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15 Essential Med-Surg Mnemonics for Your NCLEX Prep

1. Think 4 A's = Four negative symptoms of schizophrenia.
A=affective flattening
A=attention problem

Schizophrenia affects about 0.7% of the population and is characterized by a breakdown of thought processes and emotional deficits. Common positive symptoms include hallucinations, bizarre delusions, and disorganized speech and thought. Negative symptoms are above and as follows. Affective flattening means having a glazed or frozen expression with few emotions. Anhedonia is an inability to experience pleasure in normal activities. Apathy is a state of indifference or learned helplessness. Attention problems refer to their disorganized thoughts or inability to focus on a task.

2. DRIP = Causes of acute and reversible forms of urinary incontinence
D: Delirium or dementia
R: Restricted mobility, retention
I: Infection (especially elderly), impaction (fecal)
P: Polyuria, pharmaceuticals

Acute incontinence can happen even in the young or middle-aged for a variety of reasons as listed above. Some common causes could be delirium/dementia from possible infection or drug use. Restricted mobility or retention due to trauma, cancer, or kidney stones. Infection especially urinary tract infection can cause this but other infections as well such as people acutely ill from pneumonia may develop incontinence secondary to their temporary inability to self-care. Constipation can cause pressure on the bladder and lead to incontinence, especially in children. Disease-causing polyuria such as diabetic onset or taking various pharmaceuticals that have it as a side-effect can cause incontinence. This usually resolves with treatment of underlying conditions or discontinuing the medication.

3. STING = Symptoms for Hyperthyroidism

S: Sweating
T: Tremors or tachycardia
I: Intolerance to heat, irregular menstruation, irritability, irregular eyes (bulging, weakness)
N: Nervousness, neurological (chorea, paralysis, tremors, myopathy)
G: Goitre and gastrointestinal problems (diarrhea/constipation/nausea/vomiting), also called Graves Disease

Hyperthyroidism is an overactive thyroid causing excessive thyroid hormone to circulate. The most common form is Graves Disease. Too much thyroid hormone causes increase metabolism and speeds up the sympathetic nervous system. Think of it resembling an overdose of adrenaline or caffeine and you will picture the clinical symptoms as above.

4. CAGE = alcohol use screening for intake

C: Have you ever felt it necessary to CUT DOWN on your drinking?
A: Has anyone ever told you they were ANNOYED by your drinking?
G: Have you ever felt GUILTY about your drinking?
E: Have you ever felt the need to have a drink in the morning for an EYE OPENER?

You may be familiar with this but it actually is a validated scale for asking about alcoholism. It is to be used as a screening tool and not to be diagnostic of alcoholism. Essentially the answers you get during the screening can alert a clinician to have more of a conversation with the patient and figure out whether or not alcoholism is a concern/diagnosis.

5. O-P-Q-R-S-T = Questions to ask about pain besides the pain scale

O=Onset of pain.when did it start?
P=Palliative or provocative factors for the pain. What makes it better or worse?
Q=Quality of pain. Does it burn, dull, ache, stab, etc...
R=Region affected. Where is it?
S=Severity of pain. On a scale of 1-10, 10 being the worse, what number is your pain?
T=Timing/duration. When does your pain start and how long does it last?

This is a common set of questions for nurses to ask to assess pain. Although the severity is important. If a patient has pain, it is necessary to assess what could be causing it to provide nursing interventions and provide a good report to an attending.

6. BBEDDS = How to describe wounds

B: Basics: where, size, shape
Base: the color of the inside base
Edge: flat, punched out, undermined, rolled, everted
Depth: how deep is it?
Discharge: smell and color of any exudate
Surroundings: redness, warmth, or necrosis around the wound?

Wound care is an essential part of medical surgical nursing. Here are the essential parts to any wound charting/assessment that is done on admission, at the onset of the first wound assessment, or when caring for a wound.

7. BAD GUT PAINS = Reasons for Acute Abdominal Pain

B - Bowel obstruction
A - Appendicitis, Adenitis
D - Diverticulitis, Diabetic Ketoacidosis, Dysentery/Diarrhea, Drug withdrawal

G - Gastroenteritis, Gallbladder disease/obstruction
U - Urinary tract obstruction or infection
T - Testicular Torsion, Toxin

P- Pneumonia, Pleurisy, Pancreatitis, Perforated bowel/ulcer, Porphyria
A - Abdominal aneurysm
IN - Infarcted bowel, infarcted myocardium (MI), incarcerated hernia, inflammatory bowel disease,
S - Splenic rupture/infarction, Sickle cell pain crisis, Sequestration crisis

These are all common reasons for acute abdominal pain that would come in handy for patients being screened in an emergency room setting or who develop these symptoms on your floor while an inpatient.

8. 7 A's = Causes of Hyperkalemia
  1. Artifact
  2. Aldosterone antagonist
  3. Addison’s disease
  4. Acidosis
  5. ACE inhibitors
  6. Angiotensin receptor blocker
  7. Anti-inflammatory
These are all good things to think about when you get that high potassium drawback at 5 am. Is it a poor lab draw caused by a traumatic stick (artifact)? Is it related to a medication that is an aldosterone antagonist? Is the patient developing Addison's disease (chronic adrenal insufficiency) from stopping steroids too quickly? Is it a result of acidosis? Is the patient on an ACE inhibitor causing electrolyte imbalance? Is there kidney function impairment by either an angiotensin blocker or a kidney disease? Or is it the result of an anti-inflammatory reaction or medication?

9. DIG FAST = Symptoms of Mania

  1. Distractibility
  2. Indiscretion or excessive involvement in pleasurable activities
  3. Grandiosity
  4. Flight of ideas
  5. Activity increase
  6. Sleep deficit (decreased need for sleep)
  7. Talkativeness (pressured speech)

Mania can be a symptom of bipolar disorder. It can also result from prescribed medicine use or illicit drug use. These are the common symptoms and one typically has to exhibit multiple symptoms to be diagnosed with mania.

10. ABCDEFGHI = Non-GI causes of Vomiting

Acute renal failure
Brain (increased intracranial pressure)
Ears (labyrinthitis)
Foreign substances/pharmaceuticals
Hyperemesis gravidarum (pregnancy-induced nausea/vomiting)

There can be non-GI causes of vomiting and these are a few of the causes above. This is important to note that not every patient with emesis that you take care of has typical gastroenteritis and to know the complexity of the differential with these patients.

11. 4 E's = The Precipitating Factors to Angina (chest pain)

  • Exerting
  • Eating
  • Emotional distress
  • Extreme temperatures

Know what puts your cardiac patients at risk for chest pain, angina, signaling increased stress on a heart. Preventing and treating angina is essential to ensuring the wellbeing of cardiac patients and preventing adverse safety events such as a myocardial infarction or heart attack.

12. FRIED = Signs of Hypernatremia

  • Fever: look for flushed skin
  • Restless: look for irritability irritable
  • Increased fluid retention: look for urinary retention and increased blood pressure
  • Edema: look for peripheral and pitting edema or swelling particularly in the lower extremities
  • Decreased urine output: look for hourly urine measurements and dry mucose membranes

Hypernatremia or excess salt in the bloodstream is most common in dehydrated, elderly patients and those with neurological damage such as traumatic brain injuries.

13. 5 P's = The Perfusion (circulation) Assessment

  1. Pain: Limb pain may indicate poor perfusion when combined with edema or scleroderma.
  2. Paresthesia: Numbness, tingling, pins, or needles, are an indication of sensory changes that may be due to a lack of blood flow.
  3. Paralysis: Patients with paralysis are more likely to suffer from complications of poor perfusion such as deep venous thrombus and should thus be assessed more frequently in terms of perfusion. Preventative measures to increase blood circulation such as sequential compression devices should be utilized,
  4. Pallor: Coloration, or the lack of, indicated poor perfusion to the extremities. Assess for temperature as well as dusky or blue limbs are often cold.
  5. Pulse: Weak pulses that are easily obliterated or difficult to find may indicate decreased perfusion, ultrasound doppler should be used to assess further for perfusion

14. SPAMS = Leading Causes of Heart Murmurs

  • Stenosis
  • Partial obstruction
  • Aneurysm
  • Mitral regurgitation
  • Septal defect

More often than not an audible heart murmur will have a congenital cause, however, the nurse should be mindful that different patient populations are also at risk for complications signaled by the heart murmur. For example; trauma patients are particularly at risk of aneurysm, stroke patients have a common etiology in stenosis, and heart failure patients often experience obstruction and regurgitation.

15. CATS = Complications of Hypocalcemia

  • Convulsions: Seizures are a dangerous complication of low calcium
  • Arrhythmias: Calcium is an essential participant in the potassium pump channel that ensures electrical conduction in cardiac muscle tissue.
  • Tetany: Muscle cramps, spasms, and tremors are common with even mild cases of hypocalcemia.
  • Stridor: Tracheomalacia, or the collapse of the trachea, can occur with prolonged hypocalcemia due to a decrease of cartilage strength in the larynx.