion to
a s k: what’ s
wrong
W
hat brought you
to the hospital
A:
Allergy :
Seeking to know
what
ty pe o
allergic reaction
they experience.
Q uestion to ask:
Do
you
have
allergy
to
anything
W hat happens to
you when you use
something you are
M: M e d i c at i ons :
Prescribed
O TS
d ru g s ,
h e rb a l m e d s .
Q u e s t i o n t o a s k : Are you taking any medication
W
hat are you taking the medication for
W
hen did you last take your medication
P: P a s t M e d i c a l H istory : s e e k i n g t o k n o w the
p re v i o u s s t a t e of
health, a n d previous
illness.
Q u e s t i o n to a s k : Have you had this problem before
D o you have any other health problems
L: L a s t O ral I ntake: S e e k i n g w h a t a r e the last
oral i n t a ke s of the patient.
Q u e s t i o n t o a s k : W hen did you last eat or drink
anything
W hat was it that last you intake
E: E v e n t s l e a d i n g u p t o the illness or injury .
Q u e s t io n t o a s k : How did you get hurt
W
hat led to this problem
Rapid T rauma Assessment: “
LS
DCAP- B T
D CAP-BTLS is a mnemonic to remember specific soft tissue
inj uries to look for during assessment of a person after a
traumatic inj ury.
D
D eformities
C
Contusions
A
Abrasions
P
Punctures or Penetrations
B
Burn
T
Tenderness
L
Lacerations
S
Swelling
D : Def ormities
Malformations
or
distortions of the
body.
C: C o n t u s i o n s
I nj ury to tissues
with
skin
discoloration
and
without breakage
of skin; also called
a bruise.
A: A b r a s i o n s
Scrape caused by
rubbing
from
a
sharp
obj ect
resulting in surface
denuded of skin.
P: Pu n c t ures or
Penetrations
Wound
with
relatively
small
opening compared
with the depth;
produced by a narrow pointed obj ect.
B: B u r n s
Burns are inj uries to tissues caused by heat, friction,
electricity, radiation, or chemicals.
T : T enderness
The condition of being tender or sore to the touch.
L: Lacerations
A torn or j agged wound caused by blunt trauma;
incorrectly used when describing a cut.
S: Swelling
Sign of inflammation; caused by the exudation of fluid
from the capillary vessels into the tissue.
A l c o h o l i s m S c r e e n i n g : “ CAG E
CAG E questionnaire is a widely used and an extensively
validated method of screening for alcoholism. Two “yes
responses indicate that the possibility of alcoholism should
be investigated further. B y far the most important question
in the CA G E questionnaire is the use of a drink as an Eye
Opener, so much so that s ome clinicians use a “ yes ” to this
question alone a s a positive to the questionnaire; this is
because the use of an alcoholic drink a s an Eye Opener
connotes dependence since the patient is going through
possible withdrawal in the morning, hence the need for a
drink a s an Eye Opener.
C
A
C O N C E R N by the person that
there is a problem
APPARENT to others that there
is a problem
G
G RAVE consequences
E
EVI DENCE of dependence or
tolerance
C: Have you ever
felt
that
you
should CU T down
on your drinking
A: Have you ever
become
A N N OY
by
ED
of your
criticisms
drinking
G : Have you ever felt G U I LT
Y
about your drinking
E: Have you ever had a morning EY E O PEN E R to
get rid of a hangover
Emergency
I
T rauma Assessment: “ ABCDEF G H
The ABCD EF G HI mnemonic is used for a quick assessment
of trauma patients. This is especially useful for emergency
cases. The purpose of primary assessment is to preserve
the life of the victim, taking action where needed. Once the
victim’ s life-threatening conditions have been address, the
rescuer must begin secondary assessment.
Primary Survey
A
Airway
B
Breathing
C
Circulation
Secondary Survey
D
D isability
E
Expose & Examine
F
F ull set of vital signs
Give comfort measures
A: Airway
K eep the airway open to allow the body to take in oxygen
and expel carbon dioxide. Use the head-tilt chin-lift
technique to open the airway. Check or and remove
obstructions. A blocked airway can lead to respiratory or
cardiac arrest.
B: Bre a t h i n g
Once the airway is open, check for normal breathing, make
use of the look, listen, and feel techniques.
Look at the chest and observe the rising and falling for
normal respiration. Listen for air movement. F eel for air
coming through the mouth or nose. I f there is no breathing
or abnormal breathing, CPR must be initiated with 2 breaths.
C: Circulation
Oxygen-rich blood cannot be circulated without breathing.
Hence, it’ s unnecessary to check for pulse to determine
whether CPR is needed; commence immediately if no
breathing is detected.
D : Disabilit
Check the patient’ s neurological status and for obvious
deformities or disabilities.
E: E x p o s e & E x a mi n e
Remove clothing to properly a ss es s patient; be sure to keep
the patient warm.
F.: F ull s e t of vital s i g n s
Note any changes in the following signs: pulse (carotid,
brachial, radial), pupils, breathing, level of consciousness,
blood pressure, and skin color and temperature.
G.: G ive comf ort m e a s u r e s
Continue to rest and reassure. Provide comfort measures
and prevent further inj ury.
H.: H istory
a n d H ead- T o- T o e A s s e s s m e n t U
se the mnemonic SAMPLE to obtain health history and do
a head- to-toe assessment after.
I.: I n s p e c t Posterior Surf ace
I nspect for wounds, deformities, discolorations, etc.
Seven W
a r n i n g S i g n s of C a n c e r
“ CAU T I
Early detection is the key in treatment of cancers. The
CAU TI O N mnemonic is used by the American Cancer Society
to detect and recognize the early warning signs of cancer.
Though one of these signs does not necessarily mean
someone has cancer.
C
C h a n g e in b o w e l or b l a d der
habits
A
A sore throat that does not heal
U
Unusual bleeding or discharge
T
Thickening or lump in breast or
elsewhere
I
I ndigestion or dysphagia
O
Obvious change in wart or mole
N
Nagging cough or hoarseness
C: C h a n g e in b o w e l or b l a d d e r h a b i t s
C o m m o n sign of colorectal cancer.
A: A s o re throat t h a t d o e s n o t heal
I f located on the skin or in the mouth, skin cancer or
mouth cancer could be the cause.
U : U n u s u a l b l e e d i n g or d i s c h a r g e
Any bleeding from the bladder, vagina or rectum
could mean prostate, cervical or colorectal cancer.
T : T h ic ke n ing or l u m p in b r e a s t or elsewhere.
A lump on the breast can be sign of cancer, a lump on
the testicle can be testicular cancer.
I : I n d i g e s t i o n or dy s p h a g i a .
Can be symptoms of stomach, throat, esophagus or
mouth cancer.
O : O b v i o u s c h a n g e in w a rt or mole.
Most common sign of skin cancer.
N : N a g g i n g c o u g h or h o a r s e n e s s
A cough last for four weeks or longer can
symptoms of lung and/ or throat cancer.
be
Family H istory A s s e s s m e n t
“B A L D CH
ASM
F amily history plays a critical role in assessing the risk of
inherited medical conditions, chronic illnesses and
genetically transmitted diseases. Outline or diagram age
and health, or age and cause of death of siblings, parents,
and grandparents. D
ocument
presence or absence
of specific illnes s e s in
family. U se
the
mnemonic
“BAL C H A S M ” to recall the diseases that
needs to be investigated.
B
Blood pressure
A
Arthritis
L
Lung diseases
D
D iabetes
C
Cancers
H
Heart diseases
Alcoholism
B: B l o o d p re s s u re
African Americans have a higher risk for high blood
pressure. Poor lifestyle choices and diet, that can be
inherited by the family, can also pose a s a risk.
A: Arthritis
S o m e types of arthritis run in families. G enes can be a
contributing factor that can make someone susceptible to
environmental factors that m a y trigger arthritis.
L: L u n g d i s e a s e s
Cystic fibrosis is a common inherited disease that aff ects
mostly the lungs. I t is manifested by accumulation of thick,
sticky mucous, frequent infections and coughing.
D : Di a b e t e s
History of type 2 diabetes in the family poses the patient at
increased risk of developing it.
C: Ca n c e rs
Certain types of cancer, such as breast cancer and colon
cancer, appear more frequently in some families.
H : H eart d i s e a s e s
Genes can pass on the risk of cardiovascular disease, and
they can also be responsible for passing on other conditions
such as high blood pressure or high cholesterol levels.
A: Alcoholism
Certain genetic factors influence alcoholism. Research show
that children of alcoholics are about four times more likely
than the general population to develop alcohol problems.
S : S t ro ke
Risk for stroke is higher if someone in the patient’ s direct
family line that stroke. S o m e strokes m ay be symptoms of
genetic disorders like CAD ASI L.
M : M e n t a l health d i s o rd e rs (depression, bipolar,
s c h i z o phren i a etc.)
S o m e mental illnesses can run in families, although it may
be from variety of factors rather than j ust genes.
Breast Assessment: “ LMN O P
Breast ma s s e s show marked variation in etiology, from fibro
adenomas to cysts, to abscesses, mastitis, to breast cancer.
All breast m a s se s warrant careful evaluation, and definitive
diagnostic measures should be pursued.
L
Lump
M
M a m m a r y changes
N
N ipple changes
O
O ther symptoms
P
L: L u m p
I nspect
and
palpate breast for
lumps, masses.
M:
Mammar
changes
I nspect
and
palpate
for
dimpling,
tenderness,
abnormal
contours.
N:
changes
Patient risk factors
I nspect
palpate for nipple retraction, lesions, discharges.
N ipple
and
O : O ther sy m p t o m s
Check size, symmetry, appearance of skin, direction of
pointing, rashes, and ulceration.
P: Patient risk f actors
I nterview patient for predisposing factors, obtain family
history or use the Breast Cancer Risk Assessment Tool.
Ey e s A b b r e v i a t i o n Abbreviations for the eyes are often
confusing. OU which stands for the latin term Oculus
Uterque means both eyes; OD for Oculus D exter referring to
the right eye and O S for Oculus Sinister for the left eye.
Remember the mnemonic above to make sense of these
abbreviations.
Y O U
look with B O
T
H
eyes.
The R I G H T
dose won’ t O
D [ overdose] . The only one
that is LEF T
is O S .
S i gns V S S y m p t o m s Signs are commonly distinguished
from symptoms and both are something abnormal and
relevant to a potential medical condition. A sign is obj ective
and is discovered by the health-care professional during an
examination whereas a symptom is subj ective, observed
and experienced by the patient, and cannot be measured
directly.
sI gn: something I can detect even if patient is
unconscious.
sY M p t o m is something only hY M knows about.
P a i n A s s e s s m e n t : “ O PQ R S
Assessment of pain is a crucial part in the role of nurses,
and as such utilizing a problem-solving process becomes
part of the equation. Pain is an unpleasant sensory and
emotional experience associated with actual or potential
tissue damage or described in terms of damage. Pain is
subj ective thus a careful assessment and evaluation is
needed.
O
O nset
P
Provoking or Palliating F actors
Q
Q uality
R
Region & Radiation
S
Severity
T
Time & Treatment
U
Understanding & I mpact
O : O nset
W
hen did it begin? How long does it last (duration)? How
often does it occur (time)? W hat were you doing when the
pain started
P: P r o v o k i n g or Palliating F actors
W hat brings it on? W hat makes it better? W hat makes it
worse
Q : Q ualit
W
hat does it feel like? Can you describe it (throbbing,
stabbing, dull, etc.)
R: R e g i o n & Ra d i a t i on
D oes your pain radiate? W here does it spread? Point to
where it hurts the most. W here does your pain g o from
there
S : Severit
W hat is the intensity (pain scale of 1 -1 0 , visual scales)
of the symptom?
Right now? At worst? Are there
any other symptoms that accompany the pain
T.: T
ime &
T re a t me n t
W hen did the symptoms first begin? W
medicatonsare you currently taking for this? How eff
ective are these?
Side eff
hat
ects
U.: U
nderstanding &
I mpact W
hat do you believe is
causing this? How is this aff
ecting your AD
Ls, you and/ or your family
V: V a l u es
W hat is your goal for this symptom? W hat is your comfort
goal or acceptable level for this symptom? D o you have any
other concerns
I s o l a t i o n /P r e c a u t i o n s M n e m o n i c s
Dro p l e t Pre c a u t i o n s D i s e a s e s included with droplet
precautions:
Pharyngeal D iphtheria
Epiglottitis, (caused by Haemophilus influenza
type b)
F lu (contact a n d droplet)
Meningococcal D isease: Sepsis, Pneumonia,
meningitis
M u m p s (infectious parotitis)
Pneumonia
Mycoplasma Pneumonia
Parvovirus B1 9(erythema infectiosum or 5th
disease)
Pneumonic Plague
Adenovirus (contact a n d droplet)
Streptococcal pharyngitis
W hooping Cough (pertussis)
Rhinovirus
Scarlet fever
Rubella (G erman Measles)
W ho’ s A d j u s t a b l e Dro p l e t M a s k S t o p s S c a r
Pn e u ma t i c F luid P a r a s i t e s P l a g u i n g Di s t i n g u i s h e d
G e r m a n M e n ? M y Epic M u m ’ s, Rh o n d a .
W h o ’ s: W
h o oping Cough A d j ustable: A d enovirus
(remember A D D
contact precautions as well) Droplet: type
of precaution M a s k : PPE you must wear at all times Stops:
Streptococcal pharyngitis Scary: Scarlet fever Pneumatic:
Pneumonia F luid: F lu (influenza)
Parasites: Parvovirus B1 9
Plaguing: Pneumonic P l a g u e
Distinguished: Diphtheria
G erman : G e r m a n Measles (Rubella)
M e n : Meningococcal D isease: Meningitis, sEpsis, p N emonia
M y : M y coplasma Pneumonia
Epic: Epiglottitis
M u m ‘ s: M u m p s
Rhonda: Rhinovirus
Airborne Precautions
D i s e a s e s included with airborne precautions:
Chicken Pox (varicella) (Airborne a n d Contact)
Herpes Z oster (Varicella Z oster(disseminated)
Shingles (Airborne a n d Contact)
Measles (Rubeola)
M. Tuberculosis
Airborne Chicken N u m b e r 9 5 D i s s e c t e d H er T ubb
M e a l w o r m Airborn e : type of isolation precaution Chic ke n :
Chicke n Pox (Varicella) N umber 9 5 : N 9 5 mask … special
PPE you must wear at all times D i s s ected H
er:
D i s s eminated
H erpes Z oster (Shingles) T ubby: T uberculosis Mealworm:
M e a s les
Co n t a ct Pre c a u t i o n s D i s e a s e s included with contact
precautions:
Medication-Resistant Organisms: M R S A , VRE,
extended spectrum beta lactamase producers
(ESBLs), K lebsiella pnemoniae carbapenemase
(KPC)
D iarrhea infections or of unknown origin: C.diff,
noravirus, rotavirus … ..US E SOAP AND WATERF
O R H A N D WA S H I N G NOT hand-sanitizer.
NOTE: Hepatitis A. (if patient is diapered
or incontinent pt)..remember it is spread
through stool
Skin infection: impetigo, lice, s ca b ie s, h e rpe s
simplex, chickenpox (airborne a n d contact),
s ki n diphtheria, s h i n g l e s (airborne a n d
contact)
Wound infections with excessive drainage or
staphylococci
Pulmonary infections: RSV, parainfluenza
Eye infection: conjunctivitis
D o n M e d i c a l G love/ G
own W
ith Every
Co n t a ct Pre c au ti on S e s s i o n
Don: Diarrhea I nfections
M edical: M ediation Resistant Organisms
G loves/ G
o w n : PPE you must
always wear at all times
ound I nfections
W
Every: Eye infections
Contact: type of isolation precaution
Precaution: Pulmonary infections
Session: Skin infections
ith: W
Cardiovascular N ursing Mnemonics
Aortic r e g u r g i t a t i o n : c a u s e s
CREAM
C
Co n g e ni t al
R
Rheumatic damage
E
Endocarditis
A
Aortic dissection/ Aortic root
dilatation
M
Marfan’ s
Aortic s t e n o s i s c h a r a c ter i st i c s
SAD
S
Sy ncope
A
Angina
D
Dyspnea
Aortic t o r i g h t S u b c l a v i a n p a t h
ABC' S
A
Aortic arch g i v e s rise to:
B
Brachiocephalic trunk
C
Left Co m m o n Carotid
S
Left Subclavian
H e a r t v a l v e s ( r i g h t t o lef t)
Toilet Paper M y Ass, T hey P a y M e Alcohol, or " T" hugs
" P" ush " Me"
" A" round.
T
T ricuspid v a l ve
P
Pulmonary semilunar valve
M
Mitral (bicuspid) valve
A
Aortic semilunar valve
A p e x bea t : a b n o r m a l i t i e s f o u n d o n pa l pa t i on,
c a u s e s of i m p a l p a b l e
H I LT
:
H
H eaving
I
I mpalpable
L
Laterally displaced
T
Thrusting/ Tapping
I f it' s i m p a l p a b l e , c a u s e s a r e C O
P D :COPD
C
O
O besity
P
Pleural, Pericardial eff usion
D
Dextrocardia
Atrial Arrhy t h m i a s T reatment
ABCDE
A
Anticoagulants
B
Beta blockers
C
Calcium Channel Blockers
Anticoagulants :
To prevent
embolization.
B e t a blockers: To
block the effects of
certain hormones
on the heart to
slow the heart
rate.
Ca l c i u m Ch a n n el
Blockers: Help
Digoxin
slow the heart rate
by blocking the
number of
E
electrical impulses
Electro cardioversion
that pass through
the AV node into the lower heart chambers (ventricles).
Digoxin : Helps slow the heart rate by blocking the number
of electrical impulses that pass through the AV node into the
lower heart chambers (ventricles).
D
Electro cardioversion: A procedure in which electric
currents are used to reset the heart' s rhythm back to
regular pattern.
Atrial F ibrillation c a u s e s
PI RATE S
P
Pulmonary: PE, COPD
I
I atrogenic
R
Rheumatic heart: mirtral
regurgitation
A
Atherosclerotic: MI , CAD
T
Thyroid: hyperthyroid
E
Endocarditis
S
Sick sinus syndrome
Atrial fi brillation m a n a g e m e n t
ABCD
A
Anti-coagulate
B
Beta-block to control rate
C
Cardiovert
D
Digoxin
B ec k ' s t r i ad ( c a r d i ac t a m p o n a d e )
3 D' s
D
Distant heart sounds
D
Distended j ugular veins
D
Decreased arterial pressure
Betablockers: cardioselective betablockers
Betablockers Acting Exclusively At Myocardium
B
Betaxolol
A
Acebutelol
E
Esmolol
A
Atenolol
M
Metoprolol
C H F T reatment
LMNO P
L
Lasix
M
Morphine
N
N itrites
O
O xygen
P
VassoPressors
CH F: c a u s e s of e x a c e r ba t i o n
F AI LU
RE
F
Forgot medication
A
Arrhythmia/ Anaemia
I
I schemia/ I nfarction/ I nfection
L
Lifestyle: taken too much salt
U
U pregulation of CO: pregnancy,
hyperthyroidism
R
Renal failure
E
Embolism: pulmonary
C o m p l i c a t i o n s of M y o c a r di a l I nf arction
Darth Vader
D
Death
A
Arrythmia
R
Rupture(free ventricular wall/
ventricular septum/ papillary
muscles)
T
Tamponade
H
H eart failure (acute or chronic)
V
Valve disease
A
Aneurysm of Ventricles
D
Dressler' s Syndrome
E
thromboEmbolism (mural
thrombus)
R
Recurrence/ mitral Regurgitation
Co r o na ry artery by p a s s g r a f t: indications
DU S
D
Depressed ventricular function
U
U nstable angina
S
Stenosis of the left main stem
T
Triple vessel disease
ECG : lef t v s . r i g h t b u n d l e bl o c k
W iLLiaM M a R R o W
W pattern in V1 -V 2 and M pattern in V3 -V6 is Left
bundle
block.
M pattern in V1 -V 2 and Win V3 -V6
block.
is R ight bundle
E x e r c i s e r a m p ECG : c o nt r a i ndi c a t i o ns
RAMP
R
Recent MI
A
Aortic stenosis
M
M I in the last 7 days
P
Pulmonary hypertension
Endocarditis
FR O M J A N
EF Fever
R
Roth' s spots
O
O sler' s nodes
M
Murmur of heart
J
J aneway lesions
A
Anemia
N
N ail hemorrhage
E
Emboli
H eart valve s e q uence
T ry
P u ling My
ATo r tTricuspid
a
P
Pulmonary
M
Mitral (bicuspid)
A
Aorta
H eart blocks
I f the R is far from P, then you have a First Degree .
Longer, longer, longer, drop! Then you have a W e n ke b a c h .
if s o m e P ' s don' t get through, then you have M o b i t z I I . I
f P ' s and Q ' s don' t agree, then you have aT hird D e g r e e .
I nf arctions T
R E AT M E
I NI
F ARCT I O
I V access
N N arcotic
S
analgesics (e.g.
N
morphine, pethidine)
F
Facilities for defibrillation (D F )
A
Aspirin/ Anticoagulant (heparin)
R
Rest
C
Converting enzyme inhibitor
T
Thrombolysis
I
I V beta blocker
O
O xygen 6 0 %
N
N itrates
S
Stool Softeners
J V P : w a v e f orm
ASK ME
A
Atrial contraction
S
Systole (ventricular contraction)
K
Klosure (closure) of tricusps, so
atrial filling
M
Maximal atrial filling
E
Emptying of atrium
M I : basic management
BO O
MAR
B
B e d rest
O
O xygen
O
O piate
M
Monitor
A
Anticoagulant
R
Reduce clot size
M I : signs and sy
mptoms
P UPL S E
Persistent chest pains
U
U pset stomach
L
Lightheadedness
S
Shortness of breath
E
Excessive sweating
M I : t h e r a p e u t i c treatment
O BAT M A
O
O xygen
B
Beta blocker
A
ASA
T
Thrombolytics (e.g. heparin)
M
Morphine
A
Ace prn
N
N itroglycerin
M I : t r e a t m e n t of a c u t e M
CO A
C
Cyclomorph
O
O xygen
A
Aspirin
G
G lycerol trinitrate
M u r m u r attributes
"
I L P Q R S T" (person h a s ill PQ R S T heart waves)
I
I ntensity
L
Loccasion
P
Pitch
Q
Q uality
R
Radiation
S
Shape
T
Timing
M u r m u r s : i n n o c e n t m u r m u r f eatures
8 S' s
S
Soft
S
Systolic
S
Short
S
S o u n d s (S1 & S2) normal
S
Symptomless
S
Special tests normal (X -ray, EK G )
S
Standing/ Sitting (vary with
position)
S
Sternal depression
M u r m u r s : louder with inspiration v s expiration
LEft sided murmurs louder with Expiration
RI ght sided murmurs louder with I nspiration.
Murmurs: q uestions to ask
SCRI P
S
Site
C
Character (e.g. harsh, soft,
blowing)
R
Radiation
I
I ntensity
P
Pitch
T
Timing
M u r m u r s : sy stolic v s . diastolic
PASS:Pulmonic & Aortic
Stenosis= Systolic.
PAI D: Pulmonic & Aortic
I nsuffi ciency= Diastolic.
Pericarditis: c a u s e s
C A R D I A C RI ND
C
Collagen vascular disease
A
Aortic aneurysm
R
Radiation
D
D r u g s (such as hydralazine)
I
I nfections
A
Acute renal failure
C
Cardiac infarction
R
Rheumatic fever
I
I nj ury
N
N eoplasms
D
Dressler' s syndrome
Pericarditis: E K
PericarditiS
P R depression in precordial leads.
S T elevation.
P e r i ph e r al v a s c u l a r insuffi ciency : i nspec t i o n
criteria
SI CVD
S
Symmetry of leg musculature
I
I ntegrity of skin
C
Color of toenails
V
Varicose veins
D
Distribution of hair
P u l s e l e s s electrical activity : c a u s e s
PAT CH M E D
P
Pulmonary embolus
A
Acidosis
T
Tension pneumothorax
C
Cardiac tamponade
H
H ypokalemia/ H yperkalemia/
H ypoxia/ Hypothermia/ H
ypovolemia
M
Myocardial infarction
E
Electrolyte derangements
D
Drugs
S T e l e v a t i o n c a u s e s in E C
ELEVAT I
E
Electrolytes
L
LBBB
E
Early repolarization
V
Ventricular hypertrophy
A
Aneurysm
T
Treatment (e.g.
pericardiocentesis)
I
I nj ury (AMI , contusion)
O
O sborne waves (hypothermia)
N
N on-occlusive vasospasm
S u p r a v e n t r i c u l a r tachy c a r dia: t r e a t m e n t
ABCDE
A
Adenosine
B
Beta-blocker
C
Calcium channel antagonist
D
Digoxin
E
Excitation (vagal stimulation)
Ventricular tachy c a r dia: t r e a t m e n t
LAMB
L
Lidocaine
A
Amiodarone
M
Mexiltene/ Magnesium
B
Beta-blocker
W hite B l o o d Cell C o u n t
N ever let mon
keys eat bananas
N
N eutrophils
L
Lymphocytes
M
Monocytes
E
Eosinophils
B
Basophils
H eart Blocks: “ T he H eart Block P o e m
Heart blocks are abnormal heart rhythm where the heart
beats too slowly. I n this condition, the electrical signals that
tell that heart to contract are partially or totally blocked
between the upper chambers (atria) and lower chambers
(ventricles).
Right- Sided H
estations: “ AW
eart F
ailure M a n i f
H
EAD
A
Anorexia a n d n a u s e a
Results from the venous engorgement and
venous stasis within the abdominal organs
W
W eight gain
D ue to retention of fluid.
H
H e p a t o me g a l y
Results from the venous engorgement of
the liver; increased pressure m a y interfere
with the liver’ s ability to function.
E
E d e m a (Bipedal)
Edema usually aff ects the feet and ankles
and worsens when the patient stands or
sits for a long period.
A
Ascites
I s the accumulation of fluid in the
peritoneal cavity; increased pressure
within the portal vessels forces fluid into
the abdominal cavity.
D
D i s t e n d e d n e c k vein
I ncreased venous pressure leads to
distended neck veins.
W hen the right ventricle fails in right-sided heart failure,
congestion in the peripheral tissues and the viscera
predominates. This occurs because the right side of the
heart cannot ej ect blood and cannot accommodate all the
blood that normally returns to it from the venous circulation.
Right-sided heart failure primarily produces systemic signs
and symptoms.
L e f t- S i d e d H
DO
eart F
CH
ailure: “
AP
D
Dy s p n e a
May be precipitated by minimal to
moderate activity; also occurs during rest
O
O rthopnea
D yspnea that develops in the recumbent
position and is relieved with elevation of
the head with pillows.
C
Cough
Cough is initially dry and nonproductive.
Large volume of frothy sputum, which is
sometimes pink, m ay be produced, usually
indicating severe pulmonary congestion.
H
H emopty s i s
Pink or blood-tinged sputum m a y be
produced.
A
A d v e n t i ti ou s b re a t h s o u n d s
May be heard in various areas of the
lungs; as failure worsen, pulmonary
congestion increases and crackles m a y be
auscultated throughout the lung fields.
P
Pulmonary c o n g e s t i o n
(crackles/ rales)
Sustained high pressure in the pulmonary
veins eventually forces some fluid from
the blood into the surrounding microscopic
air sacs (alveoli), which transfer oxygen to
the bloodstream.
Pulmonary congestion usually occurs in left-sided heart
failure; when the left ventricle cannot eff ectively pump
blood out of the ventricle into the aorta and to the systemic
circulation. Blood volume and pressure in the left atrium
increases which decreases blood flow from the pulmonary
vessels. Pulmonary venous blood volume and pressure
increase, forcing fluid from the pulmonary capillaries into
the pulmonary tissues and alveoli, causing pulmonary
interstitial edema and impaired g a s exchange.
M a n a g e m e n t of H e a r t Failure: “ D A D BO N D
CLAS
Management of HF are to relieve patient symptoms, to
improve functional status and quality of life, and to extend
survival. Medical management depends on the type,
severity, and cause of HF —
it can include reducing the
workload of the heart by reducing preload and afterload;
elimination of contributing factors such as hypertension.
Remember the mnemonic “D AD BOND CLASH ” for the
medical management of heart failure.
D
A
D
B
O
N
D
C
L
A
S
H
Di g i t a li s
A C E I nhibitors
Dobutamine
Beta - blockers
O xy g e n
N itrates
Diuretics
Ca l c i u m C h a n n e l Blockers
Lif esty le C h a n g e s
Angiotensin
II
Receptor
Blockers
S o d i u m restriction
H y dralazine
D : Di g i t a li s
I ncreases the force of myocardial contraction and
slows conduction through the atrioventricular node;
improves contractility,
increasing left ventricular
output, and enhances diuresis.
A: A C E I nhibitors
Promotes vasodilation and diuresis by decreasing
afterload and preload, ultimately decreasing the
workload of the heart.
D: Dobutamine
I V medication
administered
to patients
with
significant left ventricular dysfunction and hypo
perfusion; stimulates the beta-1 -adrenergic receptors.
B: Beta - blockers
Reduces mortality and morbidity in HF by reducing
the adverse eff ects from constant stimulation of the
sympathetic nervous system.
O : O xy g e n
Oxygen m ay be necessary as HF progresses; need is
based on the degree of pulmonary congestion and
resulting hypoxia.
N : N itrates
Causes venous dilation, which reduces the amount of
blood return to the heart and lowers preload.
D : Diuretics
To remove excess extracellular fluid by increasing the
rate of urine produced in patients with fluid overload.
C: Ca lc i u m Ch a n n e l Bl o c ke rs Causes vasodilation,
reducing systemic vascular resistance.
L: Lif esty le C h a n g e s
Restriction of dietary sodium, avoidance of excess
fluid intake, weight reduction, and regular exercise.
A: A n g i o t e n s i n I I Re ce p t or Blo c ke rs A RBs block
the eff ects of angiotensin I I at its receptor; have
similar hemodynamic eff ects as of ACE inhibitors.
Serves as alternative for patients who cannot tolerate
ACE inhibitors.
S : S o d i u m restriction
A low-sodium diet (2 to 3 g/ day) diet and avoidance of
drinking excess amounts of fluid is recommended.
H : H y dralazine
Lowers systemic vascular resistance and left
ventricular afterload.
H ypertension
Complications
H ypertension Complications
“5
C’ s
o
The excessive pressure on the artery walls caused by
hypertension or high blood pressure can damage the blood
vessels, as well as organs in the body. The higher the blood
pressure and the longer it goes uncontrolled, the greater the
damage. W ith time, hypertension increases the risk of heart
disease, kidney disease, and stroke.
C
Coronary Artery D i s e a s e
C
Chronic R e n a l F ailure
C
C o n g e s t i v e H eart F ailure
C
Cardiac Arrest
C
Ce re b ro v a s c u l a r Accident
C: Coronary Artery D i s e a s e
Can lead to narrowing of blood vessels making them more
likely to block from blood clots or fat breaking off from the
lining of the blood vessel wall; also weakens the walls.
C: Chronic R e n a l F ailure
Constant high blood pressure can damage small blood
vessels in the kidneys making it not to function properly.
C: C o n g e s t i v e H eart F ailure
Pumping blood against the higher pressure in the vessels
causes the heart muscles to thicken. Eventually, the heart
muscles m ay have a hard time pumping enough blood to
meet the physiologic needs of the body leading to heart
failure.
C: Cardiac Arrest
High blood pressure can cause CAD , damaged arteries
cannot deliver enough oxygen to other parts of the body
eventually leading to heart attack.
C: Ce r e b ro v a s c u l a r Accident
Hypertension leads to atherosclerosis and hardening of the
large arteries. This, in turn, can lead to blockage of small
blood vessels in the brain. I t can also weaken the blood
vessels in the brain causing them to balloon and burst.
I mmediate T reatment of
a My
n f a r c ti o n
Client “
A TA SS
ocardial I
MO
N
M O N A is a mnemonic that stands for: Morphine, Oxygen,
Nitrates, and Aspirin. These are the four primary
interventions that are performed when treating a patient
with Heart Attack/ Myocardial I nfarction (MI ). However,
M O N A does not represent the order in which you should
administer these treatments as a nurse. I t is a mnemonic
intended to help you remember the components of M
treatment, not the prioritization of them.
M
M o rp h i n e
O
Oxygen
N
Nitroglycerine
A
Aspirin
T
O xy g e n
A
N itrates
M : M o rp h i n e
Analgesic drugs such as morphine are to reduce pain and
anxiety, also has other beneficial eff ects as a vasodilator
and decreases the workload of the heart by reducing
preload and afterload.
O : O xy g e n
To provide and improve oxygenation of ischemic
myocardial tissue; enforced together with bedrest to help
reduce myocardial oxygen consumption. G iven via nasal
cannula at 2 to 4 L/ min.
N : N itrogly cerine F irst-line of treatment for
angina pectoris and acute MI ; causes vasodilation and
increases blood flow to the myocardium.
A: Aspirin
Aspirin prevents the formation of thromboxane A2 which
causes platelets to aggregate and arteries to constrict. The
earlier the patient receives A S A after symptom onset, the
greater the potential benefit.
T : T hromboly tics
To dissolve the thrombus in a coronary artery, allowing
blood to flow through again, minimizing the size of the
infarction and preserving ventricular function; given in some
patients with MI .
A: A n t i c o a g u l a n t s
G iven to prevent clots from becoming larger and block
coronary arteries. They are usually given with other
anticlotting medicines to help prevent or reduce heart
muscle damage.
S : S t o o l S o f teners
G iven to avoid intense straining
arrhythmias or another cardiac arrest.
that
may
trigger
S: Sedatives
I n order to limit the size of infarction and give rest to the
patient. Valium or an equivalent is usually given.
M y o c a r d i a l I n f a r c t i o n Management:
“I N
F ARCT
IO
N
S
G oals of treatment during MI are to minimize myocardial
damage, preserve myocardial function, and prevent
the
area with
the goals
emergency
use of bythrombolytic
complications.
These
can be achieved
reperfusion
medications or by PCI . Reducing myocardial oxygen
demand, and increasing oxygen supply with medications,
oxygen administration and bed rest can minimize
myocardial damage.
I
I V access
N
Narcotic analgesics
F
F acilities for defibrillation (DF )
A
Aspirin
R
Rest
C
Converting enzyme inhibitor
Thrombolytic
I : I V access
Two I V lines are placed usually to ensure that access is
available for administering emergency medications.
N : N arcotic a n a l g e s i c s Morphine is the analgesic of choice
for MI and is administered in I V boluses to reduce pain and
anxiety; reduces preload and afterload and relaxes
bronchioles to enhance oxygenation.
F : F acilities f or defi
cart available and ready.
brillation (DF ) Have the crash
A: Aspirin
I nhibits platelet aggregation. Treatment should be initiated
immediately and continued for years.
R: R e s t
Bed rest promotes comfort and healing.
C: Co n v e rt i n g enzy m e inhibitor ACE-inhibitors lowers the
blood pressure and the kidneys excrete sodium and fluid.
T : T hromboly tic
Administered via I V to dissolve the thrombus in a coronary
artery, allowing blood reperfusion, minimizing the size of the
infarction and preserving ventricular function.
I : I V b e t a blocker
Long-term therapy with beta-blockers decreases the future
incidences of cardiac events.
O : O xy g e n
Administer at a modest flow rate for 2 to 3 LPM.
N : N itrates
To increase cardiac output and reduce myocardial
workload; relieves pain by redistributing blood to ischemic
areas of the myocardium.
S : S t o o l S o f teners
To prevent straining during defecation, which causes vagal
stimulation and m a y slow the heart rate.
M y ocardial I n f arction N
Management
CAB SCO
RE
ursing
“ BEE
Nursing care for patients who suff ered MI is directed
towards
detecting
complications,
preventing
further
myocardial damage, and promoting comfort, rest, and
emotional well-being.
B
Bed rest
E
ECG Monitoring
E
Emotional support
C
Cluster/ Organize Patient Care
A
Anti-embolism stockings
B
Bedside commode
S
Stool Softener
B: B e d rest
Bed rest helps reduce myocardial oxygen consumption.
E: ECG M o n i t o ri n g
F requently monitor ECG
to detect rate changes or
arrhythmias; place rhythm strips in the patient’ s chart for
evaluation.
E: E mo t i o n a l s u p p o rt
Provide support and help reduce stress and anxiety;
administer tranquilizers as needed.
C: Cluster/ Org a n i z e Pat ient Ca re To maximize periods of
uninterrupted rest.
A: Anti- e m b o l i s m s t o c k i n g s Can help prevent veno-stasis
and thrombophlebitis.
B: B e d s i d e c o m m o d e
Allow use of bedside commode and provide privacy as
much as possible.
S : S t o o l S o f tener
To prevent straining during defecation causing
stimulation and slow heart rate.
vagal
C: Cardiac Rehabilitation P r o g r a m
I ncludes education regarding heart disease, exercise, and
emotional support for the patient and the family.
O : O xy g e n therap
I ncreases available oxygen; set at 2-3 LPM.
R: R a n g e - of - mo t i o n Exercises
Provides physical activity for the patient; if immobilized,
turn him often.
E: E d u c a t e a n d inf o rm
Explain procedures and answer questions.
C a r d i o p u l mo na r y By p a s s C o m p l i c a t i o n s
“4 H ’ s of C B P
Cardiopulmonary bypass (CPB) mechanically circulates and
oxygenates blood for the body while bypassing the heart
and lungs. CPB maintains perfusion to body organs and
tissues and allows the surgeon to complete the anastomosis
in a motionless, bloodless, surgical field. CPB is not benign
and there are a number of associated problems; use is
limited to several hours.
H
Hypothermia
H
Hemodilution
H
Heparinization
H
Head or “Pumohead”
H : H y pothermia
Because blood is cooled during CPB to slow the body’ s
basal metabolic rate.
H : H emodilution
D ue to administration
during the procedure.
of isotonic
crystalloid
solution
H : H eparinization
Heparin is used to prevent clotting and thrombus
formation in the bypass circuit when blood comes in contact
with the surface of the tubing.
H : H e a d or “ P u m p h e a d
AK A postperfusion syndrome, include defects associated
with attention, concentration, short term memory, fine
motor function, and speed of mental and motor responses.
Th e “3 D ’ s” C a r d i a c T a m p o n a d e ( B ec k ’ s T riad)
I n cardiac tamponade, blood or fluid collects in the
pericardium, the sac surrounding the heart. Pericardial fluid
m a y accumulate slowly without causing any noticeable
symptoms until a large amount accumulates. However, a
rapidly developing eff usion can stretch the pericardium to
its maximum size and, because of increased pericardial
pressure, reduce venous return to the heart and decrease
CO. I t often has three characteristic signs that the physician
will recognize during a physical exam. These signs are
commonly referred to a s “Beck’ s Triad”or The 3 D ’ s.
D
D istant or muffl ed heart sounds
D
D istended j ugular veins
D
D ecreased pulse pressure
Fo r E n d o c a r d i t i s , y o u c a n r e m e m b e r F AME.
F
F ever
A
Anemia
M
E
Murmur
Endocarditis
T o b e a b l e to r e m e m b e r the c a u s e of h ea r t
M u r m u r, t h i n k of
SPAMS.
S
S t e n o s i s of a v a l ve
P
Partial obstruction
A
M
S
Aneurysm
Mitral
Septal defect
R e m e m b e r F AST
signsof
a stroke.
F
Face
A
Arms
S
T
Speech
Time
f o r the
B r a d y c a r d ia, c a u s e s : S TA G e R D
F
Face
A
Arms
S
T
Speech
Time
Sick sinus syndrome
Thyroid
(ie,
hypothyroidism)
Athletic heart G astrointestinal mesenteric traction
Rest/ sleep
D rugs (eg, beta-blockers, digitalis)
J aundice
Pharmacology N ursing Mnemonics &
Ti p s
Lidocaine T oxicity : “ S A M S
Lidocaine is a class I B antiarrhythmic used a s a second-line
agent and after myocardial infarction. The therapeutic drug
range for lidocaine is 1 .5-5.0
m c g / mL. W
hile generally safe,
lidocaine can be toxic if administered inappropriately, and in
s o m e cases m a y cause unintended reactions even when
properly administered. Lidocaine toxicity is seen at levels
greater than 5 mcg/ mL. Remember the mnemonic S A M S for
signs and symptoms of lidocaine toxicity.
S
S l u rred s p e e c h
A
Altered central n e rv o u s
sy s t e m
M
M u s c l e twitching
S
Seizures
M e d i c a t i o n A d mi n i s t ra t i o n Checklist: “ TR A M P
Nurses are primarily involved in the administration of
medication acro s s various settings. They are primarily
involved in both dispensing and preparation of medication.
Research on medical administration errors (MAEs) shows an
error rate of 6 0 %
, 3 4%
mainly in the form of
wrong time,
wrong rate, or wrong dose. Before
dispensing medication,
ensure the correct TRAMP.
T
Time
R
Ro u t e
A
Amount
M
Medication
P
Patient
T :T
i me
Check the order for when it would be given and when was
the last time it was given.
R: Ro u t e
Check the order if it’ s through oral, I V, SQ, I M, or etc.
A: A m o u n t
Check the medication sheet and the doctor’ s order before
medicating. Be aware of the diff erence of an adult and a
pediatric dose.
M : Medication
Check and verify if it’ s the right name and form. Beware of
look-alike and sound-alike medication names.
P: Patient
Ask the name of the client and check his/ her I Dband before
giving the medication. Even if you know that patient’ s
name, you still need to ask j ust to verify.
S e r i o u s Co mp l i c a t i o n s of O ral Birth Control Pills “ SEA
CAS
S o m e women experience side eff
ects with
“the pill”
such as irregular periods,
nausea, headaches, or weight change. I f she experiences
the side eff
ects with the acronym SEA
CASH, calling the help of a medical provider or visiting an
emergency room immediately is recommended as they may
signify a serious condition.
S
S e v e r e l e g pain
E
Eye problems
A
Abdominal pain
C
Chest pain
A
Acne
S
Swelling of ankles and feet
H
Headaches which are severe
Emergency D r u g s to “ LEAN ”
on
I n the hospital setting, emergencies typically occur in
emergency departments (ED s) and intensive care units
(I CUs). The goal of using these common emergency drugs is
to prevent the patient from deteriorating to an arrest
situation.
L
Lidocaine
E
Epinephrine
A
Atropine Sulf ate
N
N a rc a n
L: Lidocaine
ACTI ON: Suppresses automaticity of ventricular cells,
decreasing diastolic depolarization and increasing
ventricular fibrillation threshold. Produces local anesthesia
by reducing sodium permeability of sensory nerves, which
blocks impulse generation and conduction. U SES:
Ventricular arrhythmias, topical/ local anesthetic E:
Epinephrine
ACTI ON: Stimulates alpha- and beta-adrenergic receptors,
causing relaxation of cardiac and bronchial smooth muscle
and dilation of skeletal muscles. U SES: Bronchodilation;
anaphylaxis; hypersensitivity reaction; Acute asthma attack;
Chronic simple glaucoma
A: Atropine Sulf ate
ACTI ON: I nhibits acetylcholine at parasympathetic
neuroeff ector j unction of smooth muscle and cardiac
muscle, blocking sinoatrial (SA) and atrioventricular (AV)
nodes to increase impulse conduction and raise heart rate.
USES: D ecreases respiratory secretions, treats sinus
bradycardia, reverses eff
ects of
anticholinesterase
medication N : N
arcan
ACTI ON: Naloxone is used to treat an opioid emergency such
as an overdose or a possible overdose of a narcotic
medicine. U SES: Opioid-induced toxicity; opioid-induced
respiratory depression; used in neonates to counteract or
treat effects from narcotics given to mother during labor
D rugs for Bradycardia & Hypotension: “I D
EA
Beta blockers reduce circulating catecholamine levels,
decreasing both the heart rate and blood pressure. Typically,
atropine is the drug of choice for symptomatic bradycardia.
Antiarrhythmic and digoxin m a y also be used.
I
I soproterenol
D
Dopamine
E
Epinephrine
A
Atropine Sulf ate
I : I soproterenol
Acts on beta2-adrenergic receptors, causing relaxation of
bronchial smooth muscle; acts on beta1 -adrenergic
receptors in heart, causing positive inotropic and
chronotropic eff ects and increasing cardiac output. Also
lowers peripheral vascular resistance in skeletal muscle and
inhibits antigen-induced histamine release.
D: Dopamine
Causes norepinephrine release (mainly on dopaminergic
receptors), leading to vasodilation of renal and mesenteric
arteries. Also exerts inotropic eff ects on heart, which
increases the heart rate, blood flow, myocardial
contractility, and stroke volume.
E: Epinephrine
Stimulates alpha- and beta-adrenergic receptors, causing
relaxation of cardiac and bronchial smooth muscle and
dilation of skeletal muscles. Also decreases aqueous humor
production, increases aqueous outflow, and dilates pupils by
contracting dilator muscle.
A: Atropine Sulf ate
Acts on beta2-adrenergic receptors, causing relaxation of
bronchial smooth muscle; acts on beta1 -adrenergic
receptors in heart, causing positive inotropic and
chronotropic eff ects and increasing cardiac output. Also
lowers peripheral vascular resistance in skeletal muscle and
inhibits antigen-induced histamine release.
Th i a z i d e s I ndications: “ C H
IC
Thiazides aff ect the level of the nephron, inhibiting the
reabsorption of sodium by the tubules at the cortical diluting
segment of the nephron. The thiazides are the most
commonly used oral diuretics and are widely used in the
therapy of hypertension and congestive heart failure, as
well as the treatment of edema due to local, renal and
hepatic causes. Remember CHI C to thiazides indications
C
C o n g e s t i v e H eart F ailure
H
Hypertension
I
I nsipidus
C
Calcium calculi
Parkinson’ s M e d i c a t i o n s : “ A L B M
There are m a n y medications available to treat the
symptoms of Parkinson’ s, although none yet that actually
reverse the effects of the disease. Most Parkinson’ s disease
treatments aim to restore the proper balance of the
neurotransmitters acetylcholine and dopamine by increasing
dopamine levels. I t is common for people with PD to take a
variety of these medications. To familiarize yourself with the
common drugs used for PD , remember the mnemonic: “Ali
Loves Boxing Matches” . The former champion boxer
M uha m m a d Ali was diagnosed with Parkinson’ s in 1 9 8 4
at the age of 42, and is one of the most high-profile
people battling the condition.
L
Levodopa
A
Amantadine
M
M A O I nhibitors
B
Bromocriptine
L: L e v o d o p a
Levodopa is the drug most often prescribed. The body
metabolizes it to produce dopamine. G iving dopamine
directly is ineff ective, because the brain ‘ s natural defense
blocks it from being used by the body. To suppress nausea
and other possible side eff ects, levodopa is used in
conj unction with a related drug called carbidopa.
A: A m a n t a d i n e
I t improves muscle control and reduces stiffness in
Parkinson’ s disease; allows more normal movements of the
body as the disease symptoms are reduced. Amantadine is
also used to treat stiff ness and shaking caused by certain
medicines that are used to treat nervous, mental, and
emotional conditions.
M : M A O I nhibitors
MAO-B inhibitors also block the action of an enzyme that
breaks down dopamine. They m a y be taken alone early in
Parkinson’ s disease or with other drugs as the disease
progresses. M A O I nhibitors are often used alone because
combining them with other drugs can cause unwanted side
effects.
B: Bromocriptine
I t improves the ability to move and decrease shakiness
(tremor), stiff
ness, slowed movement, and unsteadiness.I
t m a y also decrease the number of episodes of not being
able to move (“on-off
syndrome” ).
Morphine Side Eff ects: “MORPHI NE
Morphine interacts with opioid receptor sites, primarily in
limbic system, thalamus, and spinal cord. This interaction
alters neurotransmitter release, altering perception of and
tolerance for pain. I f side-eff
ects occur,
opioid rotation m a y be used for managing opioid-induced
adverse eff
ects.
M
My osis
O
Out of it (sedation)
R
Respiratory depression
P
Pneumonia (aspiration)
H
Hypotension
I
I nfrequency (constipation,
urinary retention)
N
Nausea
E
Emesis
Atrial Arrhy t h mi a s : “ A B C D E
Atrial fibrillation is the most common sustained atrial
arrhythmia. A variety of medicines are available to restore
normal heart rhythm. A beta-blocker, such as bisoprolol or
atenolol, or a calcium channel blocker, such as verapamil or
diltiazem, will be prescribed. D igoxin m a y be added to help
control the heart rate further. I n some cases, amiodarone
m a y be tried, or simply remember the mnemonic ABCD E.
A
Anticoagulants
B
B e t a blockers
C
Ca l c i u m C h a n n e l Blockers
D
Di g o x i n
E
Electro cardioversion
A: A n t i c o a g u l a n t s
To prevent embolization.
B: B e t a blockers
To block the effects of certain hormones on the heart to slow
the heart rate.
C: Ca l c i u m Ch a n n e l B l o c k e r s Help slow the heart rate by
blocking the number of electrical impulses that pass through
the AV node into the lower heart chambers (ventricles).
D : Di g o x i n
D igoxin helps slow the heart rate by blocking the number of
electrical impulses that pass through the AV node into the
lower heart chambers (ventricles).
E: Electro c a rd i o ve rs i on A procedure in which electric
currents are used to reset the heart’ s rhythm back to
regular pattern.
Ventricular Arrhythmias: “SLAP
Treatment for ventricular arrhythmias depends on the
symptoms, and the type of heart disorder. S o m e people may
not need treatment. I f ventricular tachycardia becomes an
emergency situation, it m a y require CPR and electrical
defibrillation or cardioversion (electric shock). And to
prevent the arrhythmia from recurring, anti-arrhythmic
medications such as procainamide, amiodarone, lidocaine,
or sotalol are given through a vein.
S
Anticoagulants
L
B e t a blockers
A
Ca l c i u m C h a n n e l Blockers
P
Di g o x i n
S : S o t a lo l
Blocks stimulation of cardiac beta1 -adrenergic and
pulmonary, vascular, beta2-adrenergic receptor sites. This
action reduces cardiac output and blood pressure,
depresses sinus heart rate, and prolongs refractory period in
atria and ventricles.
L: Lidocaine
Suppresses automaticity of ventricular cells, decreasing
diastolic depolarization and increasing ventricular fibrillation
threshold.
A: A mio d a ro n e
Prolongs duration and refractory period of action potential.
Slows electrical conduction, electrical impulse generation
from sinoatrial node, and conduction through accessory
pathways.
P: Procainamide
D ecreases myocardial excitability by inhibiting conduction
velocity. Also depresses myocardial contractility.
F or t h e t re a t me n t o f M y ocardial I n f arction, y o u
canthink o f
the n a me M O
N
A.
M
M o rp h i n e
O
Oxygen
N
Nitroglycerine
A
Asa
The drugs that are used in the treatment of HI V can be
memorized with Z Z
LSD .
Z
Z idovudine
Z
Z alcitabine
L
Lamivudine
S
Stavudine
D
D idanosine
Remember M A D D D O G
congestive heart failure.
for the treatment of
M
M o rp h i n e
A
Aminophylline
D
D igoxin
D
D opamine
D
D iuretics
O
Oxygen
G
G a s s e s (gasses is for
monitoring the arterial blood
gasses)
Maternal and Child Health Nursing
Mnemonics & Tips
Severe Pre-Eclampsia: H E L L P Sy n d r o m e HELLP syndrome
is a life-threatening pregnancy complication usually
considered to be a variant of preeclampsia. Both conditions
usually occur during the later stages of pregnancy, or
sometimes after childbirth.
H
H emoly s i s
E
Elevated
L
Liver enzymes
L
Low
P
Platelet Count
P o s t p a r t u m A s s e s s m e n t : “ BU BBLE- H E
Nurses need to be aware of the normal physiologic and
psychological changes that take place in women’ s bodies
and minds in order to provide comprehensive care during
this period. The postpartum period covers the time period
from birth until approximately six weeks after delivery. S o it
is important to remember the mnemonic BU BBLE-HE to
denote the components of the postpartum maternal nursing
assessment.
B
Breast
U
Uterus
B
Bowel
B
Bladder
L
Lochia
E
Episiotmy
H
Homan’ s sign
F etal N
o n - S t r e s s T est: “ N N N
A nonstress test is a common prenatal test used to check on
a baby’ s health. Results of a nonstress test are considered
reactive or nonreactive. Results are considered normal
(reactive) if the baby’ s heartbeat accelerates to a certain
level twice or more. I f the baby’ s heartbeat doesn’ t meet
the criteria described, the results are considered
nonreactive.
N
N on- Reactive
N
Non-Stress Test I s
N
Not G ood
Th e APG A R s c o re i s u s e d t o g a u g e the health of a
baby a t 1
mi n u t e a n d 5
minutesaf ter b e i n g born.
A
A p p e a ra n c e : I s the baby
blue/ pale, blue/ pink, or
pink?
P
Pulse: I s the pulse absent, under
1 0 0 , or greater than 1 0 0 ?
G
Grimace: Response to
stimulation
A
Activity: F lexing of the limbs
R
Respiration: I s there crying and
is it weak or strong?
F etal W
e l l b ei n g Asesment
T e s t s : “ ALO
NE
Assessment of fetal well-being is crucial not only for high
risk patients but also for other pregnant women who might
develop unexpected complications in the course of
otherwise normal pregnancies. The primary goal of
antenatal evaluation is to identify fetuses at risk for
intrauterine inj ury and death so that intervention and timely
delivery can prevent progression to stillbirth.
A
A mn i o c e nt es i s
L
L/ S Ratio
O
O xy tocin T est
N
n o n s t r e s s test
E
Estriol Level
A mn i o c e n t e s i s is a prenatal test where a small amount of
amniotic fluid is removed from the sac surrounding the fetus
for testing. D ife rent tests can be performed on a sample,
but it is used mainly to look for certain types of birth
defects, such as D own syndrome, a chromosomal
abnormality.
Th e lecithin– s p h i n g o m y elin ratio ( a k a L- S or L/ S ratio)
is a test of fetal amniotic fluid to a s s e s s for fetal lung
immaturity.
O xy tocin T e s t or Challenge (a.k.a. Contraction Test)
involves the intravenous administration of exogenous
oxytocin to the pregnant woman. The target is to achieve
around three contractions every ten minutes.
A n o n s t r e s s t es t is used to evaluate a fetus’ health before
birth and provides useful information how the fetus’ oxygen
supply by checking its heart rate and how it responds to the
fetus’ movement.
L e v e l s of estriol in the blood is used in maternal serum
triple or quadruple screening test that is done between 1 5
and 20 weeks. The levels of the substances measured helps
estimate the chance that the baby m a y have certain
problems or birth defects.
Episiotomy H e a l i n g Evaluat ion: “ REEDDA”
I f the mother had an episiotomy or vaginal tear during
delivery, the wound might hurt for a few weeks. Extensive
tears might take longer to heal. The patient will have a
vaginal discharge (lochia) for a number of weeks after
delivery. Expect a bright red, heavy flow of blood for the first
few days. The discharg e will gradually taper off, becoming
watery and changing fro m pink or brown to yellow or white.
S o it is always important to check for R E E D A.
R
REDN E S S
E
EDEMA
E
ECCH Y M O S I S
D
DI SCH ARG ES
D
DRAI N AG E
A
APPRO X I MAT I O
N
F etal Accelerat ions a n d Decelerations: “ VEAL CHO P
Variable decelerations are associated with cord compression
(V and C). Early decelerations are associated with head
compression. This is generally a benign event (E and H).
Accelerations are associated with oxygenation, which
explains why they’ re generally a good prognostic factor (A
and O). Late decelerations* are associated with placental
insuffi ciency (L and P). The trick to this mnemonic is writing
it so each letter is associated with the one beneath it, or the
other way around.
Variable
Deceleration
Early
Deceleration
Acceleration
Late
Deceleration
C
Cord
Compression
E
H
Head
Compression
A
O
O KAY
P
Placental
I nsuffi ciency
V
L
Ch o r i o ni c Villi S a m p l i n g & A l p h a - f et o pr o t ei n
“Chorionic” has 9 letters and C V S is performed at 9 weeks
gestation.
“Alpha F etoprotein” has 1 6 letters and is measured at 1
weeks’ gestation. 6
Chorionic villus s a m p l i n g a n d
Alpha - f etoprotein
9 & 1 6
Chorionic
has 9 letters and C V S is
performed at 9 weeks
gestation
Alphaf
etoprotein
” has 1 6letters and is
measured at 1 6weeks
gestation.
Chorionic villus s a m p l i n g ( C V S ) is a first-trimester (1 0to
1 2 weeks) alternative to amniocentesis for prenatal
diagnosis of genetic abnormalities. This procedure is
accomplished by needle aspiration of a sample of chorionic
villi, either by the trans cervical or transabdominal route.
Alpha - f etoprotein is a fetal protein produced in the yolk
sac during the first 6 weeks of gestation and later by the
fetal liver. AF P is found in the amniotic fluid and maternal
serum. I f the fetus has neural tube defect, AF P levels are
elevated.
Prenatal Care Assessm ent : “ ABCDEF
The first prenatal visit is a time to establish rapport and
baseline data relevant to the patient’ s health. This begins
with obtaining a health history, including screening for any
presence of teratogens and concerns the woman m a y be
experiencing. I f you are lost with your assessment,
remember the nursing mnemonic “A BC D EF ” for the
possible areas you can ask.
A
Amniotic fluid l e a k a g e
B
B l e e d i n g vaginally
C
Contractions
D
Dy suria
E
Edema
F
F etal movement
(q uickening)
A: Amniotic fluid l e a k a g e
Check whether amniotic fluid is clear, blood-tinged (pink),
green, or brown. A woman can tell the diff erence between
urine and amniotic fluid because the fluid keeps leaking and
she can’ t control its release.
B: B l e e d i n g v a g i na ll
Bleeding during pregnancy can happen any time from
conception to the end of pregnancy. Any bleeding or
spotting can be a sign of pregnancy where the fertilized egg
develops outside the uterus (ectopic). An untreated ectopic
pregnancy can be life-threatening for the woman.
C: Contractions
A pregnant mother m a y experience them from as early as
six weeks into pregnancy to the very end, or not at all.
These contractions typically feel like a tightening or
hardening across the abdomen and should be irregular and
totally painless.
D : Dy suria
Pregnant women are also more susceptible to urinary tract
infections. Be careful not to confuse increased frequency of
urination with a bladder infection (cystitis). I f a pregnant
woman notices that she is urinating more frequently, that
urination is painful (dysuria), or that she has a fever, she
m a y have an infection.
E: E d e m a
Edema is when excess fluid collects in the tissue. I t’ s normal
to have a certain amount of swelling during pregnancy
because of water retention. Edema is most likely to trouble
during the third trimester. I t m a y be particularly severe for
women with excessive amniotic fluid or those carrying
multiples.
F : F etal m o v e m e n t (q uicke n i n g ) This can usually be
felt
between 1 6
and 2 3
weeks; movements
are intermittent and infrequent.
A b d o m i n a l P a i n C a u s e s D u r i n g P r e g n a n c y : “ LARA
CROF T
I ntermittent abdominal discomfort or pain is a common
pregnancy complaint. W hile itself m a y present to be
harmless, it can also be a sign of a serious problem. There
can be m a n y causes for abdominal pain especially during
pregnancy, remember the nursing mnemonic “LARA CROF T
”
to remind you.
L
Labor
A
Abruptio Placenta
R
Rupture (e.g., ectopic/ uterine
rupture)
A
Abortion (Spontaneous)
C
Cholestasis
R
Rectus sheath hematoma (RSH)
O
Ovarian tumor
F ibroids
L: Labor
Labor contractions usually cause discomfort or a dull ache in
a pregnant woman’ s back and lower abdomen, along with
pressure in the pelvis.
A: A b ru p t i o Placenta
The premature separation of placenta from the uterus and
typically presents with bleeding, uterine contractions, and
fetal distress. Puts mother and fetus in serious danger if left
untreated.
R: Ru p t u re (e.g., ectopic/ uterine rupture)
Ruptured ectopic pregnancy often results in internal
bleeding and intense abdominal pain.
Rupture of the uterus results in bleeding, rupture of the
amniotic sac; it is a serious emergency.
A: A b o rt i o n ( S p o n t a n e o u s )
Spontaneous abortion (a.k.a. miscarriage) is the
unintentional expulsion of an embryo or fetus before the
24th week of gestation; manifests with abdominal cramps
and vaginal bleeding.
C: Ch o l e s t a s i s
Cholestasis is the impairment of bile flow from the liver that
can trigger intense itching and abdominal pain. I t poses no
risk for the mother but can be dangerous for the developing
baby.
R: R e c t u s s h e a t h h e m a t o m a (RSH ) I t is a rare
hematoma within the rectus sheath that produces a painful,
tender swelling that can mimic an intraperitoneal m a s s with
features of an acute abdomen.
O : O v a ri a n t u mo r
Ovarian cysts typically occur in the second trimester and
typically do not pose risks to the mother or fetus; can
naturally resolve themselves before or soon after childbirth.
F :F
ibroids
F
ibroids are benign tumors that originate in the uterus and
are composed of the s a m e smooth muscle fibers a s the
myometrium; usually poses no problems during pregnancy.
T : T o rs i o n o f
t h e u t e ru s I t is the rotation of more
than 45
degrees around the long axis of the uterus;
manifests with severe abdominal pain, tense uterus, and
fetal distress. I t m a y be due to structural abnormalities in
the pelvis.
P r e e c l a m p s i a C l a s s i c T riad: “
PRE”
eclampsia
Preeclampsia is a complication characterized by high blood
pressure and signs of damage to another org a n system
(usually the kidneys). The condition usually begins after 2
weeks of pregnancy in a woman whose blood pressure had
been normal. Even a slight rise in blood pressure m a y be a
sign of preeclampsia.
P
Proteinuria
R
R i s i n g b l o o d p re s s u re
E
Edema
P: Proteinuria
Proteinuria is defined a s > 3 0 0
m g / 2 4 h.
Alternatively,
proteinuria is diagnosed based on a protein: creatinine ratio
≥ 0 .3
or a dipstick reading of 1 +
. Absence of proteinuria on
less
accurate tests (eg, urine dipstick testing, routine urinalysis)
does not rule out preeclampsia.
R: R i s i n g b l o o d p r e s s u r e High blood pressure may
develop slowly, but more commonly it has a sudden onset.
Blood pressure that is 1 4 0 / 9 0
millimeters of
mercury (mm
Hg) or greater —
documented on two occasions, at least
four hours apart —
is abnormal.
E: E d e m a
Sudden weight gains and swelling (particularly in the face
and hands) often manifests; pitting edema –an unusual
swelling, particularly of the hands, feet, or face, notable by
leaving an indentation when pressed on.
Anaesthesia N ursing Mnemonics
A n e s t h e s i a m a c h i n e / r o o m check
M S MAI D
M
M o n i t o r s (EKG , SpO 2 , EtCO 2 ,
etc.)
S
Suction
M
Machine check (according to
A S A guidelines)
A
Airway equipment (ETT,
laryngoscope, oral/ nasal airway)
I
I V equipment
D
D r u g s (emergency, inductions,
NMBs, etc.)
E n d o t rache al intubation: d i a g n o s i s of p o o r bilateral
b re a t h s o u n d s af ter intubation
DO P E
D
D i s p l a c e d (usually right
m a i n s t e m , py ref o r m f ossa,
etc.)
O
O bstruction (kinked or bitten
tube, mucous plug, etc.)
P
Pneumothorax (collapsed lung)
E
Esophagus
G eneral a n e s t h e s i a : eq u i p m e n t c h e c k s prior to
inducing
MALES
M
Masks
A
Airways
L
Laryngoscopes
E
Endotracheal tubes
S
Suction/ Stylette, bougie
Spinal anesthesia agents
" Little B o y s Prefer Toys
L
Lidocaine
B
Bupivicaine
P
Procaine
T
Tetracaine
X y locaine: w h e re n o t t o u s e with epinephrine " Ears,
Nose, Hose, F ingers and Toes
Vasoconstrictive eff ects of xylocaine with epinephrine are
helpful in providing hemostasis while suturing. However,
m a y cause local ischemic necrosis in distal structures such
as the digits, tip of nose, penis, ears.
" D
igital PEN" - D
igits, Penis, ear, nose.
S i x Q u e s t i o n s to a s k a co n s c i o u s patient or his/ her
relative in a lif e- t h re a t en i n g emergen cy
prior to
t a k i n g him/ her t o the o p e ra t i n g ro o m : S A M P L E
Smoking history
Allergies to medications or previous anesthetics
Medications or alcohol use
Past medical history
Last meal
Events leading up to present inj ury or collapse
Maintenance I ntravenous F
Child:
4
l u i d s in t h e A d u l t or
,2
,
4 mL/ k g / hr for the first 1 0
kg
2 mL/ k g / hr for the next 1 0
kg
1 mL/ kg/ hr for each remaining kg
Eg: A 3 7
adolescent e
rqure
is(4x1 0 ) +
(1 x1 7 ) 7 7
kg
(2x1 0 ) +
mL/ hr I V fluid
B e h a v i o r a l sc i e n c e Psy chiatric
N ursing Mnemonics
D e p r e s s i o n : m a j o r e p i s o d e c h a r a c ter i st ic s
S P A C E D I GS
S
Sleep disruption
P
Psychomotor retardation
A
Appetite change
C
Concentration loss
E
Energy loss
D
D epressed mood
I
I nterest wanes
G
G uilt
S
Suicidal tendencies
D epression: D SM-V Criteria for Maj or D
D isorder
" S I GE C A P S
S
S l e e p d i s t u rb an ces
I
I nterest decreased (anhedonia)
G
G uilt and/ or feelings of
worthlessness
E
Energy decreased
C
Concentration problems
A
Appetite/ weight changes
P
Psychomotor agitation or
retardation
S
Suicidal ideation
epressive
G ain: primary v s . s e c o n d a r y v s . tertiar
Primary
Patient' s Psyche
improved.
Secondary
Symptom Sympathy for
patient.
Tertiary
Therapist' s gain
Kubler - R o s s dyi n g p r o c e s s : s t a g e s
" ' D e a t h A l w ay
s Brings G
reat Acceptance
D
Denial
A
Anger
B
Bargaining
G
G rieving
A
Acceptance
Middle adolescence (1 4
y
characteristics
- 1 7
ears):
“H E R
H
H eterosexual crushes/
Homosexual Experience
E
Education regarding short term
benefits
R
Risk taking
O
Omnipotence
N arcolepsy : sy m p t o m s , e p i d e m i o l o g
“CH A P
C
Cataplexy
H
Hallucinations
A
Attacks of sleep
P
Paralysis on waking
Usual presentation
is a young male,
hence " chap
S u i c i d e: r i s k s c r e e n i n g
“SAD PERSONS” scale
SAD
S
Cataplexy
A
Hallucinations
D
Attacks of sleep
PERSO N S
P
Previous attempt
E
Ethanol abuse
R
Rational thinking loss
S
Social support problems
O
Organised plan
N
No spouse
S
Sickness (chronic illness)
S l e e p s t a g e s : f ea t u r es:
D Elta waves during D Eepest sleep (stages 3 & 4, slowwave).
d R E a M during R E M sleep.
I m p o t e n c e causes
“PLAN E
P
Psychogenic: performance
anxiety
L
Libido: decreased with androgen
deficiency, drugs
A
Autonomic neuropathy: impede
blood flow redirection
N
E
Nitric oxide deficiency: impaired
synthesis, decreased blood
pressure
Erectile reserve: can' t maintain
an erection
M a l e erectile dy sf u n c t i o n ( M E D ) : biological
causes
“M E D
M
Medicines (propranalol,
methyldopa, S S R I , etc.)
E
Ethanol
D
D iabetes mellitus
Endocrine Nursing K nemonics
Diabetes Complications
KN I V E S
K
N
I
V
E
S
Kidney – nephropathy
N euromuscular
–
peripheral
neuropathy,
mononeuritis,
amyotrophy
I nfective – UTI s, TB
Vascular –
coronary/ cerebrovascular/ peripheral
artery disease
Eye – cataracts, retinopathy
Skin – lipohypertrophy/ lipoatrophy,
necrobiosis lipoidica
Anatomy Mnemonics
Aff
Aff
arivesand an eff
exits .
erent v s eff
erent
erent connection
erent connection
Anterior leg muscles
" T
he H
ospitals A re N
ot
irty P laces
T D Tibialis
anterior
H
extensor H allucis longus
A
anterior tibial Artery
N
deep fibular N erve
D
extensor Digitorum longus
P
Peronius tertius [ aka fibularis
tertius]
Brachial plexus Remember T o Drink Cold Beer - Roots,
Trunks, Divisions, Cords, Branches Posterior cord branches
STAR - subscapular (upper and lower), thoracodorsal,
axillary, radial RAT S- Radial nerve, Axillary nerve,
Thoracodorsal nerve, Subscapular (U p p e r & Lower) nerve.
ULTRA - upper subscapular, lower subscapular,
thoracodorsal, radial, axillary U LN AR- U pper subscapular
nerve, Lower subscapular nerve, Nerve to latissimus dorsi,
Axillary nerve, Radial nerve.
Lateral Cord Branches LLM " Lucy Loves Me" - lateral
pectoral, lateral root of the median nerve,
musculocutaneous Love M e Latha (LML) - Lateral pectoral
nerve, Musculocutaneous nerve, Lateral root of Median
Nerve.
Look M y Lancer-Lateral pectoral nerve, Musculocutaneous
nerve,Lateral root of Median nerve.
Medial Cord Branches M M M U M " Most Medical M e n U
se
Morphine"
- medial pectoral, medial cutaneous nerve of
arm, medial cutaneous nerve of forearm, ulnar, medial root
of the median nerve " Money Makes M a n y M e n U
nhappy"
Medial pectoral nerve, Medial cutaneous nerve of arm,
Medial cutaneous nerve of forearm, Medial root of median
nerve, U lnar nerve.
" M4U " - Medial pectoral nerve, Medial cutaneous nerve of
arm, Medial cutaneous nerve of forearm, Medial root of
median nerve, U lnar nerve U nion of 4 Medials - U lnar
nerve, M e d i a l cutaneous nerve of arm, M e d i a l cutaneous
nerve of forearm, M e d i a l pectoral nerve, M e d i a l root of
Median Nerve.
5 main nerves of brachial plexus, in order laterally to
medially " M y Aunty Rocks M y U
ncle"
Musculocutaneous, axillary, radial, median, ulnar.
Bowel components
" D o w J o n e s I n d u s t ri a l A v e r a g e C l o s i n g S t o c k Report"
F rom proximal to distal
D
Duodenum
J
J ej unum
I
I leum
A
Appendix
C
Colon
S
Sigmoid
R
Rectum
Carotid sheath contents
I See 1 0
CC'
s in
I the II V
S e e (I .C.) = I nternal
S e e Carotid artery
1 0
CC
1 0 =
CN 1 0
(Vagus nerve)
CC = Co m m o n Carotid artery
IV
I V = I nternal J ugular Vein
Cavernous sinus contents
O TO M CA
O TOM are lateral wall components, in order from superior
to inferior.
CA are the components within the sinus, from medial to
lateral. CA ends at the level of T from O TOM.
O
T
O
M
C
A
T
O c c u lo moto r n e rv e (I I I )
Trochlear nerve (I V)
O phthalmic nerve (V1 )
Maxillary nerve (V2)
Carotid artery
Abducent nerve (VI )
T: W hen written, connects to the
T of OTOM
Celiac trunk (Coeliac trunk): branches
Lef t Hand Side (LHS)
L
Lef t g a s t r i c artery
H
H epatic artery
S
Splenic artery
Vertebral column
The servant attacks with saw and axe the lumbar, stack and
cord
C
Cervical (atlas, axis)
T
Thoracic
L
Lumbar
S
Sacral
C
Coccygeal
Tributaries of the I nferior vena cava
" ILike To Rise S o H igh
I
I liac vein ( c o m m o n )
L
Lumbar vein
T
Testicular vein
R
Renal vein
S
Suprarenal vein
H
H epatic vein
Greater sciatic foramen
Structures passing through greater sciatic foramen below
piriformis (S.N.I .P. N.I .P.)
S
Sciatic nerve
N
N erve to obturator internus
I
I nternal pudendal vessel
P
Pudendal nerve
N
Perve to quadratus femoris
I
I nferior gluteal vessels
P
Posterior cutaneous nerve of
thigh
Lesser sciatic foramen
Structures passing through lesser sciatic foramen: (P.I .N.T.)
P
P u d e n d a l nerve
I
I nternal pudendal vessels
N
N erve to obturator internus
T
Tendon of obturator internus
Tarsal tunnel a mnemonic to remember the contents of the
Tarsal tunnel from anterior to posterior is " Tom, Dick and
Harry" or alternatively " Tom, D
ick (a nd v ery
n ervous) Harry
if the a rtery, v ein,
and n erve are included.
Subclavian artery The branches of the subclavian artery can
be remembered using VI Tamin C and D.
Posterior mediastinum
The contents of posterior mediastinum can be remembered
using the mnemonic, " DATES"
D
D e s c e n d i n g a o rt a
A
Azygous vein and hemiazygos
vein
T
Thoracic duct
E
Esophagus
S
Sympathetic trunk/ ganglia.
Superior orbital fissure
Standing room only can be used to remember that
V 1 passes through the Superior orbital fissure
V 2 through the foramen Rotundum
V3 through the foramen O vale.
F oramen m a g n u m
Contents of the foramen magnum: V A M P S - ATM
V
Vertebral arteries
A
Anterior Spinal artery
M
Meningeal branches of the
cervical nerves
P
Posterior spinal arteries
S
Spinal part of the accessory
nerve
A
Alar and Apical ligaments of the
dense
T
Tectorial membrane
M
Medulla oblongata
Cerebellum
D
eep cerebellar nuclei and their positions relative to the
midline: " F at G
u y s Eat D
onuts," where each
letter indicates
the medial to lateral location
in F
the cerebellar
matter.
n u c l e u s Fwhite
astigii
G
G lobose nucleus
E
nucleus Emboliformis
D
Dentate nucleus.
Pes anserinus
A mnemonic to remember the muscles that contribute
tendons to the pes anserinus and the innervations of these
muscles is SG T F O T (SerG eanT FO T)
S
G
T
F
O
T
S- S a rt o ri u s
G - G racilis
T- semiT endinosus (from anterior
to posterior).
F- F emoral nerve
O - O bturator nerve
T- ibial division of the sciatic
nerve.
Notice the order
of the muscles (S,
G , T) follows the
order of the
innervating
nerves which
correspond to
those muscles (F ,
O, T).
F emoral triangle The femoral triangle is shaped like the sail
of a sailing ship and hence its boundaries can be
remembered using the mnemonic, " S A I L"
S a rt o ri u s
The order of
S
structures in the
femoral triangle
Adductor longus
is important in
A
the embalming of
bodies, as the
I nguinal Ligament.
femoral artery is
often exposed
IL
and used to
pump embalming
fluids into the body. The order of this neurovascular bundle
can be remembered using the mnemonic, " NAV
N
A
V
Y
N erve
Artery
Vein
SEE I N ST RU CT I O N
S BELLO W
Y -fronts (the British term of a style of men' s underwear
with a " Y "
shaped front
that acts as a fly). The " Y "
is midline
(corresponding with the penis) and the mnemonic always
reads from lateral to medial (in other words, the F emoral
Nerve is always lateral).
" for N erve, Artery,
An alternate to this mnemonic is " NAVEL
Vein, Empty Space and Lymph, to include the deep inguinal
lymph nodes located medial to the F emoral vein.
Popliteal fossa A useful m n e m o n i c to remember popliteal
fossa anatomy (medial-to-lateral arrangement) is: Serve
And Volley N ext Ball.
Semimembranosus and
S s e m i t e n d i n o s u s (superior
me d i a l border)
A
V
N
B
Artery (popliteal artery)
Vein (popliteal vein)
N erve (tibial nerve)
Biceps femoris (superior lateral
border). The lateral and medial
heads of gastrocnemius form the
inferior border.
D i a p h r a g m apertures: s p i n a l levels
M a n y mnemonics are used for diaphragm apertures
including:
N u m b e r of letters
Aortic h i a t u s = 1 2 letters =
T
1 2 O
esophagus =
1 0
letters = T1 0 V e n a c a v a = 8
letters = T8
I ate 1 0
eggs
at 1 2
I = I VC
ate = T
1 0 = T1 0
E g g s = Esophagus
At = Aorta
1 2 = T1 2
(V)oice (O )f (A)merica
V- vena cava -T
O-oesophagus-T1 0
A-aorta-T1 2
D u o d e n u m : l e n g t h s of p a r t s " Counting 1 to 4 but
staggered
1 st part: 2 inches 2 nd part: 3 inches 3 rd part: 4 inches 4 th
part: 1 inch Endocrine g l a n d s The maj or glands of the
endocrine system, excluding ovaries and testes: " T - AP . (T2, A3 , P4) T
hymus T
hyroid A nterior
pituitary A drenal
cortex Adrenal medulla Posterior pituitary Parathyroid gland
Pancreas Pineal
Extraocular m u s c l e s A good mnemonic to remember
which muscles are innervated by what nerve is to
paraphrase it as a molecular equation: LR 6 SO 4 R 3 .
Lateral Rectus - Cranial Nerve VI Superior O blique - Cranial
Nerve I V
the Rest of the muscles - Cranial Nerve I I IAnother way to
remember which nerves innervate which muscles is to
understand the meaning behind all the Latin words.
The fourth cranial nerve, the trochlear, is so named because
the muscle it innervates, the superior oblique, runs through
a little fascial pulley that changes its direction of pull (the
trochlea of superior oblique). This pulley exists in the
superiomedial corner of each orbit, and " trochl-" is Latin for
" pulley.
The sixth cranial nerve, the abducens , is so named because
it controls the lateral rectus, which abducts the eye (rotates
it laterally) upon contraction.
The third cranial nerve, the oculomotor, is so named
because it is in charge of the movement (motor) of the eye
(oculo-). I t controls all the other muscles.
G .I . tract lay e r s ( s i mp l i fi
ed)
M.S.M.S
M
Mucosa
S
Submucosa
M
Muscularis propria
S
Serosa
Kidney f unctions
A W ET B E D
A
A – ma i n t a i n i n g ACI D - base
b a l a nce
W
W – maintaining W ATER balance
E
E – ELECTROLY TE balance
T
T – TOX I N removal
B
B – BLOOD Pressure control
E
E – making ERY THROPOI ETI N
D
D – Vitamin D metabolism
Lateral g e n i c ulat e n u c l e u s A simple mnemonic for
remembering this is " See I ?
I see, I
see,"
representing
the C with
in " contralateral,"
" see
and " I "
representing
the I in " ipsilateral."
Another is " Emily and Pete
m
meet
eteye to
I psi
eye"
to I psi.
a s in " M and P meet I to I ,"
or
again, M away
Another
g n oofand
remembering
Parvo
5,
this is 2 + 3 =
which isso ipsilateral side, and 1 +4 doesn' t equal 6 , so
correct,
contralateral.
Pl a c e n t a - c r o s s i n g s u b s t a n c e s W A N
T
M y Hot D o g
W astes
W
A
N
T
M
H
D
Antibodies
N utrients
Teratogens
Microorganisms
H ormones, H I V
Drugs
Retina
A mnemonic to remember the layers of the retina:
My
Membrane (internal
limiting)
Nerves
Nerve fibers
G et
G anglions
In
I nner plexiform
K nots
I nner nuclear
Outside
Outer plexiform
Our
Outer nuclear
Easy
External limiting
membrane
Practice
Photoreceptors
Review
Retinal pigment
epithelium
Sperm: path through male reproductive system
" M y boyfriend' s name is STEVE"
S
Seminif e r o u s T u b u l e s
E
Epididymis
V
V a s deferens
E
Ej aculatory duct
Sternal angle
F or structures lying at the level of the sternal angle, the
following mnemonic can be used:
RAT PLLANT
Rib 2
Aortic arch
Tracheal bifurcation
Pulmonary trunk
Ligamentum arteriosum
Left recurrent laryngeal
Azygos Vein
N erves (Cardiac and Pulmonary plexuses)
Thoracic duct
PLOT of EARTH PLLANTS
is a more detailed mnemonic including: Phrenic and Vagus
Nerve Lymph Nodes O blique fissure of lungs (top of it)
Th y m u s Esophagus (trending right to left) Aortic Arch
(bottom of the arch) Rib 2, Manubrium-sternal angle,
T4(more specifically T4-5 disc) T racheal Bifurcation (Carina:
Latin –like keel of boat) H eart Pulmonary trunk bifurcation
L2 : Left Recurrent Laryngeal (Looping under Aorta);
Ligamentum Arteriosum: Connects Aortic Arch to Pulmonary.
Bifurcation Azygous vein arches over the root of the Rt.
Lung and opens in SVC.
N erve plexi: Cardiac and Pulmonary Plexus T horacic duct
(on its way to drain into the Left Subclavian) S V C going
down
Spine
Breakfast at 7 :0 0 --- 7
cervical
vertebrae
Lunch at 1 2:0 0 --- 1 2 thoracic vertebrae
D inner at 5:0 0 --- 5 lumbar vertebrae
Hand Carpal bones: S o m e Lovers T ry Positions That They
Can' t Handle:
Scaphoid, Lunatum, T riquetrum, Pisiforme, T rapezium,
Trapezoid, Capitate and H amate Carpal Bones: S h e Looks
Too Pretty T ry To Catch H er:
S caphoid, Lunate, T riquetrum, P isiforme, T rapezium,
Trapezoid, C apitate and H amate Carpal bones: S cabby Lucy
Tried P issing H ours after C opulating T wo Twins:
Scaphoid, Lunate, T riquetrum, Pisiforme, H amate, Capitate,
Trapezoid, and T rapezium:
I n clockwise order from Scaphoid-remember zoids do not
touch each other. M. Hall
Carpal bones:
S o Long T o Pinky H ere Co m e s T he Thumb:
Straight Line T o Pinky H ere Co m e s T he Thumb:
Scaphoid, Lunatum, T riquetrum, Pisiforme, H amate,
Capitate, Trapezoid, Trapezium
I nternal iliac artery: branches I Like G oing Places U sing M y
Very O wn U nmanned Vehicle
Posterior division: I liolumbar artery Lateral sacral artery
Superior gluteal artery Anterior division: I nferior gluteal
artery I nternal pudendal artery Umbilical artery Middle
rectal artery Superior and inferior vesical artery O bturator
artery U terine artery (female) Vaginal artery (female)
Coronal section of brain (structures)
" I n Extremis, Cannibals Eat People' s G
l obus Pallidi I nstead of
Their Hearts" :
F rom insula to midline:
I nsula
Extreme capsule
Claustrum
External capsule
Putamen
Globus pallidus
I nternal capsule
Thalamus
Hypothalamus
Anterior Pituitary Hormones
F LAG TOP
FS H
LH
ACTH
GH
TS H
Melan O cyte Stimulating Hormone
Prolactin
Miscellaneous
W h e n t r e a t i n g a f racture, k e e p P R I C E in mind.
P
Pre s s u re
R
Rest
I
C
E
I ce
Compression
Elevation
Th e s y m p t o m s o f
roidism can be
G
.
H
y perthy
grouped as S T
IN
S
Sweating
T
Tremors or Tachycardia
I
N
G
I ntolerance to heat, I rregular
period, I rritability, I rregular
eyes
(e.g.,
weakness
or
bulging)
Nervousness, Neurological
(e.g., chorea, myopathy,
paralysis)
Goitre, G astrointestinal
problems (such as vomiting,
nausea, as well as
constipation or diarrhea)
Mania is one of the primary symptoms of bipolar disorder. I t
can also be the side eff ect from the use of prescription
medications as well as some illicit drugs. DI G F A S T is
the acronym for the symptoms of mania.
D
Distractibility
I
I ndiscretion or excessive
I nvolvement in pleasurable
activities
G
Grandiosity
F
F light of ideas
A
Activity increase
S
Sleep deficit ( meaning, there
is a decrease in the need for
sleep)
T
Talkativeness
O n e last thing
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