Eyes

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)
Nursing Process


A Nice Delicious PIE
A= Assessment

ND = Nursing diagnosis

P= Plan

I= Interventions

E= Evaluation
Heart Sounds
APE TO Man
Atrial, Pulmonic, Erb's point, Tricuspid, Matrial
Key questions needed in an emergency history taking situation - "AMPLE"
Allergies

Medication

Past medical history

Last meal

Events and environment related to injury
Physical Assessment

RLQ PAIN: DIFFERENTIAL
APPENDICITIS:
Appendicitis/ Abscess

PID/ Period

Pancreatitis

Ectopic/ Endometriosis

Neoplasia

Diverticulitis

Intussusception

Crohns Disease/ Cyst (ovarian)

IBD

Torsion (ovary)

Irritable Bowel Syndrome

Stones
Eyes Physical Assessment
PERRLA

Pupils Equally Round and Reactive to Light and Accommodation






RESUSCITATION
RESUSCITATION: BASIC STEPS
ABCDE:
Airway

Breathing

Circulation

Drugs

Environment
HYPERTHERMIA
MALIGNANT HYPERTHERMIA TREATMENT

"Some Hot Dude Better Give Iced Fluids Fast!" (Hot dude = hypothermia):
Stop triggering agents

Hyperventilate/ Hundred percent oxygen

Dantrolene (2.5mg/kg)

Bicarbonate

Glucose and insulin

IV Fluids and cooling blanket

Fluid output monitoring/ Furosemide/ Fast heart [tachycardia]






Atrial Fibrillation
ATRIAL FIBRILLATION: CAUSES OF NEW ONSET

THE ATRIAL FIBS:

Thyroid

Hypothermia

Embolism (P.E.)

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)


Stool Assessment
Stool assessment"ACCT"

Amount

Color

Consistency

Timing
Pain
Pain: assessment"PQRST"

What Provokes the pain?

What is the Quality of the pain?

Does the pain Radiate?

What is the Severity of the pain?

What is the Timing of the pain?

Pain: management"ABCs"

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

PAIN HISTORY CHECKLIST

OLDER SAAB:
Onset

Location

Description (what does it feel like)

Exacerbating factors

Radiation

Severity

Associated symptoms

Alleviating factors

Before (ever experience this before)
Manipulation: nursing planpromote the "3C's"
Cooperation

Compromise

Collaboration
Diet
Diet: low cholesterolavoid the "3C's"

Cake
Cookies
Cream (dairy, e.g., milk, ice cream)

PLACENTA-CROSSING SUBSTANCES

"Want My Hot Dog":
Wastes

Antibodies

Nutrients

Teratogens

Microorganisms

Hormones/ HIV

Drugs


Preterm Infant
Preterm infant: anticipated problems"TRIES"

Temperature regulation (poor)

Resistance to infections (poor)

Immature liver

Elimination problems (necrotizing enterocolitis [NEC])

Sensory-perceptual functions (retinopathy of prematurity [ROP])
Obstetric (Maternity) History
Obstetric (maternity) history"GTPAL"

Gravida

Term

Preterm

Abortions (SAB, TAB)

Living children


Newborn Assessment
Newborn assessment components"APGAR"
Appearance

Pulse

Grimace

Activity

Respiratory effort

Family Planning
IUD: potential problems with use"PAINS"

Period (menstrual: late, spotting, bleeding)

Abdominal pain, dyspareunia

Infection (abnormal vaginal discharge)

Not feeling well, fever or chills

String missing

Oral contraceptives: signs of potential problems"ACHES"

Abdominal pain (possible liver or gallbladder problem)

Chest pain or shortness of breath (possible pulmonary embolus)

Headache (possible hypertension, brain attack)

Eye problems (possible hypertension or vascular accident)

Severe leg pain (possible thromboembolic process)
Infections during pregnancy
Infections during pregnancy"TORCH"

Toxoplasmosis

Other (hepatitis B, syphilis, group B beta strep)

Rubella

Cytomegalovirus

Herpes simplex virus
Episiotomy
Episiotomy assessment"REEDA"

Redness
Edema
Ecchymosis
Discharge
Approximation of skin

Dystocia
Dystocia: etiology"3P's"

Power
Passageway
Passenger

Dystocia: general aspects (maternal)"3P's"

Psych
Placenta
Position



Preeclampsia
Complication of severe preeclampsia"HELLP" syndrome

Hemolysis
Elevated Liver enzymes
Low Platelet count
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
12 Cranial Nerve
Oh, Oh, Oh, To Touch And Feel Virgin Girls Vagina, And Hymen/Hooters

I - Olfactory nerve
II - Optic nerve
III - Oculomotor nerve
IV - Trochlear nerve/pathic nerve
V - Trigeminal nerve/dentist nerve
VI - Abducens nerve
VII - Facial nerve
VIII - Vestibulocochlear nerve/Auditory nerve
IX - Glossopharyngeal nerve
X - Vagus nerve
XI - Accessory nerve/Spinal accessory nerve
XII - Hypoglossal nerve
Cholelithiasis
Patients are predisposed to Cholelithiasis (aka Gallstones) by the:

4 F's (Fat, Forty, Female, and Fertile).
moles malignant potential
use the abcd rule to assess a moles 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?
PREGNANCY INDUCED HYPERTENSION
PREGNANCY INDUCED HYPERTENSION- HELP

HEMOLYSIS

ELEVATED LIVER ENZYMES

LOW

PLATELETS
SICKLE CELL DISEASE
SICKLE CELL DISEASE- HOPIA

HYDRATION
OXYGENATION
PAIN
INFECTION
AVOID HIGH PLACES
MG SO4 TOXICITY
MG SO4 TOXICITY- BURP
BP DECREASE

URINE OUTPUT DECREASE

RESPIRATORY RATE DECREASE

PATELLAR REFLEX ABSENT
CONGESTIVE HEART FAILURE
CONGESTIVE HEART FAILURE- D MAD DOG
DIGOXIN

MORPHINE

AMINOPHYLLINE

DOPAMINE

DIURETICS

O2

GASSES MONITOR (ABG)
EARLY SIGNS OF HYPOXIA

RESTLESSNESS

AGITATION

TACHYCARDIA

LATE SIGNS OF HYPOXIA

BRADYCARDIA

EXTREME RESTLESSNESS

DYSPNEA

CYANOSIS
Intra Cranial Pressure
INCREASE ICP HYPERBRADYBRADY

CUSHINGS TRIAD:

HYPERTENSION (WIDE PULSE PRESSURE)

BRADYCARDIA

BRADYPNEA
Chickenpox
Days of appearance of rashesVaricella(chickenpox)
"Very Sick Patients Must TakeDouble Exercise"

1st dayScarlet fever

2nd dayPox(smallpox)

3rd dayMumps

4th dayTyphus

5th dayDengue

6th dayEnteric fever(typhoid)
Parkinson's Disease

Cardinal Symptoms of Parkinson's Disease - "TRAP"

Tremor

Rigidity

Akinesia and bradykinesia

Postural Instability
Spleen

Causes of huge spleen - "3M's"

Myelofibrosis

Malaria

Myelogenous leukemia

Anti-cholinergic Crisis

Signs of anti-cholinergic crisis - "SLUD"

Salivation

Lacrimation

Urination

Defecation
Scarlet Fever

Six "S" in Scarlet Fever

Streptococci causal organism

Sorethroat

Swollen tonsils

Strawberry tongue

Sandpaper rash

miliary Sudamina vesicles over hands, feet, abdomen
Cor Pulmonale
Signs of cor pulmonale - "Please Read His Text"

Peripheral edema

Raised JVP

Hepatomegaly

Tricuspid incompetence
Amino acids

10 essential amino acids - "PVT. TIM HALL"

Phenylalanine

Valine

Tryptophan

Threonine

Isoleucine

Metheonine

Histidine(semi-essential)

Arginine(semi-essential)

Leucine

Lysine
Hematology
Order of prevalence of White Blood Cells, most prevalent to least
"Never Let Monkeys EatBananas"

Neutrophils

Lymphocytes

Monocytes

Eosinophils

Basophils
Stages of mitosis/meiosis including interphase as a phase
"In Philippines, Men AreTalented"

Interphase

Prophase

Metaphase

Anaphase

Telophase
Diarrhea

Viruses causing diarrhea - "ACNE CAR"

Adeno virus
Corana virus
Norwak virus
Entero virus
Calci virus
Astro virus
Rota virus
Skeletal System

Carpal bones of the hand (lateral to medial)
"She Looks Too Proud, Try To Chase Her"

Proximal row:
Scaphoid

Lunate

Triquetrum

Pisiform

Distal row:

Trapezium

Trapezoid

Capitate

Hamate
Integumentary System

Layers of the scalp - "SCALP"

Skin

Connective tissue

Aponeurosis

Loose areolar tissue

Pericranium





Cranial Nerves


Cranial Nerves - "Oh Ohh Ohhh To Try And Fit A Gold Velvet So Heavenly"

Olfactory CN I

Optic CN II

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
Joints
Types of Joint movements - "FEEDPIPE CARDSHARP"

Flexion

Extension

Eversion

Dorsiflexion

Pronation

Inversion

Plantarflexion

Elevation

Circumduction

Abduction

Rotation

Depression

Supination

Hyperextension

Adduction

Retraction

Protraction
Nervous System
"Cut C4, breathe no more"

The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm.
"Point and Shoot!"
For remembering that Parasympathetics are involved with erection and
Sympathetics with ejaculation.
Cardiovascular System
Location of the heart valve from right to left - "A Permanently Temperamental Man"

Aortic

Pulmonary

Tricuspid

Mitral
Cancer

SIGNS OF CANCER- "CAUTION US"

Change in bowel /bladder habits

A sore that doesnt heal

Unusual bleeding/ Discharge

Thickening of lump breast or elsewhere

Indigestion/ Dysphagia

Obvious change in wart/ mole

Nagging cough/ hoarseness


Unexplained anemia

Sudden weight loss
FOCUS OF PATIENT CARE IN CLIENTS WITH CANCER

Chemotherapy

Assess body image disturbance (related to alopecia)

Nutritional needs when N/V present

Comfort from pain

Effective response to Tx? (Evaluate)

Rest (for patient and family)
NEUROLOGICAL FOCAL DEFICITS

NEUROLOGICAL FOCAL DEFICITS

10 S's:
Sugar (hypo, hyper)

Stroke

Seizure (Todd's paralysis)

Subdural hematoma

Subarachnoid hemorrhage

Space occupying lesion (tumor, avm, aneurysm, abscess)

Spinal cord syndromes

Somatoform (conversion reaction)

Sclerosis (MS)

Some migraines
DIABETIC KETOACIDOSIS MANAGEMENT

KING UFC:
K+ (potassium)

Insulin (5u/hour. Note: sliding scale no longer recommended in the UK)

Nasogastic tube (if patient comatose)

Glucose (once serum levels drop to 12)

Urea (check it)

Fluids (crytalloids)

Creatinine (check it)/ Catheterize
Ventricular Fibrillation

VENTRICULAR FIBRILLATION: TREATMENT

"Shock, Shock, Shock, Everybody Shock, Little Shock, Big Shock, Momma Shock, Poppa Shock":

Shock= Defibrillate

Everybody= Epinephine

Little= Lidocaine

Big= Bretylium

Momma= MgSO4

Poppa= Pocainamide
Subarachnoid Hemorrahage

SUBARACHNOID HEMORRHAGE (SAH) CAUSES

BATS:

Berry aneurysm
Arteriovenous malformation/ Adult polycystic kidney disease
Trauma (eg being struck with baseball bat)
Stroke
Shock

SHOCK: SIGNS AND SYMPTOMS

TV SPARC CUBE:
Thirst

Vomiting

Sweating

Pulse weak

Anxious

Respirations shallow/rapid

Cool

Cyanotic

Unconscious

BP low

Eyes blank
SHOCK HYPOTACHYTACHY

HYPOTENSION

TACHYPNEA

TACHYCARDIA
Aorta

"TRY PULLING MY AORTA":

Tricuspid

Pulmonary

Mitral

Aorta

Femoral Hernia

FEMORAL HERNIA FEMoral hernias are more common in FEMales.
Cardiac Valves
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.
Croup

CROUP - Signs and Symptoms

SSS
S - Stridor
S - Subglottic swelling
S - Seal-bark cough
Pneumonia

PNEUMONIA - risk factors
INSPIRATION

I - Immunosuppression
N - Neoplasia
S - Secretion retention
P - Pulmonary oedema
I - Impaired alveolar macrophages
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)
Pneumothorax

PNEUMOTHORAX Signs and Symptoms

P-THORAX

P - Pleuritic pain
T - Trachea deviation
H - Hyper resonance
O - Onset sudden
R - Reduced breath sounds (& dypsnea)
A - Absent fremitus
X - X-ray shows collapse
inducing drugs for Respiratory Depression

STOP breathing
S - Sedatives and hypnotics
T - Trimethoprim
O - Opiates
P - Polymyxins

Bleeding
BLEEDING - S/SBEEP
B - Bleeding gums
E - Ecchymoses (bruises)
E - Epistaxis (nosebleed)
P - Petechiae (tiny purplish spots)
Trauma
Trauma care: complications"TRAUMA"

Thromboembolism; Tissue perfusion, altered

Respiration, altered

Anxiety related to pain and prognosis

Urinary elimination, altered

Mobility impaired

Alterations in sensory-perceptual functions and skin integrity (infections)
Transient Ischemic Attacks

Transient ischemic attacks: assessment"3Ts"

Temporary unilateral visual impairment

Transient paralysis (one-sided)

Tinnitus = vertigo
Traction

Traction: nursing care plan"TRACTION"

Trapeze bar overhead to raise and lower upper body

Requires free-hanging weights; body alignment

Analgesia for pain, prn

Circulation (check color and pulse)

Temperature (check extremity)

Infection prevention

Output (monitor)

Nutrition (alteration related to immobility)

Tracheoesophageal Fistula
Tracheoesophageal fistula: assessment"3Cs"

Coughing

Choking

Cyanosis

Sprain
Sprain: nursing care plan"RICE"

Rest

Ice

Compression

Elevation

Postoperative Complications

Postoperative complications: order"4W's"

Wind (pulmonary)

Wound

Water (urinary tract infection)

Walk (thrombophlebitis)

Myocardial Infarction

Myocardial infarction: treatment"MONA"

Monitor/ Morphine

Oxygen

Nitroglycerin

Aspirin
Basic MI management - "BOOMAR"

Bed rest

Oxygen

Opiate

Monitoring

Anticoagulation

Reduce clot size
Melanoma

Melanoma characteristics"ABCD"
Asymmetry

Border

Color

Diameter
Hypoglycemia: signs and symptoms"DIRE"

Diaphoresis
Increased pulse
Restless
Extra hungry
Hypertension
Hypertension: complications"4 C's"

CAD (coronary artery disease)
CHF (congestive heart failure)
CRF (chronic renal failure)
CVA (cardiovascular accident; now called brain attack or stroke)
Hypertension: nursing care plan "I-TIRED"

Intake and output (urine)

Take blood pressure

Ischemia attack, transient (watch for TIAs)

Respiration, pulse

Electrolytes

Daily weight

Portal hypertension features - "ABCDE"

Ascites

Bleeding (hematemesis, piles)

Caput medusae

Diminished liver

Enlarged spleen
Diabetes

Diabetes: signs and symptoms"3P's,"

Polydipsia (very thirsty)
Polyphagia (very hungry)
Polyuria (urinary frequency)
Cushing's Syndrome
Cushing's syndrome: symptoms"3S's"

Sugar (hyperglycemia)
Salt (hypernatremia)
Sex (excess androgens)
Coma
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; temperature abnormalities (hypothermia, heat stroke)
Infection (e.g., meningitis)
Psychogenic ("hysterical coma")
Stroke or space-occupying lesions in the cranium
COMA: CONDITIONS TO EXCLUDE AS CAUSE

MIDAS:
Meningitis

Intoxication

Diabetes

Air (respiratory failure)

Subdural/ Subarachnoid hemorrhage
Cleft lip
Cleft lip: nursing care plan (postoperative)"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)
Positionnever on abdomen
Cholecystitis
Cholecystitis: risk factors"5F's"

Female
Fat
Forty
Fertile
Fair
Blood glucose
Blood glucose (rhyme)

Symptom Implication
Cold and clammy . . . give hard candy
Hot and dry . . . glucose is high
Neurovascular Occlusion
Neurovascular Occlusion: symptoms "6 P's"

Pain
Pale
Pulseless
Paresthesia
Poikilothermic
Paralysis
Appendicitis
Appendicitis: assessment"PAINS"

Pain (RLQ)
Anorexia
Increased temperature, WBC (15,00020,000)
Nausea
Signs (McBurney's, Psoas)
Anorexia nervosa: clinical features"ANOREXIC"

Adolescent women/ Amenorrhea
NGT alimentation (most severe cases)
Obsession with losing weight/ becoming fat though underweight
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)
Angina Pectoris
Angina: precipitating factors"4E's"

Eating
Emotion
Exertion (Exercise)
Extreme Temperatures (Hot or Cold weather)
hypocalcemia
"cats" of "hypocalcemia"

c - convulsions
a- arrhythmias
t - tetany
s - spasms and stridor
hypernatremia
hypernatremia signs and symptoms
"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
HYPERKALEMIA
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)
Wernicke-Korsakoff syndrome (alcohol-associated neurological disorder)
"COAT RACK"

Wernicke's encephalopathy (acute phase) clinical features:

Confusion

Ophthalmoplegia

Ataxia

Thiamine is an important aspect of Tx

Korsakoff's psychosis (chronic phase) characteristic findings:

Retrograde amnesia (recall of some old memories)

Anterograde amnesia (ability to form new memories)

Confabulation

Korsakoff's psychosis
Schizophrenia

Schizophrenia: primary symptoms"4A's"

Affect

Ambivalence

Associative looseness

Autism
Psychotropic Medications
Psychotropic medications: common antidepressives (tricyclics)"VENT"

Vivactil

Elavil

Norpramin

Tofranil

Mental Retardation
Mental retardation: nursing care plan"3R's"
Regularity (provide routine and structure)

Reward (positive reinforcement)

Redundancy (repeat)
Cognitive Disorders
Cognitive disorders: assessment of difficulties"JOCAM"

Judgment
Orientation
Confabulation
Affect
Memory
Alcohol Withdrawal
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
Bronchodilators
Bronchodilators - "TO A SIS"

Terbutaline

Orciprenaline

Adrenaline

Salbutamol

Isoprenaline

Salmeterol
Medication Administration
Medication administration"six rights"

RIGHT medication

RIGHT dosage

RIGHT route

RIGHT time

RIGHT client

RIGHT technique
VFIB/VTACH DRUGS
VFIB/VTACH DRUGS USED ACCORDING TO ACLS

"Every Little Boy Must Pray":
Epinephrine

Lidocaine

Bretylium

Magsulfate

Procainamide


Immunoglobulins
To Remember Immunoglobulins - "GAMED"

IgG

IgA

IgM

IgE

IgD
Chloroquine

Uses of Chloroquine (other than malaria) - "RED LIP"

Rheumatoid arthritis

Extra intestinal amoebiasis

Discoid lupus erythematosus

Lepra reaction

Infectious mononucleosis

Photogenic reactions



Krebs Cycle
The Krebs cycle - "Can I Actually See Some Filipina Mothers"

Citrate

Isocitrate

alpha Ketoglutarate

Succinyl CoA

Succinate

Fumarate

Malate

Oxaloacetate
Endotracheal Tube Deliverable Drugs
ENDOTRACHEAL TUBE DELIVERABLE DRUGS

O NAVEL
Oxygen

Naloxone

Atropine

Ventolin (albuterol)

Epinephrine

Lidocaine
IPECAC
IPECAC: CONTRAINDICATIONS

4 C's:

Comatose
Convulsing
Corrosive
hydroCarbon
Emergency Medicine
ACTIVATED CHARCOAL: CONTRAINDICATIONS
CHEMICAL CamP:

Cyanide

Hydrocarbons

Ethanol

Metals

Iron

Caustics

Airway unprotected

Lithium

CAMphor

Potassium
Alcohol withdrawal: clinical features"HITS"
Hallucinations (visual, tactile)
Increased vital signs and insomnia
Tremens delirium tremens (potentially lethal)
Shakes/ Sweats/ Seizures/ Stomach pains (nausea, vomiting)
Eye Medications


Mydriatic = dilated pupils
Miotic = tiny (constricted) pupils
MALARIA: COMPLICATIONS OF FALCIPARUM MALARIA

CHAPLIN:
Cerebral malaria/ Coma

Hypoglycemia

Anaemia

Pulmonary edema

Lactic acidosis

Infections

Necrois of renal tubules (ATN)