Steps in the Nursing Process ADPIE (A Delicious PIE) A-ssessment D- iagnosis P-lanning I-mplementation E-valuaton Inflammation (HIPER) H-eat

I-nduration P-ain E-dema R-edness Acid-Base (ROME) R-espiratory O-pposite M-etabolic E-qual CANCER'S Early Warning Signs CAUTION UP C-hange in bowel or bladder A- lesion that does not heal U-nusual bleeding or discharge T-hickening or lump in breast or elsewhere I-ndigestion or difficulty swallowing O-bvious changes in wart or mole N-agging cough or persisten hoarseness U-nexplained weight loss P-ernicious Anemia CANCER Interventions C-omfort A-ltered Body Image N-utrition C-hemotherapy E-valuate response to meds R-espite for caretakers Hypoglycemia (TIRED) - an abnormal decrease of blood in the sugar

T-achycardia I-rritability R-estless E-xcessive Hunger D-iaphoresis/ Depression Adrenal Gland Hormones (SSS) S-ugar (Glucocorticoids) S-alt (Mineralcorticoids) S-ex (Androgens) Pulmonary Edema (MAD DOG) M-Morphine A-Aminophylline D- Digitalis D-Diuretics (Lasix) O- Oxygen G- ases (Blood Gases ABG's) 5 P's of Circulatory Checks P-Pain P-Paresthesia P-Paralysis P-Pulse P-Pallor (Paleness) Hypertension Nursing Care (DIURETIC) D-aily Weight I- ntake and Output (I & O) U- rine Output R-esponse of BP E-lectrolytes T-ake Pulses I-schemic Episodes (TIA) C-omplications: 4C's 4 C's of Hypertension (Complications) C- Coronary Artery Disease C- Coronary Rheumatic Fever C- Congestive Heart Failure C- Cardio Vascular Accident

Complications of Trauma Client (TRAUMATIC) T-issue Perfusion Problems R-espiratory Problems A-nxiety U-nstable Clotting Factors M-alnutrition A-ltered Body Image T-hromboembolism I-nfection C-oping Problems Cyanotic Defects: 4 T's T- Tetralogy of Fallot T- Truncus Arteriosus T- Transportation of the Great Vessels T- Tricuspid Atresia Cranial Nerve Mnemonic 01 O-Lympic (Olfactory) O-Pium (Optic) O-Ccupies (Oculomotor) T-ROubled (Trochlear) T-RIathletes (Trigeminal) A-fter (Abducens) F-inishing (Facial) V-Egas (Vestibulocochlear) G-ambling (Glossopharyngeal) V-Acations (Vagus) S-till (Spinal Accessory) H-igh (Hypoglossal) Cranial Nerve Mnemonic 02 O- Oh O- Oh O- Oh T- To T- Touch A- And F - Feel A G - irl's V - agina S - So H- Heavenly

Cranial Nerve Mnemonic 03 O- On O -Old O- Obando T- Tower T- Top AF- Filipino A - Army G - Guards V - Villages A - And H - Huts Cranial Nerve Mnemonics (Sensory, Motor or Both) S - Some S - Says M- Marilyn M- Monroe B - But M- My B- Brother S- Says B- Bridget B - Bardot M- Mmm M- Mmm Cranial Nerve Mnemonics 02 (Sensory, Motor or Both) S- Some S- Say M - Marry M- Money B- But M- My B - Brother S- Says B- Bad B- Business M - Marry M - Money Nursing Care for Sprains and Strains (RICE)

R- Rest I - Ice C - Compression E- Elevation Care of Client in Traction (TRACTION) T- Temperature (Extremity, Infection) R - Ropes hang freely A - Alignment C - Circulation Check (5 P's) T- Type & Location of fracture I - Increase fluide intake O - Overhead trapeze N - No weights on bed or floor OB Non-Stress Test (NNN) 3 negatives in a row to interpret results of Non-Stress Test N - Non-reactive N - Non- Stress is N - Not good Severe Pre-Eclampsia (HELLP) H- emolysis E- levated L- iver function tests L- ow P- latelet count Assessment Tests for Fetal Well-Being (ALONE) A- Amniocentesis L- L/S Ratio O - Oxytocin Test N - Non-Stress Test E - Estriol Level Evalution of Episiotomy Healing (REEDA) R- Redness E- Edema E - Ecchymosis D - Discharge, Drainage A - Approximation Evalution of Episiotomy Healing (REEDA)

R- Redness E- Edema E - Ecchymosis D - Discharge, Drainage A - Approximation Post-Partum Assessment (BUBBLE) B-reasts U-terus B-owels B-ladder L-ochia E-pisiotomy/lateration/C-section incision Tracheal Esophageal Fistula (3 C's) C- Choking C- Coughing C - Cyanosis Cleft Lip - Post Op Care (CLEFT LIP) C-hoking L-ie on back E-valuate Airway F-eed Slowly T-eaching L-arger nipple opening I-ncidence incerase in males P-revent crust formation and aspiration ADLs (Activity of Daily Living) BATTED B-athing A-mbulation T-oileting T-ransfers E-ating D-ressing IADLS (Instrumental Activities of Daily Living) SCUM S-hopping C-ooking and Cleaning U-sing telephone or transportaiton M-anaging money and medications

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) Canes and Walkers (COAL) C- Cane O- Opposite A- Affected L- Leg Canes and Walkers (WWAL) Wandering Wilma's Always Late W- Walker W- With A- Affected L - Leg Common Causes of Transient Incontinence (DIAPPERS) D-elirium I-nfection A-trophic Urethra P-harmaceuticals P-sychologic E-xcess Urine Output R-estricted Mobility S-tool Impaction Promotion of Normal Elimination (POOPER SCOOP) P-osition O-utput O-ffer Fluids P-rivacy E-xercise R-eport Results S-ize (Amount) C-onsistency O-ccult Blood O-dor P-eristalsis

Emergency Trauma Assessment (ABCDEFGHI) A-irway B-reathing C-irculation D-isability E-xamine F-ahrenheit G-et Vitals H-ead to Toe Assessment I-ntervention Trauma Surgery (AMPLE) after initial assessment A-llergies M-edications P-ast Medical History L-ast Meal E-vents Surrounding Injury Trauma Surgery (AMPLE) after initial assessment A-llergies M-edications P-ast Medical History L-ast Meal E-vents Surrounding Injury 6 P's of Dyspnea P- Pulmonary Bronchial Constriction P- Possible Foreign Body P- Pulmonary Embolus P- Pneumothorax P- Pump Failure P- Pneumonia Lidocaine Toxicity (SAMS) S-lurred Speech A-ltered Central Nervous System M-uscle Twitching S-eizures

TDCI (These Drugs Can Interact) T - Theophyline D - Dilantin C - Coumadin I - losone (Erythromycin) Serious Complications of Oral Birth Control Pills (ACHES) A- Abdominal Pain C - Chest Pain H - Headache E - Eye Problems S - Severe Leg Pain Emergency Drugs to LEAN on L- Lidocaine E - Epinephrine A- Atropine Sulfate N - Narcan Drugs for Bradycardia & low BP (IDEA) I - Isoproterenol D - Dopamine E - Epinephrine A - Atropine Sulfate Cholinergic Crisis (SLUD) S-alivation L-acrimation U-rination D-efecation Depression Assessment (SIG) S-leep Disturbances I-nterest Decreased G-uilty Feelings Energy Decreased (CAPS) C-oncentration decreased A-ppetite P-sychomotor function decreased S-uicidal Ideations 5 A's to Alzheimer Diagnosis

A-mnesia A-nomia A-praxia A-gnosia A-phasia Major Symptoms of a Manic Attack (DIG FAST) D- Distractibility I - Indiscretion G - Grandiosity F- Flight of Ideas A- Activity Increase S- Sleep Deficit T - Talkative 3 P's of Blindness P- Preventable P- Painless P- Permanent Symptoms of Leukemia (ANT) A- Anemia N- Neutropenia T- Thrombocytopenia Exercise Guide for Diabetic Fitness (FIT) F - Frequency (3x per week) I - Intensity (60-80% of Maximal Heart Rate) T- Time (Aerobic Activity) Symptoms of Hypoxia (RAT BED) Early Hypoxia: R-estlessness A-nxiety T-achycardia/ Tachypnea Late Hypoxia: B-radycardia E-xtreme Restlessness D-yspnea Symptoms of Hypoxia (in Pediatrics) - FINES

F-eeding difficulty I-nspiratory Stridor N-ares Flares E-xpiratory Grunting S-ternal Retractions Management of ASTHMA A-drenergics (Albuterol) S-teroids T-heophylline H-ydration (IV) M-ask (Oxygen) A-ntibiotics Epiglottitis (AIR RAID) A-irway Closed I-ncreased Pulse R-estlessness R-etractions A-nxiety Increased I-nspiratory Stridor D-rooling Blood Flow Through the Cardiac Valves (Tissue Paper My Assets) T-ricuspid P-ulmonic M-itrial A-ortic Immediate Treatment of a Myocardial Infarction Client (MONA) M- Morphine O- Oxygen N- Nitroglycerine A- ASA Treating CHF (UNLOAD FAST) U-pright Position N-itrates (in low dose) L-asix O-xygen A-minophylline

D-igoxin F-luids (decrease) A-fterload (decrease) S-odium restriction T-est (Dig level, ABGs, K level) DEMENTIA Make sure they don't have problems with: D-rug and alcohol E-yes and ears M-etabolic and endocrine disorders E-motional disorders N-eurologic disorders T-umors and trauma I-nfection A-rteriovascular disease Osteoporosis Risk Factors (ACCESS) A-lcohol Use C-orticosteroid Use C-alcium low E-strogen low S-moking S-edentary lifestyle/s ACCESS leads to OSTEOPOROSIS Who needs dialysis? (Check the vowels: AEIOU) A- Acid-Base Problems E- Electrolyte Problems I- Intoxications O- Overload of fluids U - Uremic Symptoms Prostate Problems are no... FUN F- Frequency U- Urgency N- Nocturia BRAT Diet (for severe dehydration) B- Banana R- Rice

A- Apple T- Toasted Bread Gluten Free Diet (ROW) R- Rye O- Oats W- Wheat Assess Changes in Senile Dementia (JAMCO) J- Judgment A- Affect M- Memory C- Cognition O- Orientation 3 P's of Diabetes Mellitus - Type 1 Signs & Symptoms P- Polyuria (excessive urination) P- Polydypsia (excessive thirst) P- Polyphagia (excessive hunger) Right-Sided Heart Failure (HEAD) H- Hepatomegaly E- Edema (Bipedal) A- Ascites D- Distended Neck Vein Left-Sided Heart Failure (CHOP) C- Cough H- Hemoptysis O- Orthopnea P- Pulmonary Congestion (crackles/ rales) Hyperkalemia Management (KIND) K- Kayexalate (orally/ enema) I- Insulin N- Na HCO3 D- Diuretics (Furosemide & Thiazides) Management of Myocardial Infarction (MONATAS) M- Morphine O- Oxygen N- Nitrates (Nitroglycerin) A- Aspirin (ASA)

T- Thormbolytics A- Anti-Coagulants S- Stool Softeners Electrolytes - PISO P- Potassium I- Inside S- Sodium O- Outside Eating Disorder: ANOREXIA A-menorrhea delayed N-o organic factors accounts for weight loss O-bviously thin but feels FAT R-efusal to maintain normal body weight E-pigastric discomfort is common X-symptoms (peculiar symptoms) I-ntense fears of gaining weight A-lways thinking of foods Eating Disorder: BULIMIA B-inge eating U-nder strict dieting L-acks control over-eating I-nduced vomiting M-inimum of to binge eating episodes I-ncrease/Persistent concern of body size/shape A-buse of diuretics & laxatives Findings of a Bulimia client: WASHED W-eight loss of 15% of original body weight A-menorrhea S-ocial withdrawal H-istory of high activity & achievement E-lectrolyte Imbalance D-epression/ Distorted Body Image Outcome of Alcoholism: BAD B- Brain Damage A- Alcoholic Hallucinosis D- Death 5 D's of Behavioral Problems of Alcoholism

D- Denial D- Dependency D- Demanding D- Destructive D- Domineering Situations requiring Crisis Situation: RAPE R- Ruthless A- Abusive P- Personal E- Experience Warning Signs of a Child Abuse/ Neglect: CHILD ABUSE C-hild's excessive knowledge on sex & abusive words H-air growth in various lengths I-nconsistent stories from the child & parent/s L-ow self-esteem D-epression A-pathy, no emotion B-ruised U-nusual injuries S-erious injuries E-vidence of old injuries not reported The HYPERKALEMIA "Machine" - Causes of Increased Serum K+ M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism, hemolysis I - Intake - Excesssive N - Nephrons, renal failure E - Excretion - Impaired MURDER Signs and Symptoms of Increased Serum K+ M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

HYPERNATREMIA "You Are Fried" F - Fever (low grade), flushed skin R - Restless (irritable) I - Increased fluid retention and increased BP E - Edema (peripheral and pitting) D - Decreased urinary output, dry mouth Can also use this one: SALT S = Skin flushed A = Agitation L = Low-grade fever T = Thirst "CATS" of "HYPOCALCEMIA" C - Convulsions A- Arrhythmias T - Tetany S - Spasms and stridor To remember which blood types are compatible, visualize the letter "O" as an orb representing the universe, because type O blood is the universal donor blood. Patients with any blood type can receive it. But O also means "odd man out": Patients with type O blood can receive only type O blood. Think BEEP to remember the signs of minor bleeding: B: Bleeding gums E: Ecchymoses (bruises) E: Epistaxis (nosebleed) P: Petechiae (tiny purplish spots) Having difficulty distinguishing hypoplasia from hyperplasia? When you see plasia in any word, think of "plastic." Plastic, in turn, means forming or developing. As for hypo and hyper, that's the easy part. Hypo means under, or below normal. Hyper means excessive, or above normal. Thus, hypoplasia means underdevelopment, and hyperplasia means overdevelopment. To remember the four causes of cell injury, think of how the injury tipped (or TIPD) the scale of homeostasis: T: Toxin or other lethal (cytotoxic) substance I: Infection P: Physical insult or injury D: Deficit, or lack of water, oxygen, or nutrients.

When asking assessment questions, remember the American Cancer Society's mnemonic device CAUTION: C: Change in bowel or bladder habits A: A sore that doesn't heal U: Unusual bleeding or discharge T: Thickening or lump I: Indigestion or difficulty swallowing O: Obvious changes in a wart or mole N: Nagging cough or hoarseness. Use the ABCD rule to assess a mole's malignant potential: A: Asymmetry--Is the mole irregular in shape? B: Border--Is the border irregular, notched, or poorly defined? C: Color--Does the color vary (for example, between shades of brown, red, white, blue, or black)? D: Diameter--Is the diameter more than 6 mm? Side effects of steroids. The 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 PERRLA Pupils Equally Round and Reactive to Light and Accomodation Learning the Systems of the Body? MR DICE RUNS M= Muscle R= Respiratory D=Digestive I= Integumentary C= Circulatory E= Endocrine R= Reproductive U= Urinary N= Nervous S= Skeletal

Trouble figuring out which eye is which? OS is left eye OD is the right eye You can remember which one is the right eye (OD), because you can make the D into an R - You just have to draw to stick legs on the bottom of the D. Write it down on paper, you'll see what I mean (it's hard to show you when all I can do is type) S/S of Hyponatremia S tupor/coma A norexia, N&V L ethargy T endon reflexes decreased L imp muscles (weakness) O rthostatic hypotension S eizures/headache S tomach cramping Immediate treatment of MI, think MONA: M Morphine sulfate O Oxygen N Nitroglycerin A ASA Treatment of CHF, think UNLOAD FAST: U sit Upright N Nitro L Lasix O Oxygen A Aminophylline D Digoxin F Fluids- decrease A Afterload - decrease S Sodium - decrease T Tests: dig level, ABG, K+ Assistive devices -- Canes: C Cane O Opposite A Affected L Leg

Signs of a Cholinergic Crisis, think SLUD: S Salivation L Lacrimation U Urination D Defication Memory Trick:Need to remember which kind of beta blocker has which action? B1 Blocks the heart (you have only one heart) B2 Blocks the lungs (you have two lungs) fetal accelerations and decelerations!!! Just remember VEAL CHOP Variable Cord compression Early Head compression Accelerations OK Late Placental insufficiency Heart sounds: S3= Heart fail-ure (3 syllables) S4=Hy-per-ten-sion (4 syllables) effects of anticholinergics: Can't see Can't pee Can't spit Can't --defecate Nine-point Postpartum Assessment... BUBBLEHER B- Breasts U- Uterus B- Bladder B- Bowel function L- Lochia E- Episiotomy H- Homan's sign E- Emotional Status R- Respiratory System The 5 P's of circulation loss in a limb. Pain, Pallor, Pulselessness, Parasthesia, Poikilothermia

side effects & adverse reactions to immunizations: F- Fever I- Itching S- Stiffness H- Headache E- Edema R- Redness F- Fussy L- Localized Tenderness A- Appetite decrease G- General Aches Pains Remember that here in the USA you D drive on the right side of the road. O= optical A= auditory AD - right ear AS - left ear AU - both ears OD - right eye OS - left eye OU - both eyes Mneumonic device for remembering questions to ask emergency room admits: Car? (circumstances of event) Please (precipitating events) Listen (location of event) To This: (Time of event) Watch (when symptoms appeared) Underage (unconsciousness after injury?) Alcoholics (arrival time in ER) Heading (hospital admits previously?) Home (previous history/health status) And (allergies) Maybe (medications) Flattening (fears for safety) My (meal, time of last) Poodle (period, time of last menstrual) Dog (primary doctor, name and location of) Tonight (tetanus, date of last immunization)

Everyone knows to make the ABCD (airway breathing circulation and neurologic disability) assessment first. Then as soon as possible, further assessment/intervention is done, which includes: His (health history) Head (head to toe assessment) Is (insert monitoring devices -- caths, ECG, arterial lines) So (splints for fractures) Wide (wound care) Olivia (other interventions) Parkinson's Medications: "Ali Loves Boxing Matches" A-Amantadine L- Levodopa B- Bromocriptine M-MAO inhibitors The 4 H's that invalidate a neuro exam: Hypotension Hpoxia Hypoglycemia Hypothermia* Pinpoint pupils: Drugs, drops & nearly dead Drugs: opiates Drops: meds for glaucoma Nearly dead: damage in the pons area of the brainstem Dilated pupils: Fear, Fits & Fast Living Fear: panic, extreme anxiety Fits: seizures Fast Living: cocaine, crack, phencyclidine (PCP) The pathophysiology of ARDS: Assault on the respiratory system Respiratory distress Decreased lung compliance Severe respiratory failure Diagnostic criteria of ARDS Acute onset Ratio (PaCO2/FiO2) <200

Diffuse infiltration Swan-Ganz wedge pressure (PAWP) <18mm Hg Complications of thrombolytic therapy: The 3 B's Bleeding Brady's (dysrhythmias) Bloodclots (d/t excessive thrombin) Complications of cardiopulmonary bypass (CPB): The 3 H's Hypothermia (to decrease O2 consumption)...Effects SVR (vasoconstriction) and causes myocardial depression (decreases contractility) Hemodilution (to improve macrocirculation)...fluid shifting (third-spacing), e-lyte imbalances (K+, Mg+ & Ca++ often need replacing!) Heparinzation (to prevent clots in circuit)...monitor aPTT. Signs and symptoms of cardiac tamponade (Beck's Triad): The Three D's Distant heart sounds Distended jugular veins Decreased pulse pressure (think of a narrow pulse pressure as opposed to a wide one) Atrial Arrhythmias: ABCDE Adenosine/amiodorone or anticoagulate (if Afib/Flutter has been present >48h) Beta blockers Calcium channel blockers Digoxin Electrocardiovert (if <48h) For ventricular arrhythmias: AL Amiodorone Lidocaine NSAID Drugs N - Naproxen S - Salicylates A - Advil I - Ibuprofen D - Diclofenac S - Sulinclac

8 A's for Hepatotoxic Drugs (Check SGPT/SGOT) Antituberculosis Anticonvulsant S - sodium Luminal G - gabapentin P - phenytoin T - tegretol Anticancer Aspirin Alcohol Antifamily (contraceptice pills) Acetaminophen Aflatoxins Breast self examination (i made a song out of this) 1 little 2, little 3 little fingers Do BSE 7 days after menses Press nipple once check for discharge Call your doctor I'm sure you will do it more... Alkalosis and Acidosis Alkalosis - has a 'k' - Kicking the pH up Acidosis - has a 'd' - Dropping the pH down Solutions: Isotonic, Hypotonic, Hypertonic Isotonic - "Same as I" - the solution used will be the same as normal body fluid composition. Fluids remain inside intravascular space. Hypotonic - "Hypo, hippo" - the solution pulls fluid from the intravascular space into the ICF - the cell "swells like a hippo". For remembering the coronary arteries and which side they are on: I have a RIGHT to CAMP if you LEFT off the AC Right = Right C=oronary A=Artery M=Marginal Artery P=Posterior Interventricular Artery Left=Left

A=Anterior Interventricular Artery C=Circumflex Artery