RN Mnemonics ABC - Notes PDF

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ABDOMINAL AORTIC ANEURISM “4-A’s” Asymptomatic Abdominal mass Abdominal pulse Aches low back ABDOMINAL DISTENSTION "5-F's" Fat Fluid Feces Flatus Fetus ACE INHIBITOR SIDE EFFECTS "CAPTOPRIL" Cough Anaphylaxis Palpitations Taste Orthostatic -↓BP Potassium - ↑K+ Renal impairment Impotence Leukocytosis 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 ACIDOSIS/ALKALOSIS “ROME” Respiratory Opposite: pH↑ PCO2↓ = alkalosis pH↓ PCO2↑ = acidosis Metabolic Equal: pH↑ HCO3↑ = Alkalosis pH↓ HCO3↓ = Acidosis ACIDOSIS/ALKALOSIS – COMPENSTATION “RUB MUB” Respiratory Uses Bicarb Metabolic Uses Breathing ALKALOSIS AND ACIDOSIS AlKalosis has “K” – it’s “K”icking pH up = PH↑ AciDosis has “D” – it’s “D”ropping pH Down = PH↓ ACUTE INFLAMMATION FEATURES

Think: "what a cute pair of SLIPpeRs" to tie acute inflammation to “SLIPR”mnemonic). “SLIPR” Swelling Loss of function Increased heat Pain Redness ADRENAL GLAND HORMONES “SSS” S-sugar (Glucocorticoids) S-salt (Mineralocorticoids) S-sex (Androgens) AIMS for improvement “PETEES” AIMS P - Patient centered care E - Efficient T - Timely E - Effective E - Equitable S - Safety ALCOHOL WITHDRAWAL – CLINICAL FEATURES "HITS" Hallucinations (visual, tactile) Increased vital signs & insomnia Tremens delirium tremens (potentially lethal) Shakes/Sweat/Seizures/Stomach pain (N/V) ALCOHOLISM – BEHAVIORAL PROBLEMS “5-D's” D- Denial D- Dependency D- Demanding D- Destructive D- Domineering ALCOHOLISM OUTCOME “BAD” B- Brain Damage A- Alcoholic Hallucinosis D- Death ALDOSTERONE IS REGULATED BY: "RNA’S" Renin-angiotensin mechanism Na concentration in blood Anp (ANP – atrial natriuretic peptide) Stress ALZHEIMER – “5 A’s” to DIAGNOSIS “5-A's” Amnesia – loss of memories Anomia – unable to recall names of everyday objects

Apraxia – unable to perform tasks of movement Agnosia – inability to process sensory information Aphasia – disruption with ability to communicate ANGINA – PRECIPITATING FACTORS "4-E's" Eating Emotion Exertion (Exercise) Extreme Temperatures (Hot/Cold weather) “ANOREXIA” – EATING DISORDER A-menorrhea delayed N-o organic factors accounts for weight loss O-obviously thin but feels FAT R-refusal to maintain normal body weight E-epigastric discomfort is common X-symptoms (peculiar symptoms) I-intense fears of gaining weight A-always thinking of foods ANOREXIA NERVOSA – CLINICAL FEATURES "ANOREXIC" A-adolescent women/Amenorrhea N-GT alimentation (most severe cases) O-obsession w/ wt. loss/becoming fat though underweight R-refusal to eat (5% die) E-electrolyte abnormalities (e.g., K+, cardiac arrhythmia) X-exercise I-intelligence often above average/Induced vomiting C-cathartic use (and diuretic abuse) ANTICHOLINERGIC CRISIS Can't see (blurred vision) Can't spit (dry mouth) Can't pee (urinary retention) Can't shit (constipation) ANTICHOLINERGIC CRISIS – SIGNS "SLUD" Salivation Lacrimation Urination Defecation ANTI-TB DRUGS & SIDE EFFECTS “RIPES” Rifampicin – red-orange urine Isoniazid – peripheral neuritis Pyrazinamide – increase uric acid Ethambutol – eye problems Streptomycin – ototoxic

(use a star as these drugs stain the teeth) – ??? (H-eat, I-nduration) – ??? APGAR SCORING "APGAR" Appearance: cyanosis--peripheral, central, none Pulse: pulse rate Grimace: response to stimulation Activity: movement of the baby (muscle tone) Respiration: respiratory rate APPENDICITIS - ASSESSMENT “PAINS” Pain (RLQ) - pain in RLQ of abdomen Anorexia - loss of appetite Increased temperature, WBC (15,000-20,000) Nausea Signs (McBurney's, Psoas) ARTERIAL BLOOD GASES 1. look at pH: Low pH = acidosis High pH = alkalosis 2. use “ROME” mnemonic (to determine if its respiratory or metabolic): Respiratory – Opposite Metabolic – Equal ASSESSING CHANGES IN BEHAVIOR "DEMENTIA" Drug and alcohol Eyes and ears Metabolic and endocrine disorders Emotional disorders Neurologic disorders Tumors and trauma Infection Arterial vascular disease ASTHMA MANAGEMENT "ASTHMA" Adrenergics (Albuterol) Steroids Theophylline Hydration (IV) Mask (Oxygen) Antibiotics ASTHMA - MANAGEMENT Asthma is a spasm of the airways, which causes difficulty breathing. “ASTHMA” Adrenergic (Albuterol) Steroids Theophylline

Hydration (IV) Mask (Oxygen) Antibiotics ATRIAL FIBRILLATION – NEW ONSET CAUSES “THE ATRIAL FIBS” Thyroid Hypothermia Embolism (PE) 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) ATRIOVENTRICULAR VALVES "LAB RAT" Left Atrium: Bicuspid Right Atrium: Tricuspid ATROPINE "A goes with B" Atropine used to treat bradycardia. BENNER'S MODEL N - Nickerr's - easy to remember b/c it rhymes with Benner's Novice – strictly able to focus on learning the rules, onset of education A - and - "ad"vanced beginners – distinguish abnormal findings but cannot readily understand significance C - Comp - Competent – able to handle their pt. load and prioritize situation P - Planetary – big picture is the key word Proficiency E - Experts – Leader/ role model not every nurse becomes one. BETA 1 AND BETA 2 Beta 1 adrenergic receptors are mostly found in the heart. Beta 2 adrenergic receptors are found in lungs, GI tract, vascular smooth muscle, skeletal muscle, liver. Beta 1 beta blockers act primarily on the heart. Beta 2 beta blockers act primarily on the lungs. Beta 1: heart Beta 2: lungs - You have one heart and two lungs BETA BLOCKERS

B1 Blocks the heart (only have ONE heart) B2 Blocks the lungs (have TWO lungs) BETA BLOCKER CONTRAINDICATIONS "ABCDE" Asthma Block (heart block) COPD Diabetes mellitus Electrolyte (hyperkalemia) BETA BLOCKERS "You have 1 heart and 2 lungs" Beta-1 act primarily on heart Beta-2 act primarily on lungs BLEEDING PRECAUTIONS “RANDI” R- Razor Electric/Blades A- Aspirin N- No needles (esp. in small gauge) D- Do decrease in needle sticks) I - Injury (Protect from) BLEEDING PRECAUTIONS If a patient is taking an anticoagulant to prevent blood clots there is increased risk for bleeding. Be careful with blades when shaving. Do not take aspirin as it interferes with blood clotting and can magnify the effect of the medication. Avoid excess needle sticks and protect the patient from injury. “RANDI” Razor Electric/Blades Aspirin Needles- small gauge Decrease needle sticks Injury (Protect from) BLOOD FLOW THROUGH HEART VALVES "Tissue Paper My Ass" Tricuspid Pulmonic Mitral Aortic BLOOD GLUCOSE Symptom Implication (rhyme) Cold and clammy . . . give hard candy Hot and dry . . . glucose is high BLOOD TYPES Picture type O as a huge circle, like the universe, because they are the universal donor. They can give to everyone. However, also think of them as the “odd man out” because they can only receive type O as well. They

are universally odd, able to give to all but only receive from themselves! BODY SYSTEMS "MR DICE RUNS" Muscle Respiratory Digestive Integumentary Circulatory Endocrine Reproductive Urinary Nervous Skeletal BRADYCARDIA & LOW BP DRUGS “IDEA” I - Isoproterenol D - Dopamine E - Epinephrine A - Atropine Sulfate BRADYCARDIA & LOW BLOOD PRESSURE DRUGS This refers to symptomatic bradycardia and hypotension. Bradycardia and hypotension are not necessarily adverse clinical findings requirement treatment in and of themselves. “IDEA” Isoproterenol Dopamine Epinephrine Atropine Sulfate BRADYCARDIA AND HYPOTENSION MEDS "IDEA" Isoproterenol Dopamine Epinephrine Atropine Sulfate BREASTFEEDING ASSESSMENT "LATCH" Latch achieved by infant Audible swallow Type of nipple Comfort of mother Help given to mother with nursing BRONCHODILATORS "TO A SIS" Terbutaline Orciprenaline Adrenaline Salbutamol

Isoprenaline Salmeterol “BULIMIA” – EATING DISORDER B-binge eating U-under strict dieting L-lacks control over-eating I-induced vomiting M-minimum of two binge eating episodes I-increased/Persistent concern of body size/shape A-abuse of diuretics & laxatives BULIMIA CLIENT FINDINGS “WASHED” W-weight loss of 15% of original body weight A-amenorrhea S-social withdrawal H-history of high activity & achievement E-electrolyte Imbalance D-depression/ Distorted Body Image CANCER ASSESSMENT "CAUTION" Change in bowel or bladder habits A sore that doesn't heal Unusual bleeding or discharge Thickening or lump Indigestion or difficulty swallowing Obvious changes in a wart or mole Nagging cough or hoarseness CANCER - EARLY WARNING SIGNS Cancer can sometimes be difficult to identify, but the earlier it is detected the better chance treatment will be effective. “CAUTION UP” Change in bowel or bladder A lesion that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious changes in wart or mole Nagging cough or persistent hoarseness Unexplained weight loss Pernicious Anemia CANCER - INTERVENTIONS “CANCER” Comfort Altered Body Image Nutrition Chemotherapy Evaluate response to meds Respite for caretakers

CANCERS THAT METASTASIZE IN BONE "Particular Tumors Love Killing Bone" Prostate Thyroid Lung Kidney Breast CANES AND WALKERS "COAL" and "WWAL" Cane Opposite Affected Leg Walker With Affected Leg CANES AND WALKERS “COAL & WWAL” C- Cane O- Opposite A- Affected L- Leg W- Walker W- With A- Affected L – Leg CARDIAC VALVES BLOOD FLOW This simple mnemonic helps to remember the order in which blood passes through the four heart valves in sequential order. “Toilet Paper My A**” Tricuspid Pulmonic Mitral Aortic CEREBELLAR DAMAGE SYMPTOMS "VANISHED" Vertigo Ataxia Nystagmus Intention tremor Slurred (or staccato) speech Exaggerated broad based gait Hypotonic reflexes Dysdiadochokinesia. CHF TREATMENT "UNLOAD FAST" Upright Position

Nitrates (in low dose) Lasix Oxygen Aminophylline Digoxin Fluids (decrease) Afterload (decrease) Sodium restriction Test (Dig level, ABGs, K level) CHF - TREATMENT These treatments used in conjunction will help in reducing the symptoms and complications associated with CHF. “UNLOAD FAST” U sit Upright Nitro Lasix Oxygen Aminophylline Digoxin Fluids - decrease Afterload - decrease Sodium - decrease Tests: dig level, ABG, K+ CHILD ABUSE/NEGLECT – WARNING SIGNS “CHILD ABUSE” C-child’s excessive knowledge on sex & abusive words H-hair growth in various lengths I-inconsistent stories from the child & parent/s L-low self-esteem D-depression A-apathy, no emotion B-bruised U-unusual injuries S-serious injuries E-evidence of old injuries not reported Wernicke-Korsakoff syndrome (WKS) – (alcoholassociated neurological disorder) "COAT RACK" Wernicke's encephalopathy (acute phase) clinical features: C-confusion O-ophthalmoplegia A-ataxia Thiamine is an important aspect of T-x Korsakoff's psychosis (chronic phase) characteristic findings: R-retrograde amnesia (recall of some old memories)

A-anterograde amnesia (ability to form new memories) C-confabulation K-korsakoff's psychosis CHLOROQUINE USES (OTHER THAN MALARIA) "RED LIP" Rheumatoid arthritis Extra intestinal amoebiasis Discoid lupus erythematosus Lepra reaction Infectious mononucleosis Photogenic reactions CHOLECYSTITIS – RISK FACTORS “5 F's” Female Fat Forty Fertile Fair CHOLINERGIC CRISIS "SLUD" Salivation Lacrimation Urination Defecation CHOLINERGIC CRISIS - SIGNS AND SYMPTOMS “SLUDGE” Salvation Lacrimation Urination Defecation Gastric upset Emesis CHRONIC OBSTRUCTIVE PULMONARY DISEASE "blue bloater vs. pink puffer" emPhysema has letter P (and not B) so Pink Puffer. chronic Bronchitis has letter B (and not P) so Blue Bloater. CIRCULATION CHECKS "5 P's" Pain Paresthesia Paralysis Pulse Pallor (Paleness) CIRCULATORY CHECKS “The 5 P’s” Pain Paresthesia (numbness/tingling)

Paralysis Pulse Pallor (Paleness) CLEFT LIP – POST-OP NURSING CARE PLAN "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) CLEFT LIP POST OP CARE "CLEFT LIP" Choking Lie on back Evaluate Airway Feed Slowly Teaching Larger nipple opening Incidence increase in males Prevent crust formation and aspiration CLIENT IN TRACTION NURSING CARE "TRACTION" Temperature (Extremity, Infection) Ropes hang freely Alignment Circulation Check (5 P's) Type & Location of fracture Increase fluid intake Overhead trapeze No weights on bed or floor COAGULATION TESTS "PiTT" (PTT - I for Intrinsic pathway) - PiTTsburgh "PeT" (PT - E for Extrinsic pathway) **Bleeding Time – provides assessment of platelet count & function (normal value: 2-8 minutes). **Prothrombin Time (PT) – measures effectiveness of “E”xtrinsic pathway. Mnemonic – PET (normal value: 10-15 seconds). **Partial Thromboplastin Time (PTT) – measures effectiveness of “I”ntrinsic pathway. Mnemonic – PITT (normal value: 25-40 seconds). **Thrombin Time (TT) – time for Thrombin to convert Fibrinogen → Fibrin (a measure of Fibrinolytic Pathway). (normal value 9-13 seconds).

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; temp abnormalities (hypothermia, heat stroke) Infection (e.g., meningitis) Psychogenic ("hysterical coma") Stroke or space-occupying lesions in cranium COMMON CAUSES OF POST OP FEVER "Five W's" Wind (pneumonia) Water (dehydration) Wound (infection, dehiscence) Walking (PE) Wonder drug (wrong antibiotic) COMPLEMENT: FUNCTION OF C3A vs C3B C3A: Activates Acute [inflammation]. C3B: Bonds Bacteria [to macrophages- easier digestion]. · If wish to know more than just C3: C3a, C4a, C5a – Activate Acute. C3b, C4b – Bind Bacteria. CONGESTIVE HEART FAILURE “DAM DDOG” Digoxin Aminophylline Morphine Dopamine Diuretics O2 Gasses - monitor (ABG) CONGESTIVE HEART FAILURE – TREATMENT “UNLOAD FAST” U-upright Position N-nitrates (in low dose) L-Lasix O-oxygen

A-aminophylline D-digoxin F-fluids (decrease) A-afterload (decrease) S-sodium restriction T-test (Dig level, ABGs, K level) COPD 4 TYPES AND HALLMARK SIGN "ABCDE" Asthma Bronchiectasis Chronic bronchitis Dyspnea [hallmark of group] Emphysema CORONARY ARTERIES Right = Right C= Coronary A= Artery M= Marginal Artery P= Posterior Interventricular Artery Left = Left A= Anterior Interventricular Artery C= Circumflex Artery CORONARY ARTERIES - LOCATION “I have a RIGHT to CAMP if you LEFT off the AC” Right C = coronary A = artery M = marginal artery P = posterior intraventricular artery Left A = anterior ventricular artery C = circumflex artery COR PULMONALE – SIGNS "Please Read His Text" Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence COR PULMONALE - SIGNS & SYMPTOMS Cor pulmonale is an enlargement of the right side of the heart caused by a problem with the lungs or pulmonary vessels. “Please Read His Text” Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence CORTICOSTEROID ADVERSE SIDE EFFECTS "CUSHINGS BAD MD"

Cataracts Up all night (sleep disturbances) Suppression of HPA axis Hypertension/ buffalo Hump Infections Necrosis (avascular) Gain weight Striae Bone loss (osteoporosis) Acne Diabetes Myopathy, moon faces Depression and emotional changes CORTICOSTEROID SIDE EFFECTS "5 S's" Sick- easier to get sick Sad-causes depression Sex-increases libido Salt-retains more and causes weight gain Sugar-raises blood sugar

CRANIAL NERVE MNEMONICS “Oh Oh Oh To Try And Fit A Gold Velvet So Heavenly” “Oh Oh Oh To Touch And Feel A Girl's Vagina, Ah Heaven” “Olympic Opium Occupies Troubled Triathletes After Finishing Vegas Gambling Vacations Still High” “Old Operators Occasionally Troubleshoot Tricky Abducted Family Veterans Galloping Valiantly Across History” “Oh oh oh to touch and feel very good velvet…ah” “Oh Oh Oh To Touch And Feel Very Generous Vegas Slot Handles” “On Old Olympus Towering Top A Fine Agile German Vaulted And Hopped” “On Old Olympus' Towering Tops, A Finn And German Viewed Some Hops!” “On Occasion, Our Trusty Truck Acts Funny Very Good Vehicle Any How” “Oh Oh Oh To Touch And Feel A Guy's Viagra Sent ("Spinal Access") Hard-on” “Oh Once One Takes The Anatomy Final - Very Good Vacations Are Heavenly” “Old Opie Occasionally Tries Trigonometry and Feels Very Gloomy Vague and Hypoactive” “Oh Oh Oh To Tough And Feel Virgin Girls Vaginas And Hymens” CRANIAL NERVES – SENSORY, MOTOR OR BOTH “Some Say Marry Money But My Brother Says Big Boobs Matter More” “Some Say Money Matters But My Brother Says Big Brains Matter More”

CRISIS SITUATIONS “RAPE” R- Ruthless A- Abusive P- Personal E- Experience CUSHING'S SYNDROME – SYMPTOMS “3 S's” Sugar (hyperglycemia) Salt (hypernatremia) Sex (excess androgens) CUSHINGS VS ADDISONS Cushing is gushing cortisol. Addison's patient's cortisol doesn't add up. CUSHING SYNDROME "CUSHING" Central obesity/Comedones (acne) Urinary glucose increase Striae/ Suppressed immunity Hypercortisolism/Hypertension/Hyperglycemia/Hir sutism Iatrogenic (Increased administration of corticosteroids) Noniatrogenic (Neoplasms) Glucose intolerance/ Growth retardation "Cut C4, breathe no more" The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm. CYANOTIC DEFECTS "3 T's" Tetralogy of Fallot Truncus Arteriosus Tricuspid Atresia CYCLOSPORINE – SIDE EFFECTS “5 H's” Hirsutism Hyperplasia of gums Harm to Kidneys Hypertension Hyperglycemia DELEGATION - WHAT NEVER DELEGATE TO UAP Don’t share your “TEAACUP” T – Teach E – Education A – Assessment A– C– U– P – Plan

DEEP VEIN THROMBOSIS DIAGNOSIS "DVT" Dilated superficial veins/discoloration Venography is gold standard Tenderness of thigh and calf DEHYDRATION – SEVERE “BRAT” Diet B- Banana R- Rice A- Apple T- Toasted Bread DEMENTIA (SENILE) – ASSESSING CHANGES “JAMCO” J- Judgment A- Affect M- Memory C- Cognition O- Orientation DEMENTIA Make sure they don't have problems with: D-Drug and alcohol E-Eyes and ears M-Metabolic and endocrine disorders E-Emotional disorders N-Neurologic disorders T-Tumors and trauma I-Infection A-Arteriovascular disease DEPRESSION ASSESSMENT “SIG” S-Sleep Disturbances I-Interest Decreased G-Guilty Feelings DIABETES – SIGN & SYMPTOMS “3 P's” Polydipsia (very thirsty) Polyphagia (very hungry) Polyuria (urinary frequency) DIABETES MELLITUS - TYPE 1 “3 P's” (Signs & Symptoms) P- Polyuria (excessive urination) P- Polydipsia (excessive thirst) P- Polyphagia (excessive hunger) DIABETIC FITNESS “FIT” exercise guide F - Frequency (3x per week) I - Intensity (60-80% of Maximal Heart Rate) T- Time (Aerobic Activity) DIABETIC KETOACIDOSIS – MANAGEMENT

“KING UFC” K+ (potassium) Insulin (5u/hr. Note: sliding scale not recommended in UK) Nasogastric tube (if patient comatose) Glucose (once serum levels drop to 12) Urea (check it) Fluids (crystalloids) Creatinine (check it)/ Catheterize DIABETES COMPLICATIONS "KNIVES” Kidney Neuropathy Infection Vascular (Cardio) Eyes Skin lesions DIABETES TYPE 1 SYMPTOMS "3 P's" Polyuria (excessive urination) Polydipsia (excessive thirst) Polyphagia (excessive hunger) DIABETIC KETOACIDOSIS (DKA) - CAUSES "5 I's" Infection Ischemia (cardiac, mesenteric) Infarction Ignorance (poor control) Intoxication (alcohol) DIABETIC KETOACIDOSIS (DKA) - SIGNS "DKA" Dehydrated Ketones/Kussmaul breathing/K drops Acidosis DIALYSIS – WHO NEEDS DIALYSIS? “AEIOU” (check the vowels) A- Acid-Base Problems E- Electrolyte Problems I- Intoxications O- Overload of fluids U - Uremic Symptoms DIALYSIS CANDIDATES "AEIOU" Acid-Base Problems Electrolyte Problems Intoxications Overload of fluids Uremic Symptoms DIARRHEA - TREATMENT

The BRAT diet is a bland diet that is low in protein, fiber, and fat. It is thought to be easy on the GI tract and helpful to lesson diarrhea. It is not used commonly anymore because of the lack of protein in the diet. “BRAT” Banana Rice Apple Toast DIC “PCFCFMCF” Platelets Clotting Factors Consumed, Form Microthrombi, Coagulation Fails DIET FOR SEVERE DEHYDRATION "BRAT" Banana Rice Apple Toasted Bread DILATED PUPILS...