BONGSKHIE D.

GOCOTANO BUKIDNON STATE UNIVERSITY COLLEGE OF NURSING

HYPOCALCEMIA CATS C - Convulsions A - Arrhythmias T - Tetany S - Spasms and stridor BLEEDING - S/Sx BEEP B - Bleeding gums E - Ecchymoses (bruises) E - Epistaxis (nosebleed) P - Petechiae (tiny purplish spots)

R - RTI (prior) A - Antibiotics & cytotoxics T - Tracheal instrumentation I - IV dug abuse O - Other (general debility, immobility) N - Neurologic impairment of cough reflex, (eg NMJ disorders) CROUP - S/Sx SSS S - Stridor S - Subglottic swelling S - Seal-bark cough SHORTNESS OF BREATH - Causes AAAA PPPP A - Airway obstruction A - Angina A - Anxiety A - Asthma P - Pneumonia P - Pneumothorax P - Pulmonary Edema P - Pulmonary Embolus CARDIAC VALVES "TRI before you BI": Tricuspid valve is located in left heart and Bicuspid valve is located in right heart. Blood flows through the tricuspid before bicuspid.

MNEMONICS FOR NURSES

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

RESPIRATORY DEPRESSION - inducing drugs STOP breathing S - Sedatives and hypnotics T - Trimethoprim O - Opiates P - Polymyxins PNEUMOTHORAX - S/Sx P-THORAX P - Pleuretic pain T - Trachea deviation H - Hyperresonance O - Onset sudden R - Reduced breath sounds (& dypsnea) A - Absent fremitus X - X-ray shows collapse PNEUMONIA - risk factors INSPIRATION I - Immunosuppression N - Neoplasia S - Secretion retention P - Pulmonary oedema I - Impaired alveolar macrophages

FEMORAL HERNIA FEMoral hernias are more common in FEMales.

Hydrocarbons "TRY PULLING MY AORTA": Tricuspid Pulmonary Mitral Aorta Ethanol Metals Iron Caustics Airway unprotected Lithium PLACENTA-CROSSING SUBSTANCES CAMphor "Want My Hot Dog": Potassium Wastes

Hypothermia Embolism (P.E.) Alcohol Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct

Antibodies Nutrients Teratogens Microorganisms Hormones/ HIV Drugs

IPECAC: CONTRAINDICATIONS Bad valves (mitral stenosis) 4 C's: Stimulants (cocaine, theo, amphet, caffeine) Comatose Convulsing Corrosive hydroCarbon ENDOTRACHEAL TUBE DELIVERABLE DRUGS O NAVEL: Oxygen Naloxone

EMERGENCY MEDICINE ACTIVATED CHARCOAL: CONTRAINDICATIONS CHEMICAL CamP: Cyanide

ATRIAL FIBRILLATION: CAUSES OF NEW ONSET Atropine THE ATRIAL FIBS: Ventolin (albuterol) Thyroid

Epinephrine Lidocaine

Heparin

Anxious Respirations shallow/rapid

PAIN HISTORY CHECKLIST Cool MALARIA: COMPLICATIONS OF FALCIPARUM MALARIA CHAPLIN: Cerebral malaria/ Coma Hypoglycemia Anaemia Pulmonary edema Lactic acidosis Infections Necrois of renal tubules (ATN) OLDER SAAB: Cyanotic Onset Unconscious Location BP low Description (what does it feel like) Eyes blank Exacerbating factors Radiation Severity Associated symptoms Alleviating factors Before (ever experience this before) MI: IMMEDIATE TREATMENT DOGASH: Diamorphine Oxygen GTN spray Asprin 300mg Streptokinase SHOCK: SIGNS AND SYMPTOMS TV SPARC CUBE: VENTRICULAR FIBRILLATION: TREATMENT Thirst "Shock, Shock, Shock, Everybody Shock, Little Shock, Big Vomiting Sweating Pulse weak Shock, Momma Shock, Poppa Shock": Shock= Defibrillate Everybody= Epinephine Trauma (eg being struck with baseball bat) Stroke SUBARACHNOID HEMORRHAGE (SAH) CAUSES BATS: Berry aneurysm Arteriovenous malformation/ Adult polycystic kidney disease

Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Pocainamide

Urea (check it) Fluids (crytalloids) Creatinine (check it)/ Catheterize

Intoxication Diabetes Air (respiratory failure) Subdural/ Subarachnoid hemorrhage

NEUROLOGICAL FOCAL DEFICITS VFIB/VTACH DRUGS USED ACCORDING TO ACLS "Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium Magsulfate Procainamide 10 S's: Sugar (hypo, hyper) Stroke Stop triggering agents Seizure (Todd's paralysis) Hyperventilate/ Hundred percent oxygen Subdural hematoma Dantrolene (2.5mg/kg) Subarachnoid hemorrhage Bicarbonate Space occupying lesion (tumor, avm, aneurysm, abscess) Glucose and insulin Spinal cord syndromes DIABETIC KETOACIDOSIS MANAGEMENT Somatoform (conversion reaction) KING UFC: Sclerosis (MS) K+ (potassium) Some migraines Insulin (5u/hour. Note: sliding scale no longer recommended in the UK) COMA: CONDITIONS TO EXCLUDE AS CAUSE Nasogastic tube (if patient comatose) MIDAS: Glucose (once serum levels drop to 12) Meningitis Breathing Airway ABCDE: RESUSCITATION: BASIC STEPS Fluid output monitoring/ Furosemide/ Fast heart [tachycardia] IV Fluids and cooling blanket MALIGNANT HYPERTHERMIA TREATMENT "Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia):

Circulation Drugs Environment

Acidosis Respiratory (opposite): pH Pco2 Metabolic(equal): pH HCO3 Alkalosis

Adolescent women/ Amenorrhea NGT alimentation (most severe cases) Obsession with losing weight/ becoming fat though underweight

RLQ PAIN: DIFFERENTIAL Respiratory (opposite): pH Pco2 APPENDICITIS: Metabolic(equal): pH HCO3 Appendicitis/ Abscess PID/ Period Pancreatitis Ectopic/ Endometriosis Neoplasia Diverticulitis Intussusception Alcohol withdrawal: clinical features"HITS" Hallucinations (visual, tactile) Increased vital signs and insomnia

Refusal to eat (5% die) Electrolyte abnormalities (e.g., K+, cardiac arrhythmia) X - ercise Intelligence often above average/ Induced vomiting Cathartic use (and diuretic abuse)

Appendicitis: assessment"PAINS" Tremens delirium tremens (potentially lethal) Pain (RLQ) Shakes/ Sweats/ Seizures/ Stomach pains (nausea, vomiting) Anorexia Increased temperature, WBC (15,00020,000) Crohns Disease/ Cyst (ovarian) IBD Torsion (ovary) Irritable Bowel Syndrome Stones Acid-base"ROME" (Respiratory Opposite, Metabolic Equal) Anorexia nervosa: clinical features"ANOREXIC" Angina: precipitating factors"4E's" Nausea Eating Signs (McBurney's, Psoas) Emotion Exertion (Exercise) Extreme Temperatures (Hot or Cold weather) Neurovascular Occlusion: symptoms "6 P's" Pain Pale

Pulseless Paresthesia

Fair

Alcohol, acidosis (hyperglycemic coma) Epilepsy (also electrolyte abnormality, endocrine problem)

Cleft lip: nursing care plan (postoperative)"CLEFT LIP" Poikilothermic Crying, minimize Paralysis Logan bow Uremia and other renal problems Blood glucose (rhyme) Symptom Implication Cold and clammy . . . give hard candy Hot and dry . . . glucose is high Liquid (sterile water), rinse after feeding Stroke or space-occupying lesions in the cranium Blood vessels in umbilical cord"AVA" (2 arteries and 1 vein) Positionnever on abdomen Artery Hemolysis Vein Artery Cognitive disorders: assessment of difficulties"JOCAM" Elevated Liver enzymes Judgment Low Platelet count Orientation Cholecystitis: risk factors"5F's" Confabulation Female Affect Fat Memory Forty Sex (excess androgens) Fertile Coma: causes"A-E-I-O-U TIPS" Salt (hypernatremia) Sugar (hyperglycemia) Cushing's syndrome: symptoms"3S's" Complication of severe preeclampsia"HELLP" syndrome Impaired feeding (no sucking) Elbow restraints Trauma; temperature abnormalities (hypothermia, heat Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Psychogenic ("hysterical coma") stroke) Infection (e.g., meningitis) Overdose (or poisoning) Insulin (hypoglycemic shock)

Take blood pressure Diabetes: signs and symptoms"3P's," Polydipsia (very thirsty) Polyphagia (very hungry) Polyuria (urinary frequency) Episiotomy assessment"REEDA" Ischemia attack, transient (watch for TIAs) Redness Respiration, pulse Edema Electrolytes Ecchymosis Daily weight Discharge Diet: low cholesterolavoid the "3C's" Approximation of skin Cake Diaphoresis Cookies Cream (dairy, e.g., milk, ice cream) Eye medications Increased pulse Mydriatic = dilated pupils Restless Miotic = tiny (constricted) pupils Dystocia: etiology"3P's" Power Passageway Passenger Hypertension: complications"4 C's" Infections during pregnancy"TORCH" CAD (coronary artery disease) Toxoplasmosis CHF (congestive heart failure) Other (hepatitis B, syphilis, group B beta strep) CRF (chronic renal failure) Dystocia: general aspects (maternal)"3P's" CVA (cardiovascular accident; now called brain attack or Psych Placenta Hypertension: nursing care plan "I-TIRED" Position Intake and output (urine) IUD: potential problems with use"PAINS" stroke) Cytomegalovirus Herpes simplex virus Rubella Extra hungry Hypoglycemia: signs and symptoms"DIRE"

Period (menstrual: late, spotting, bleeding) Abdominal pain, dyspareunia Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing

Asymmetry Border Color

Activity Respiratory effort

Obstetric (maternity) history"GTPAL" Diameter Gravida Mental retardation: nursing care plan"3R's" Manipulation: nursing planpromote the "3C's" Cooperation Compromise Collaboration Myocardial infarction: treatment"MONA" Medication administration"six rights" RIGHT medication RIGHT dosage RIGHT route RIGHT time Newborn assessment components"APGAR" RIGHT client Appearance RIGHT technique Pulse What Provokes the pain? Melanoma characteristics"ABCD" Grimace What is the Quality of the pain? Pain: assessment"PQRST" Severe leg pain (possible thromboembolic process) Monitor/ Morphine Oxygen Nitroglycerin Headache (possible hypertension, brain attack) Aspirin Eye problems (possible hypertension or vascular accident) Oral contraceptives: signs of potential problems"ACHES" Abdominal pain (possible liver or gallbladder problem) Chest pain or shortness of breath (possible pulmonary embolus) Regularity (provide routine and structure) Reward (positive reinforcement) Redundancy (repeat) Term Preterm Abortions (SAB, TAB) Living children

Does the pain Radiate? What is the Severity of the pain? What is the Timing of the pain?

Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP])

Compression Elevation

Stool assessment"ACCT" Amount

Pain: management"ABCs" Psychotropic medications: common antidepressives Ask about the pain Believe when clients say they have pain Choiceslet clients know their choices Deliver what you can, when you said you would Empower/Enable clients' control over pain (tricyclics)"VENT" Vivactil Elavil Norpramin

Color Consistency Timing

Tracheoesophageal fistula: assessment"3Cs" Tofranil Coughing Postoperative complications: order"4W's" Wind (pulmonary) Wound Water (urinary tract infection) Walk (thrombophlebitis) Schizophrenia: primary symptoms"4A's" Affect Ambivalence Traction: nursing care plan"TRACTION" Associative looseness Trapeze bar overhead to raise and lower upper body Autism Requires free-hanging weights; body alignment Preterm infant: anticipated problems"TRIES" Temperature regulation (poor) Resistance to infections (poor) Sprain: nursing care plan"RICE" Rest Ice Analgesia for pain, prn Circulation (check color and pulse) Temperature (check extremity) Choking Cyanosis

Infection prevention Output (monitor) Nutrition (alteration related to immobility)

clinical features: Confusion

Nagging cough/ hoarseness

Unexplained anemia Ophthalmoplegia Sudden weight loss Ataxia Transient ischemic attacks: assessment"3Ts" Thiamine is an important aspect of Tx Temporary unilateral visual impairment Transient paralysis (one-sided) Tinnitus = vertigo Korsakoff's psychosis (chronic phase) characteristic findings: Retrograde amnesia (recall of some old memories) Trauma care: complications"TRAUMA" Anterograde amnesia (ability to form new memories) Thromboembolism; Tissue perfusion, altered Confabulation Respiration, altered Korsakoff's psychosis Anxiety related to pain and prognosis SIGNS OF CANCER Urinary elimination, altered Change in bowel /bladder habits Mobility impaired A sore that doesnt heal Alterations in sensory-perceptual functions and skin integrity (infections) Unusual bleeding/ Discharge Thickening of lump breast or elsewhere Wernicke-Korsakoff syndrome (alcohol-associated neurological disorder)"COAT RACK" Indigestion/ Dysphagia Obvious change in wart/ mole Wernicke's encephalopathy (acute phase) Anticoagulation Reduce clot size Opiate Monitoring Oxygen Bed rest Basic MI management - "BOOMAR" Rest (for patient and family) Effective response to Tx? (Evaluate) Comfort from pain FOCUS OF PATIENT CARE IN CLIENTS WITH CANCER Chemotherapy Assess body image disturbance (related to alopecia) Nutritional needs when N/V present

Eversion To Remember Immunoglobulins - "GAMED" Dorsiflexion IgG Pronation IgA Inversion IgM Plantarflexion IgE Elevation IgD Circumduction Location of the heart valve from right to left - "A Permanently Temperamental Man" Rotation Aortic Depression Pulmonary Supination Tricuspid Hyperextension Mitral Adduction "Cut C4, breathe no more" The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm. Cranial Nerves - "Oh Ohh Ohhh To Try And Fit A Gold Types of Joint movements - "FEEDPIPE CARDSHARP" Flexion Extension Velvet So Heavenly" Retraction Abduction

Occulomotor CN III Trochlear CN IV Trigeminal CN V Abducens CN VI Facial CN VII Auditory CN VIII Glasopharyngeal CN IX Vagus CN X Spinal/Accessory CN XI Hypoglossal CN XII

"Point and Shoot!" For remembering that Parasympathetics are involved with erection and Sympathetics with ejaculation.

Layers of the scalp - "SCALP" Protraction Skin Connective tissue Aponeurosis Olfactory CN I Loose areolar tissue Optic CN II

Pericranium

Calci virus Astro virus

Telophase

Carpal bones of the hand (lateral to medial) - "She Looks Too Proud, Try To Chase Her" Proximal row: The Krebs cycle - "Can I Actually See Some Filipina Scaphoid Lunate Triquetrum Pisiform Distal row: Trapezium Trapezoid Capitate Hamate Mothers" Citrate Isocitrate alpha Ketoglutarate Succinyl CoA Rota virus

Order of prevalence of White Blood Cells, most prevalent to least - "Never Let Monkeys Eat Bananas" Neutrophils Lymphocytes Monocytes Eosinophils Basophils

10 essential amino acids - "PVT. TIM HALL" Succinate Phenylalanine Fumarate Valine Malate Tryptophan Oxaloacetate Threonine Viruses causing diarrhea - "ACNE CAR" Adeno virus Interphase Corana virus Prophase Norwak virus Metaphase Entero virus Anaphase Leucine Arginine(semi-essential) Histidine(semi-essential) Stages of mitosis/meiosis including interphase as a phase - "In Philippines, Men Are Talented" Metheonine Isoleucine

Lysine

Raised JVP Hepatomegaly

Lung Prostat Kidney Thyroid

Uses of Chloroquine (other than malaria) - "RED LIP" Tricuspid incompetence Rheumatoid arthritis Extra intestinal amoebiasis Discoid lupus erythematosus Lepra reaction Infectious mononucleosis Photogenic reactions Portal hypertension features - "ABCDE" Breast Ascites Bleeding (hematemesis, piles) Caput medusae Diminished liver Enlarged spleen Bronchodilators - "TO A SIS" Strawberry tongue Terbutaline Orciprenaline Allergies Adrenaline Medication Salbutamol Past medical history Isoprenaline Last meal Salmeterol Events and environment related to injury Urination Signs of cor pulmonale - "Please Read His Text" Malignancies that metastisize to bone - "Laging Panalo Peripheral edema Kung Taga Bulacan" Defecation Lacrimation Salivation Signs of anti-cholinergic crisis - "SLUD" miliarySudamina vesicles over hands, feet, abdomen Key questions needed in an emergency history taking situation - "AMPLE" Sandpaper rash Six "S" in Scarlet Fever Streptococci causal organism Sorethroat Swollen tonsils

SHOCK HYPOTACHYTACHY Causes of huge spleen - "3M's" HYPOTENSION Myelofibrosis TACHYPNEA Malaria TACHYCARDIA Myelogenous leukemia AGITATION TACHYCARDIA Cardinal Symptoms of Parkinson's Disease - "TRAP" INCREASE ICP HYPERBRADYBRADY Tremor Rigidity Akinesia and bradykinesia Postural Instability CUSHINGS TRIAD: HYPERTENSION (WIDE PULSE PRESSURE) BRADYCARDIA BRADYPNEA Days of appearance of rashesVaricella(chickenpox) - "Very Sick Patients Must Take Double Exercise" 1st dayScarlet fever HYPOGLYCEMIA 2nd dayPox(smallpox) CONGESTIVE HEART FAILURE 3rd dayMumps 4th dayTyphus 5th dayDengue 6th dayEnteric fever(typhoid) | DIAPHORESIS DOPAMINE TREMORS, TACHYCARDIA IRRITABILITY RESTLESSNESS EXTREME DIGOXIN MORPHINE AMINOPHYLLINE CYANOSIS LATE SIGNS OF HYPOXIA BRADYCARDIA EXTREME RESTLESSNESS DYSPNEA RESTLESSNESS EARLY SIGNS OF HYPOXIA

DIURETICS O2 GASSES MONITOR (ABG)

PREGNANCY INDUCED HYPERTENSION HEMOLYSIS ELEVATED LIVER ENZYMES LOW

COMPRESSION ELEVATION

TETRALOGY OF FALLOT PLATELETS MG SO4 TOXICITY DISPLACED AORTA RIGHT VENTRICULAR HYPERTROPHY BP DECREASE GI SYMPTOMS AND TOXICITY TO DIGOXIN URINE OUTPUT DECREASE PULMONARY STENOSIS RESPIRATORY RATE DECREASE PATELLAR REFLEX ABSENT VOMITTING ANOREXIA NAUSEA DIARRHEA SICKLE CELL DISEASE ABDOMINAL PAIN HYDRATION OXYGENATION PAIN INFECTION PRESSURE AVOID HIGH PLACES REST NUMBNESS PARESTHESIA ICE OTOSTASIS FRACTURE U-WAVE ON ECG CONSTIPATION TOXICITY TO DIGOXIN IRREGULAR WEAK PULSE SKELETAL MUSCLE WEAKNESS HYPOKALEMIA OPENING INTO THE SEPTUM (VSD)

DAMAGE TO VESSELS PAIN ASSESSMENT HYPERCOAGUABILITY ABDOMINAL AORTIC ANEURISM (4A) PROVOCATION QUALITY RADIATION, RELIEF SEVERITY TIME ASSYMPTOMATIC ABDOMINAL MASS ABDOMINAL PULSE

N - NITROFURANTOIN T - TETRACYCLINE

LR6 - LATERAL RECTUS : CN6 SO4 - SUPERIOR OBLIQUE : CN4 ALL3 - ALL THE REST : CN3

RADIATION TX VIA: ACHES LOW BACK MUSTARD ANTI TB DRUGS AND SIDE EFFECTS ESTROGEN NEUROVASCULAR CHECK PAIN PULSELESSNESS PARESTHESIA PARALYSIS PALLOR RIFAMPICIN RED-ORANGE URINE ISONIAZID PERIPHERAL NEURITIS PYRAZINAMIDE INCREASE URIC ACID ETHAMBUTOL EYE PROBLEMS DILUTE DECREASE OSMOLALITY STREPTOMYCIN OTOTOXIC NITROGEN STEROIDS ANTIBIOTICS

VIRCHOWS TRIAD IN DVT

USE STRAW BECAUSE THESE DRUGS STAIN THE TEETH L - LUGOL'S SOLUTION

VENUS STASIS

I - IRON