Small Secret

8/8/2019 Small Secret

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HYPERNATREMIAFRIED SALTF - Fever (low), flushed skinR - Restless (irritable)I - Increased fluid retention & increased BPE - Edema (peripheral and pitting)D - Decreased urinary output, dry mouth

SALT S - Skin flushedA - AgitationL - Low-grade fever T - Thirst

HYPERKALEMIA - Signs & SymptomsMURDERM - Muscle weaknessU - Urine, oliguria, anuriaR - Respiratory distressD - Decreased cardiac contractilityE - ECG changesR - Reflexes, hyperreflexia, or areflexia (flaccid)

HYPERKALEMIA - CausesMACHINEM - Medications - ACE inhibitors, NSAIDS

A - Acidosis - Metabolic and respiratoryC - Cellular destruction - Burns, traumatic injuryH - Hypoaldosteronism/ hemolysisI - Intake - ExcessiveN - Nephrons, renal failureE - Excretion - Impaired

HYPOCALCEMIACATSC - ConvulsionsA - ArrhythmiasT - TetanyS - Spasms and stridor

BLEEDING - S/SxBEEPB - Bleeding gumsE - Ecchymoses (bruises)E - Epistaxis (nosebleed)P - Petechiae (tiny purplish spots)

RESPIRATORY DEPRESSION - inducing drugsSTOP breathing S - Sedatives and hypnoticsT - TrimethoprimO - OpiatesP - Polymyxins

PNEUMOTHORAX - S/SxP-THORAXP - Pleuretic painT - Trachea deviationH - Hyperresonance

O - Onset suddenR - Reduced breath sounds (& dypsnea)A - Absent fremitusX - X-ray shows collapse

PNEUMONIA - risk factors INSPIRATION I - ImmunosuppressionN - NeoplasiaS - Secretion retentionP - Pulmonary oedemaI - Impaired alveolar macrophagesR - RTI (prior)A - Antibiotics & cytotoxics

PAIN HISTORY CHECKLIST

OLDER SAAB:

OnsetLocationDescription (what does it feel like)Exacerbating factorsRadiationSeverityAssociated symptomsAlleviating factorsBefore (ever experience this before)

SHOCK: SIGNS AND SYMPTOMS

TV SPARC CUBE:

ThirstVomitingSweatingPulse weakAnxiousRespirations shallow/rapidCool

CyanoticUnconsciousBP lowEyes blank

SUBARACHNOID HEMORRHAGE (SAH) CAUSESBATS:

Berry aneurysmArteriovenous malformation/ Adult polycystic kidney diseaseTrauma (eg being struck with baseball bat)Stroke

VENTRICULAR FIBRILLATION: TREATMENT

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

Shock= DefibrillateEverybody= EpinephineLittle= LidocaineBig= BretyliumMomma= MgSO4Poppa= PocainamideVFIB/VTACH DRUGS USED ACCORDING TO ACLS

"Every Little Boy Must Pray":

EpinephrineLidocaineBretylium

MagsulfateProcainamide

DIABETIC KETOACIDOSIS MANAGEMENT

KING UFC:

K+ (potassium)

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

Nasogastic tube (if patient comatose)


2/12

T - Tracheal instrumentationI - IV dug abuseO - Other (general debility, immobility)N - Neurologic impairment of cough reflex, (eg NMJ disorders)

CROUP - S/SxSSSS - Stridor S - Subglottic swellingS - Seal-bark cough

SHORTNESS OF BREATH - CausesAAAA PPPP A - Airway obstructionA - AnginaA - AnxietyA - AsthmaP - PneumoniaP - PneumothoraxP - Pulmonary EdemaP - Pulmonary EmbolusCARDIAC 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.

FEMORAL HERNIA

FEMoral hernias are more common in FEMales.

"TRY PULLING MY AORTA":

Tricuspid

Pulmonary

Mitral

Aorta

PLACENTA-CROSSING SUBSTANCES

"Want My Hot Dog":

Wastes

Antibodies

Nutrients

Teratogens

Microorganisms

Hormones/ HIVDrugs

EMERGENCY MEDICINEACTIVATED CHARCOAL: CONTRAINDICATIONSCHEMICAL CamP: Cyanide

HydrocarbonsEthanolMetals

Glucose (once serum levels drop to 12)

Urea (check it)

Fluids (crytalloids)

Creatinine (check it)/ Catheterize

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

COMA: CONDITIONS TO EXCLUDE AS CAUSE

MIDAS:

Meningitis

Intoxication

Diabetes

Air (respiratory failure)

Subdural/ Subarachnoid hemorrhage

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]

RESUSCITATION: BASIC STEPS


3/12

IronCausticsAirway unprotectedLithiumCAMphor Potassium

IPECAC: CONTRAINDICATIONS

4 C's:

ComatoseConvulsingCorrosivehydroCarbon

ATRIAL FIBRILLATION: CAUSES OF NEW ONSET

THE ATRIAL FIBS:

ThyroidHypothermiaEmbolism (P.E.)Alcohol

Trauma (cardiac contusion)Recent surgery (post CABG)IschemiaAtrial enlargementLone or idiopathicFever, anemia, high-output statesInfarctBad valves (mitral stenosis)Stimulants (cocaine, theo, amphet, caffeine)

ENDOTRACHEAL TUBE DELIVERABLE DRUGS

O NAVEL:

OxygenNaloxoneAtropineVentolin (albuterol)EpinephrineLidocaine

MALARIA: COMPLICATIONS OF FALCIPARUM MALARIA

CHAPLIN:

Cerebral malaria/ ComaHypoglycemiaAnaemiaPulmonary edemaLactic acidosisInfections

Necrois of renal tubules (ATN)

MI: IMMEDIATE TREATMENT

DOGASH:

DiamorphineOxygenGTN sprayAsprin 300mgStreptokinaseHeparin

ABCDE:

Airway

Breathing

Circulation

Drugs

Environment

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


4/12

PAGE 2Acid-base"ROME" (Respiratory Opposite, Metabolic Equal)

Acidosis

Respiratory (opposite): pH Pco2

Metabolic(equal): pH HCO3

Alkalosis

Respiratory (opposite): pH Pco2

Metabolic(equal): pH HCO3

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)

Angina: precipitating factors"4E's"

Eating

Emotion

Exertion (Exercise)

Extreme Temperatures (Hot or Cold weather)

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)

Appendicitis: assessment"PAINS"

Pain (RLQ)

Anorexia

Increased temperature, WBC (15,00020,000)

Nausea

Signs (McBurney's, Psoas)

Complication of severe preeclampsia"HELLP" syndrome

Hemolysis

Elevated Liver enzymes

Low Platelet count

Cushing's syndrome: symptoms"3S's"

Sugar (hyperglycemia)

Salt (hypernatremia)

Sex (excess androgens)

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

Polydipsia (very thirsty)

Polyphagia (very hungry)

Polyuria (urinary frequency)

Diet: low cholesterolavoid the "3C's"

Cake

Cookies

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

Dystocia: etiology"3P's"

Power

Passageway

Passenger

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

Psych

Placenta

Position

Episiotomy assessment"REEDA"

Redness

Edema

Ecchymosis

Discharge

Approximation of skin

Eye medications

Mydriatic = dilated pupils

Miotic = tiny (constricted) pupils


5/12

Neurovascular Occlusion: symptoms "6 P's"

PainPalePulselessParesthesiaPoikilothermic

Paralysis

Blood glucose (rhyme)

Symptom Implication

Cold and clammy . . . give hard candy

Hot and dry . . . glucose is high

Blood vessels in umbilical cord"AVA" (2 arteries and 1 vein)

Artery

Vein

Artery

Cholecystitis: risk factors"5F's"

Female

Fat

Forty

Fertile

Fair

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 atrepair)

Liquid (sterile water), rinse after feeding

Impaired feeding (no sucking)

Positionnever on abdomen

Cognitive disorders: assessment of difficulties"JOCAM"

Judgment

Orientation

Confabulation

Affect

Memory

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

Hypoglycemia: signs and symptoms"DIRE"

Diaphoresis

Increased pulse

Restless

Extra hungry

Infections during pregnancy"TORCH"

Toxoplasmosis

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

Rubella

Cytomegalovirus

Herpes simplex virus

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

Manipulation: nursing planpromote the "3C's"

Cooperation

Compromise

Collaboration

Medication administration"six rights"


6/12

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

RIGHT medication

RIGHT dosage

RIGHT route

RIGHT time

RIGHT client

RIGHT technique

Melanoma characteristics"ABCD"

Asymmetry

Border

Color

Diameter

Mental retardation: nursing care plan"3R's"

Regularity (provide routine and structure)

Reward (positive reinforcement)

Redundancy (repeat)

Myocardial infarction: treatment"MONA"

Monitor/ Morphine

Oxygen

Nitroglycerin

Aspirin

Newborn assessment components"APGAR"

Appearance

Pulse

Grimace

Activity

Respiratory effort

Obstetric (maternity) history"GTPAL"

Gravida

Term

Preterm

Abortions (SAB, TAB)

Living children

Oral contraceptives: signs of potential problems"ACHES"


7/12

Page 3Abdominal 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)

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

Postoperative complications: order"4W's"

Wind (pulmonary)

WoundWater (urinary tract infection)

Walk (thrombophlebitis)

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])

Psychotropic medications: common antidepressives (tricyclics)"VENT"

Vivactil

Elavil

Norpramin

Tofranil

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

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

"Point and Shoot!"

For remembering that Parasympathetics are involved with erectionand Sympathetics with ejaculation.

Layers of the scalp - "SCALP"

SkinConnective tissueAponeurosisLoose areolar tissuePericranium

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

Proximal row:

ScaphoidLunateTriquetrumPisiformDistal row:TrapeziumTrapezoidCapitateHamate

Viruses causing diarrhea - "ACNE CAR"

Adeno virusCorana virusNorwak virusEntero virusCalci virusAstro virusRota virus


8/12

Schizophrenia: primary symptoms"4A's"

Affect

Ambivalence

Associative looseness

Autism

Sprain: nursing care plan"RICE"

Rest

Ice

Compression

Elevation

Stool assessment"ACCT"

Amount

Color

Consistency

Timing

Tracheoesophageal fistula: assessment"3Cs"

Coughing

Choking

Cyanosis

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)

Transient ischemic attacks: assessment"3Ts"

Temporary unilateral visual impairment

Transient paralysis (one-sided)

Tinnitus = vertigo

Trauma care: complications"TRAUMA"

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

Citrate

Isocitrate

alpha Ketoglutarate

Succinyl CoA

Succinate

Fumarate

Malate

Oxaloacetate

Stages of mitosis/meiosis including interphase as a phase - "InPhilippines, Men Are Talented"

InterphaseProphaseMetaphaseAnaphaseTelophase

Order of prevalence of White Blood Cells, most prevalent toleast - "Never Let Monkeys Eat Bananas"

NeutrophilsLymphocytesMonocytesEosinophilsBasophils

10 essential amino acids - "PVT. TIM HALL"

Phenylalanine

ValineTryptophanThreonineIsoleucineMetheonineHistidine(semi-essential)Arginine(semi-essential)LeucineLysine

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

Rheumatoid arthritisExtra intestinal amoebiasisDiscoid lupus erythematosusLepra reactionInfectious mononucleosisPhotogenic reactions

Bronchodilators - "TO A SIS"

TerbutalineOrciprenalineAdrenalineSalbutamolIsoprenaline


9/12

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)

Wernicke-Korsakoff syndrome (alcohol-associated neurologicaldisorder)"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

SIGNS OF CANCER

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

Salmeterol

Signs of cor pulmonale - "Please Read His Text"

Peripheral edema

Raised JVP

Hepatomegaly

Tricuspid incompetence

Portal hypertension features - "ABCDE"

Ascites

Bleeding (hematemesis, piles)

Caput medusae

Diminished liver

Enlarged spleen

Key questions needed in an emergency history taking situation- "AMPLE"

AllergiesMedicationPast medical historyLast meal

Events and environment related to injury

Malignancies that metastisize to bone - "Laging Panalo KungTaga Bulacan"

LungProstatKidneyThyroidBreast

Six "S" in Scarlet Fever

Streptococci causal organism

Sorethroat

Swollen tonsils

Strawberry tongue

Sandpaper rash

miliarySudamina vesicles over hands, feet, abdomen

Signs of anti-cholinergic crisis - "SLUD"

Salivation

Lacrimation

Urination


10/12

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)

Basic MI management - "BOOMAR"

Bed restOxygenOpiateMonitoringAnticoagulationReduce clot size

To Remember Immunoglobulins - "GAMED"

IgGIgAIgMIgEIgD

Location of the heart valve from right to left - "A PermanentlyTemperamental Man"

AorticPulmonaryTricuspidMitral

"Cut C4, breathe no more"

The 3rd, 4th and 5th cervical spinal nerves innervate the diaphragm.

Types of Joint movements - "FEEDPIPE CARDSHARP"

FlexionExtensionEversionDorsiflexionPronationInversionPlantarflexion

Elevation

CircumductionAbductionRotationDepressionSupinationHyperextensionAdductionRetractionProtraction

Defecation

Causes of huge spleen - "3M's"

MyelofibrosisMalariaMyelogenous leukemia

Cardinal Symptoms of Parkinson's Disease - "TRAP"

Tremor RigidityAkinesia and bradykinesiaPostural Instability

Days of appearance of rashesVaricella(chickenpox) - "Very SickPatients Must Take Double Exercise"

1st dayScarlet fever

2nd dayPox(smallpox)

3rd dayMumps

4th dayTyphus

5th dayDengue

6th dayEnteric fever(typhoid)

SHOCK HYPOTACHYTACHY

HYPOTENSION

TACHYPNEA

TACHYCARDIA

INCREASE ICP HYPERBRADYBRADY

CUSHINGS TRIAD:

HYPERTENSION (WIDE PULSE PRESSURE)

BRADYCARDIA

BRADYPNEA

HYPOGLYCEMIA

TREMORS, TACHYCARDIA

IRRITABILITY

RESTLESSNESS

EXTREME

DIAPHORESIS


11/12

PAGE 4

EARLY SIGNS OF HYPOXIA

RESTLESSNESSAGITATIONTACHYCARDIA

LATE SIGNS OF HYPOXIA

BRADYCARDIAEXTREME RESTLESSNESSDYSPNEACYANOSIS

CONGESTIVE HEART FAILURE

DIGOXINMORPHINEAMINOPHYLLINEDOPAMINEDIURETICSO2GASSES MONITOR (ABG)

MG SO4 TOXICITY

BP DECREASEURINE OUTPUT DECREASERESPIRATORY RATE DECREASEPATELLAR REFLEX ABSENT

SICKLE CELL DISEASE

HYDRATIONOXYGENATIONPAININFECTIONAVOID HIGH PLACES

PREGNANCY INDUCED HYPERTENSION

HEMOLYSISELEVATED LIVER ENZYMESLOWPLATELETS

GI SYMPTOMS AND TOXICITY TO DIGOXIN

VOMITTINGANOREXIANAUSEADIARRHEAABDOMINAL PAIN

FRACTURE

PRESSURERESTICECOMPRESSIONELEVATION

USE STRAW BECAUSE THESE DRUGS STAIN THE TEETH

L - LUGOL'S SOLUTION

I - IRON

N - NITROFURANTOIN

T - TETRACYCLINE

LR6 - LATERAL RECTUS : CN6

SO4 - SUPERIOR OBLIQUE : CN4

ALL3 - ALL THE REST : CN3

RADIATION TX VIA:

MUSTARD

ESTROGEN

NITROGEN

STEROIDS

ANTIBIOTICS

DILUTE DECREASE OSMOLALITY
http://2.bp.blogspot.com/_Efcf5tC-eSE/RlyH9IpL6-I/AAAAAAAAAAM/cGGahLUxElU/s1600-h/glass_with_straw.gif


12/12

TETRALOGY OF FALLOT

DISPLACED AORTARIGHT VENTRICULAR HYPERTROPHYOPENING INTO THE SEPTUM (VSD)PULMONARY STENOSIS

HYPOKALEMIA

SKELETAL MUSCLE WEAKNESSU-WAVE ON ECGCONSTIPATIONTOXICITY TO DIGOXINIRREGULAR WEAK PULSEOTOSTASISNUMBNESS PARESTHESIA

PAIN ASSESSMENT

PROVOCATIONQUALITYRADIATION, RELIEFSEVERITYTIME

NEUROVASCULAR CHECK

PAINPULSELESSNESSPARESTHESIAPARALYSISPALLOR

VIRCHOWS TRIAD IN DVT

VENUS STASISDAMAGE TO VESSELSHYPERCOAGUABILITY

ABDOMINAL AORTIC ANEURISM (4A)

ASSYMPTOMATICABDOMINAL MASSABDOMINAL PULSEACHES LOW BACK

ANTI TB DRUGS AND SIDE EFFECTS

RIFAMPICIN RED-ORANGE URINEISONIAZID PERIPHERAL NEURITISPYRAZINAMIDE INCREASE URIC ACIDETHAMBUTOL EYE PROBLEMSSTREPTOMYCIN OTOTOXIC

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