Acid-base—"RAMS" (Respiratory Alternate, Metabolic Same)

Alcohol withdrawal: clinical features—"HITS"^a

• Hallucinations (visual, tactile)
• Increased vital signs and insomnia
• Tremens → delirium tremens (potentially lethal)
• Shakes/Sweats/Seizures/Stomach pains (nausea, vomiting)

Angina: precipitating factors—"three Es"

• Eating
• Emotion
• Exertion (Exercise)

Anorexia nervosa: clinical features—"A²NOREXI²C"^a

• 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)
• ↑ eXercise
• Intelligence often above average/Induced vomiting
• Cathartic use (and diuretic abuse)

Appendicitis: assessment—"PAINS"

• Pain (RLQ)
• Anorexia
• Increased temperature, WBC (15,000–20,000)
• Nausea
• Signs (McBurney's, psoas)

Arterial occlusion: symptoms—"six Ps"

• Pain
• Pale
• Pulseless
• Paresthesia
• Poikilothermic
• Paralysis

Blood glucose (rhyme)

Blood vessels in umbilical cord—"AVA"

• Artery
• Vein
• Artery

Cancer: early signs—"CAUTION"

• Change in bowel or bladder habits
• A persistant sore throat
• Unusual bleeding or discharge
• Thickening or lump
• Indigestion: dysphagia
• Obvious change in a wart/mole
• Nagging cough or hoarseness

Cancer: focus of patient care—"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)

Cholecystitis: risk factors—"five Fs"

• Female
• Fat
• Forty
• Fertile
• Fair

Cleft lip: nursing care plan (postoperative)—"CLEFT²LIP"

• Crying, minimize
• Logan bow
• Elbow restraints
• Feed with Breck feeder
• Teach feeding techniques/Two months of age (average age at repair)
• Liquid (sterile water), rinse after feeding
• Impaired feeding (no sucking)
• Position—never on abdomen

Cognitive disorders: assessment of difficulties—"JOCAM"

• Judgment
• Orientation
• Confabulation
• Affect
• Memory

Coma: causes—"A²-E³-I-O-U T²IPS²"^b

• 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

Complication of severe preeclampsia—"HELLP" Syndrome

• Hemolysis
• Elevated Liver enzymes
• Low Platelet count

Cushing's syndrome: symptoms—"three Ss"

• Sugar (hyperglycemia)
• Salt (hypernatremia)
• Sex (excess androgens)

Diabetes: signs and symptoms—"three Ps," "three 'poly's"

• Polydipsia (very thirsty)
• Polyphagia (very hungry)
• Polyuria (urinary frequency)

Diet: low cholesterol—avoid the three Cs:

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

Dystocia: etiology—"three Ps"

• Power
• Passageway
• Passenger

Dystocia: general aspects (maternal)—"three Ps"

• Psych
• Placenta
• Position

Episiotomy assessment—"REEDA"

• Redness
• Edema
• Ecchymosis
• Discharge
• Approximation of skin

Eye medications

• Mydriatic = dilated pupils
• Miotic = tiny (constricted) pupils

Hypertension: complications—"four Cs"

• 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

Infections: signs—"INFE³CT"

• Increased—pulse, respiration, WBC
• Nodes—enlarged
• Function—impaired

E³: Erythema, Edema, Exudate

• Complaints—discomfort, pain
• Temperature—local or systemic

IUD: potential problems with use—"PAINS" ^c

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

Manipulation: nursing plan—promote the "three Cs"

• Cooperation
• Compromise
• Collaboration

Medication administration—"six rights"

• RIGHT medication
• RIGHT dosage
• RIGHT route
• RIGHT time
• RIGHT client
• RIGHT technique

Melanoma characteristics—"ABCD"

• Asymmetry
• Border
• Color
• Diameter

Mental retardation: nursing care plan—"three Rs"

• Regularity (provide routine and structure)
• Reward (positive reinforcement)
• Redundancy (repeat)

Myocardial infarction: treatment—"M²ONA"

• MONA greets every M.I.:
• 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" ^c

• 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)

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—"ABCDE"

• Ask about the pain
• Believe when clients say they have pain
• Choices—let clients know their choices
• Deliver what you can, when you said you would
• Empower/Enable clients' control over pain

Postoperative complications: order—"four Ws"

• Wind (pulmonary)
• Wound
• Water (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

Schizophrenia: primary symptoms—"four As"

• Affect
• Ambivalence
• Associative looseness
• Autism

Sprain: nursing care plan—"RICE"

• Rest
• Ice
• Compression
• Elevation

Stool assessment—"ACCT"

• Amount
• Color
• Consistency
• Timing

Tracheoesophageal fistula: assessment—"three Cs"

• 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—"three Ts"

• Temporary unilateral visual impairment
• Transient paralysis (one-sided)
• Tinnitus = vertigo

Trauma care: complications—"T²RAUMA"

• 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 neurological disorder)—"COAT RACK" ^d

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

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^a Modified from Rogers, PT: The Medical Student's Guide to Top Board Scores. Little, Brown, Boston (out of print).

^b Adapted from Caroline, NL: Emergency Care in the Streets, ed 5. Little, Brown, Boston (out of print)

^c From Hatcher, RA, et al: Contraceptive Technology, ed 16. Irving, New York.

^d Adapted from Rogers, PT: The Medical Student's Guide to Top Board Scores. Little, Brown, Boston (out of print).