AAPIE – An Apple PIE A = Assessment A = Analysis P = Planning I = Implementation E = Evaluation ADPIE – An Delicious PIE A = Assessment D = Diagnosis P = Planning I = Implementation E = Evaluation
PERRLA P = Pupils E = Equally R = Round and R = Reactive to L = Light and A = Accommodate HIPER H = Heat I = Indurations (hardening) P = Pain E = Edema R = Redness OPQRST O = Onset P = Provoke or Palliative = Q uality uality Q = R = Region or Radiation S = Signs, Severity, Symptoms T = Time of onset, duration, and intensity
Alkalosis has K, therefore it is kicking the pH UP Acidosis has D, therefore it is dropping the pH DOWN
ROME R = Respiratory O = Opposite M = Metabolic E = Equal Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis
pH
pCO2
HCO3
Low High Low High
Normal Normal High Low
Low High Normal Normal
Equal Equal Opposite Opposite
SALT LOSS S = Stupor/coma A = Anorexia, N&V L = Lethargy T = Tendon reflexes, decreased L = Limp muscles (weakness) O = Orthostatic hypotension S = Seizures/headache S = Stomach cramping CATS C = Convulsions A = Arrhythmias T = Tetany S = Spasms and Stridor Hypocalcemia is low levels of calcium in the blood. Calcium in the blood can be bound to proteins, bound to anions like phosphate or ionized stores of calcium, or in the bones. Calcium blocks sodium channels inhibiting depolarization of muscle and nerve fibers. The effects of hypocalcemia are the results of muscle fibers being more excitable. So, the S&S have a lot to do with muscles. m uscles. Mnemonic to remember the S&S of hypocalcemia is CATS – C: Convulsions, A: Arrhythmias, T: Tetany, and S: Spasms and Stridor. (Tetany: Remember how calcium has a lot to do with muscle fibers being more excitable. So, S&S include some issues with muscles. So, numbness, tingling, and maybe some twitches. A common one is the lips, tongue, face feeling numb and tingly, that is a classic sign. So, that’s what tetany is).
Groans, Moans, Bones, Stones, Overtones Groans = Constipation Moans = Joint pain Bones = Loss of calcium from bones (calcium is leaving bones and going into bloodstream) Stones = Kidney stones Overtones = Psychiatric overtones (confusion, depression)
MODEL M = Medications/Meals O = Osmotic diuretics D = Diabetes insipidus E = Excessive water loss L = Low water intake 3 Mnemonics for S&S of Hypernatremia
FRIED: You are FRIED F = Flushed skin R = Restlessness; irritability I = Increased fluid retention and increased BP E = Edema (peripheral and pitting) D = Decreased urinary output, Dry mouth SWINE: Bacon has high amounts of sodium S = Sleepy (lethargy – typically the very first sign) W = Weakness I = Irritability N = Neuromuscular excitability E = Edema SALT S = Skin flushed A = Agitation L = Low-grade fever T = Thirst MACHINE: The hyperkalemia MACHINE M = Medications – ACE inhibitors, NSAIDs, potassium-sparing diuretics A = Acidosis – Metabolic and Respiratory C = Cellular Destruction – Burns, traumatic injury, hemolysis H = Hypoaldosteronism – Addison’s disease I = Intake – Excessive N = Nephrons – Renal failure E = Excretion – Impaired MURDER M = Muscle weakness U = Urine – Oliguria, Anuria R = Respiratory distress D = Decreased cardiac contractility E = ECG changes R = Reflexes – Hyperreflexia or Areflexia (flaccid)
AIRED A = Administer IV calcium – To immediately decrease cardiac toxicity I = Increase excretion – Via both stool (Kayexalate) and urine (diuretics) R = Remove sources of potassium – From all sources, including parenteral, enteral, IV, and PO E = Enhance potassium uptake into cells – Insulin, glucose, sodium bicarb, beta-adrenergic antagonists (want to increase pulling K from outside cell to inside cell)
D = Dialysis – Emergent response for pts with lethal hyperkalemia 6 L’s L = Lethargy L = Leg cramps L = Limp muscles L = Low, shallow respirations L = Lethal cardiac dysrhythmias L = Lots of urine (polyuria)
CAUTION UP C = Change in bowel or bladder (common sign of colorectal cancer)
A = A lesion that does not heal (if on skin or in mouth, skin cancer or oral cancer could be cause)
U = Unusual bleeding or discharge (any bleeding from bladder, vagina, or rectum could mean prostate, cervical, or colorectal cancer)
T = Thickening or lump in breast or elsewhere (lump on breast can be sign of cancer. Lump on testicle can mean testicular cancer)
I = Indigestion or difficulty swallowing (can be symptom of stomach, throat, esophagus, or mouth cancer)
O = Obvious changes in wart or mole (most common sign of skin cancer)
N = Nagging cough or persistent hoarseness (cough that lasts for 4 wks or longer can be symptom of lung and/or throat cancer)
U = Unexplained weight loss P = Pernicious anemia ABCDs A = Asymmetry – Is the mole irregular in shape? B = Border – Is the border irregular, notched, or poorly defined? C = Color – Does the color vary (e.g., between shades of brown, red, w hite, blue, or black)? D = Diameter – Is the diameter more than 6 mm? ANT A = Anemia N = Neutropenia
T = Thrombocytopenia
MAD DOG M = Morphine – Causes vasodilation, resulting in decreased BP A = Aminophylline – Relaxes airways to make breathing easier D = Digitalis – Improve heart function in pulmonary edema D = Diuretics (Lasix) – Pull excess fluid off O = Oxygen – Improve oxygenation G = Gases (Blood Gases/ABGs) – Assess respiratory status RAT BED Early Hypoxia:
R = Restlessness A = Anxiety T = Tachycardia/Tachypnea Late Hypoxia:
B = Bradycardia E = Extreme Restlessness D = Dyspnea 6 P’s P = Pulmonary Bronchial Constriction P = Possible Foreign Body P = Pulmonary Embolus (PE) P = Pneumothorax P = Pump Failure P = Pneumonia
ASTHMA A = Adrenergic (Albuterol) S = Steroids T = Theophylline H = Hydration (IV) M = Mask (oxygen) A = Antibiotics
5 P’s P = Pain P = Paresthesia P = Paralysis P = Pulse
P = Pallor (Paleness) TPMA – Toilet Paper My Ass T = Tricuspid P = Pulmonic M = Mitral A = Aortic White Right, Clouds Over Grass, Smoke Over Fire, and C hocolate on the Stomach
White Right – You’re grabbing your white lead first, put that on upper right chest shoulder. Kind of lower shoulder area.
Clouds Over Grass – White (clouds) over green (grass). Grab green lead second, and put it on t he right side, kind of lower chest area.
Smoke Over Fire – Black over red. So, put black lead on left side, kind of opposite where the white one is. Same thing with red one, for smoke over fire, and that’s kind of opposite where the green one is
Chocolate on the Stomach – Put brown lead directly on t he stomach, but somewhat on the center of the chest. CAMP, AC 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 All People Enjoy Time Magazine All = Aortic (2nd intercostal space, right sternal border) People = Pulmonic (2nd intercostal space, left sternal border) Enjoy = Erb’s Point (3rd intercostal space, left sternal border) Time = Tricuspid (4th or 5th intercostal space, left sternal border) Magazine = Mitral (5th intercostal space, left midclavicular line) 1 heart, 2 lungs Beta 1: Heart Beta 2: Lungs You have one heart, and two lungs
4 C’s C = Coronary artery disease C = Coronary rheumatic fever C = Congestive heart failure C = Cerebrovascular accident
IDEA I = Isoproterenol D = Dopamine E = Epinephrine A = Atropine Sulfate Isoproterenol: Acts on beta2-adrenergic receptors, causing relaxation of bronchial smooth muscle; acts on beta1adrenergic receptors in heart, causing positive inotropic and chronotropic effects and increasing CO. Also lowers PVR in skeletal muscles and inhibits antigen-induced histamine r elease. Dopamine : Causes norepinephrine release (mainly on dopaminergic receptors), leading to vasodilation of renal and mesenteric arteries. Also exerts inotropic effects on heart, which increases HR, blood flow, myocardial contractility, and SV 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. Atropine Sulfate: Acts on beta2-adrenergic receptors, causing relaxation of bronchial smooth muscle; acts on beta1adrenergic receptors in heart, causing positive inotropic and chronotropic effects and increasing CO. Also lowers PVR in skeletal muscle and inhibits antigen-induced histamine r elease
MONATAS M = Morphine O = Oxygen N = Nitrates (Nitroglycerin) A = Aspirin (ASA) T = Thrombolytics A = Anticoagulants S = Stool softeners MONA M = Morphine sulfate O = Oxygen N = Nitroglycerin A = ASA (Aspirin) HEAD, CHOP Right Sided: HEAD
H = Hepatomegaly E = Edema (Bipedal) A = Ascites D = Distended Neck Vein Left Sided: CHOP
C = Cough H = Hemoptysis O = Orthopnea P = Pulmonary Congestion (Crackles/Rales)
UNLOAD FAST U = Upright (sit Upright) N = Nitroglycerin L = Lasix O = Oxygen A = Aminophylline D = Digoxin F = Fluids - Decrease A = Afterload - Decrease S = Sodium - Decrease T = Tests – Digoxin level, ABG, K+ PRHT – Please Read His Text P = Peripheral edema R = Raised JVP H = Hepatomegaly T = Tricuspid incompetence
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! BEEP B = Bleeding E = Epistaxis (nose bleed) E = Ecchymoses (bruising) P = Petechiae RANDI R = Razor Electric/Blades A = Aspirin N = Needles – Small gauge D = Decrease needle sticks I = Injury (Protect from)
AIR RAID A = Airway Closed I = Increased Pulse R = Restlessness
R = Retractions – Occur when the muscles between the ribs pull inward A = Anxiety Increased I = Inspiratory Stridor – High-pitched breath sound resulting from turbulent airflow in the larynx D = Drooling POOPER SCOOP (Promotion)
P = Position O = Output O = Offer fluids P = Privacy E = Exercise R = Report results (Evaluation)
S = Size (Amount) C = Consistency O = Occult Blood O = Odor P = Peristalsis BRAT Diet B = Banana R = Rice A = Apple T = Toast PAINS P = Pain (RLQ) – Pain in RLQ of abdomen A = Anorexia – Loss of appetite I = Increased temperature, WBC (15,000 – 20,000) N = Nausea S = Signs (McBurneys, Psoas)
6 F’s F = Female (gallbladder disease and gallstones are most common in women d/t the high levels of estrogen) F = Fair (gallstones more common in Caucasians, fair skin) F = Fat (overweight – overweight people have more cholesterol in their bile, and more gallstones are deposits of cholesterol)
F = Forty (age near or above 40 – 40 is an indicator of premenopausal time for women, bringing on spikes of estrogen levels)
F = Fertile (premenopausal-increased estrogen is thought to increase cholesterol levels in bile and decrease gallbladder contractions) (women who are pregnant have higher levels of hormones or estrogen, therefore increasing risk)
F = Family Hx
3 S’s S = Sugar (Glucocorticoids) S = Salt (Mineralocorticoids) S = Sex (Androgens)
TIRED T = Tachycardia I = Irritability R = Restlessness E = Excessive Hunger D = Diaphoresis/Depression Hyperglycemia Hyper = Hot/Dry = Sugary High Hypo = Cold/Clammy = Needs candy
DIAPPERS D = Delirium I = Infection A = Atrophic urethra (atrophy of the urethra) P = Pharmaceuticals – BP meds, antidepressants, diuretics, sleeping pills P = Psychologic E = Excess urine output R = Restricted mobility S = Stool impaction Who Needs Dialysis? Check the Vowels : AEIOU
A = Acid-base problems E = Electrolyte problems I = Intoxication O = Overload of fluids U = Uremic symptoms
Prostate problems are no…FUN
F = Frequency U = Urgency N = Nocturia
BATTED B = Bathing A = Ambulation T = Toileting T = Transfers E = Eating D = Dressing SCUM S = Shopping C = Cooking and Cleaning U = Using telephone or transportation M = Managing money and medications ACCESS leads to osteoporosis A = Alcohol use C = Corticosteroid use C = Calcium low E = Estrogen low S = Smoking S = Sedentary lifestyle RICE R = Rest I = Ice C = Compression E = Elevation
COAL C = Cane O = Opposite A = Affected L = Leg WWAL – Wandering Wilma Always Late W = Walker W = With A = Affected L = Leg TRACTION
T = Temperature (Extremity, Infection) R = Ropes hang freely A = Alignment C = Circulation Check (5 P’s) T = Type and Location of fracture I = Increased fluid intake O = Overhead trapeze N = No weights on bed or floor
Things to Assess For :
AEIO TIPS A = Alcohol/drugs E = Endocrine I = Insulin O = Overdose T = Trauma I = Infection P = Psychiatric S = Shock 3 C’s C = Choking C = Coughing C = Cyanosis Signs and Symptoms
Fines F = Feeding difficulty I = Inspiratory stridor N = Nares flares E = Expiratory grunting S = Sternal retractions Things to Assess For :
Cleft Lip C = Choking L = Lie on back E = Evaluate airway F = Feed slowly T = Teaching L = Larger nipple opening I = Increased incidence in males
P = Prevent crust formation and aspiration Child Abuse C = Child’s excessive knowledge of sex and abusive words H = Hair growth in various lengths I = Inconsistent stories from the child’s 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 Two Arteries, One Vein Two Umbilical Arteries One Umbilical Vein Aches A = Abdominal pain C = Chest pain H = Headaches E = Eye problems S = Severe leg pain NNN N = Non-reactive N = Non-stress test is N = Not good Pains P = Period (Menstrual: Late, spotting, bleeding) A = Abdominal pain, dyspareunia (painful intercourse) I = Infection (abnormal vaginal discharge) N = Not feeling well, fever or chills S = String missing Signs and Symptoms
HELLP H = Hemolysis E = Elevated L = Liver function tests
L = Low P = Platelet count ALONE A = Amniocentesis L = L/S ratio O = Oxytocin test N = Non-stress test E = Estriol level VEAL CHOP What we are trying to understand with this mnemonic is when to be co ncerned while monitoring the fetal heart rate.
V = Variable deceleration E = Early deceleration A = Acceleration L = Late acceleration Evaluation of Healing
REEDA R = Redness E = Edema E = Ecchymoses D = Discharge, Drainage A = Approximation 4 T’s T = Tetralogy of Fallot T = Truncus Arteriosus T = Transposition of the Great Vessels T = Tricuspid Atresia
DIG FAST D = Distractibility I = Indiscretion G = Grandiosity F = Flight of ideas A = Activity increase S = Sleep deficit T = Talkative SIG
C = Cord compression H = Head compression O = Okay! P = Placental insufficiency
S = Sleep disturbances I = Interest decreased G = Guilty feelings DEMENTIA Make sure they don’t have problems with:
D = Drugs 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 5 A’s A = Amnesia – Loss of memories A = Anomia – Unable to recall names of everyday objects A = Apraxia – Unable to perform tasks of movement A = Agnosia – Inability to process sensory information A = Aphasia – Disruption with ability to communicate
Anorexia A = Amenorrhea N = No organic factors accounts for we ight loss O = Obviously thin but feels FAT R = Refusal to maintain normal body weight E = Epigastric discomfort is common X = X-symptoms (peculiar symptoms) I = Intense fears of gaining weight A = Always thinking of food Bulimia B = Binge eating U = Under strict dieting L = Lacks control/over-eating I = Induced vomiting M = Minimum of 2 binge eating episodes I = Increase/persistent concern of body size/shape A = Abuse of diuretics and laxatives WASHED W = Weight loss of 15% of original body weight
A = Amenorrhea S = Social withdrawal H = History of high activity and achievement E = Electrolyte imbalance D = Depression/distorted body image 5 D’s D = Denial D = Dependency D = Demanding D = Destructive D = Domineering
Traumatic T = Tissue perfusion problems R = Respiratory problems A = Anxiety U = Unstable clotting factors M = Malnutrition A = Altered body image T = Thromboembolism – fat embolism I = Infection C = Coping problems ABCDEFGHI A = Airway (with simultaneous cervical spine protection) Keep airway open to allow body to take in oxygen and excel carbon dioxide. Use head-tilt chin-lift technique to open airway. Check or remove obstructions. A blocked airway c an lead to respiratory or cardiac ar rest.
B = Breathing Once airway is open, check for normal breathing, make use of look, listen, and feel techniques. Look at chest and observe rising and falling for normal respiration. Listen for air movement. Fee l for air coming through mouth or nose. If 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 = Disability (neuro status) Check pts neurological status and for obvious deformities or disabilities.
E = Expose/Environmental controls (remove clothes and keep pt warm) Remove clothing to properly assess pt; be sure to keep pt warm
F = Full set of vital signs Note any changes in the following signs: Pulse (carotid, brachial, radial), pupils, breathing, LOC, BP, and skin color and temperature
G = Give comfort measures Continue to rest and reassure. Provide comfort me asures and prevent further injury (verbal reassurance, touch, and pharm and nonpharm management of pain)
H = Hx and Head-to-toe assessment Use the mnemonic SAMPLE to obtain health Hx and do a head-to-toe assessment after
I = Inspect posterior surfaces Inspect for wounds, deformities, discolorations, etc.
Drugs to LEAN on
L = Lidocaine E = Epinephrine A = Atropine Sulfate N = Narcan Lidocaine Action: Suppresses automaticity of ventricular cells, decreasing diastolic depolarization and increasing V-fib threshold. Produces local anesthesia by reducing sodium permeability of sensory nerves, which blocks impulse generation and conduction. Uses: Ventricular arrhythmias, topical/local anesthetic Epinephrine Action: Stimulates alpha- and beta-adrenergic receptors, causing relaxation of cardiac and bronchial smooth muscle and dilation of skeletal muscles. Uses: Bronchodilation; anaphylaxis; hypersensitivity reaction; acute asthma attack; chronic simple glaucoma Atropine Sulfate Action: Inhibits acetylcholine at parasympathetic neuroeffector junction of smooth muscle and car diac muscle, blocking SA and AV nodes to increase impulse conduction and raise HR. Uses: Decreases respiratory secretions, treats sinus bradycardia, reverses effects of anticholinesterase med Narcan Action: Naloxone is used to treat opioid emergency such as OD or a possible OD of a narcotic med. Uses: Opioid-induced toxicity; opioid-induced respiratory depression; used in neonates to counteract or treat effects from narcotics given to mother during labor
6 T’s T = Tachycardia T = Tachypnea T = Tremors T = Toxic look T = Tiredness T = Temperature (fever)
BROW B = Barley R = Rye O = Oats W = Wheat
Fat Soluble Vitamins: ADEK - All Dogs Eat Kibbles Take your Birth Control with water. Vitamins B and C are water soluble
The rest of the vitamins are fat soluble (ADEK)
All Dogs Eat Kibbles A (vitamin A) D (vitamin D) E (vitamin E) K (vitamin K) 6 S’s S = Sugary – Hyperglycemia (raises blood sugar) S = Soggy Bones – Causes osteoporosis S = Sick – Decreased immunity (Get Sick easier) S = Sad – Depression S = Salt – Water and salt retention (HTN) S = Sex – Increased libido
SAMS S = Slurred Speech A = Altered Central Nervous System M = Muscle Twitching S = Seizures TDCI – These Drugs Can Interact T = Theophylline D = Dilantin C = Coumadin I = Ilosone (Erythromycin) Can’t See – Blurred vision Can’t Pee – Urinary retention Can’t Spit – Dry mouth Can’t Shit – Constipation An anticholinergic is a substance that blocks the ne urotransmitter acetylcholine in the central and peripheral ner vous system. They inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine and its receptor in the nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movement of smooth muscles present within the GI tract, lungs, urinary tract, etc. So, ther e’s a lot of different uses for anticholinergics. You might not even realize you’re using yourself or giving to your pt are anticholinergics. They are given for GI issues, urinary issues, respiratory issues. Atropine is actually a big one that we give for symptomatic bradycardia, insomnia, dizziness, that kind of stuff. A few of the me ds – Benadryl, that’s a pretty wellknown one; Wellbutrin, that’s an interesting one; Atropine; Cogentin; just a ton of different ones that are out the re. The side effects, as you can imagine this like anticholinergics really affect a lot of systems of the body, so you can have a lot of side effects from these medications. The mnemonic for side effects of anticholinergics is – You can’t see it, can’t pee, can’t spit, and can’t shit. You can’t see – blurred vision is a side effect. Can’t pee – urinary retention. Can’t spit – you have dry mouth. Can’t shit – constipation.
SLUDGE S = Salivation
L = Lacrimation (excessive tears) U = Urination D = Defecation G = Gastric upset E = Emesis Another mnemonic when pts are receiving anticholinergics, is for cholinergic crisis. So, the S&S that go along with the cholinergic crisis – SLUDGE. These actually, surprisingly enough, are kind of opposite of your anticholinergic issues. If you think of it like anticholinergics are kind of drying t hings up, cholinergics are kind of lubricating everything. You just have things coming out of everywhere. So, t hat’s kind of how to remember the t wo. Anticholinergic kind of drives things up, cholinergic crisis kind of has stuff coming out of eve rywhere, out of your eyes, bowels, bladder, mouth (emesis and salivation both), just a lot going on, kind of a me ssy situations there with the cholinergic crisis. So, that’s what you w ant to be thinking about when you’re thinking anticholinergic and c holinergic, how to differentiate the two. https://www.nrsng.com/nursing-mnemonics/
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