Memory tricks for med-surg nursing

CAUTION UP helps nurses remember the key indicators of cancer. Early detection dramatically improves treatment outcomes — knowing these signs helps you advocate for your patients before symptoms worsen.

Blood flows through the heart valves in a specific sequence. Remembering this order is essential for understanding cardiac physiology, heart sounds, and valve disorders. The sequence follows blood from the right side to the left side of the heart.

Left-sided HF (most common): left ventricle fails → blood backs up into pulmonary circulation. Signs: dyspnea (especially at rest or lying flat — orthopnea), paroxysmal nocturnal dyspnea, crackles in lungs, pink frothy sputum (severe), decreased SpO2, S3 gallop. Right-sided HF: right ventricle fails → backs up into systemic circulation. Signs: JVD (jugular vein distension), dependent pitting edema (ankles, sacrum), hepatomegaly, ascites, weight gain. Both: fatigue, decreased activity tolerance. Management: daily weights (report >2 lb gain in 1 day or >5 lb in 1 week), fluid restriction, low-sodium diet, elevate HOB, oxygen.

Coronary arteries supply oxygenated blood to the heart muscle. Understanding their location is essential for cardiac nursing — knowing which artery is blocked tells you which part of the heart is at risk during an MI.

Heart murmurs occur when turbulent blood flow creates abnormal sounds. Knowing which phase (systolic vs diastolic) a murmur occurs in is critical for identifying the underlying valve problem on NCLEX and in clinical practice.

APE To Man gives you the five auscultation sites in order. Aortic and Pulmonic are both in the 2nd intercostal space (2 words, 2nd space). Erb's point is in the 3rd. Tricuspid is at the 4th to 5th left lower sternal border. Mitral (sounds like "mid") is at the midclavicular line.

Appendicitis is one of the most common surgical emergencies. PAINS helps you recognize it quickly. Pain typically starts periumbilical then migrates to the right lower quadrant. McBurney's point is 1/3 the distance from the anterior superior iliac spine to the navel.

Hypercalcemia occurs when calcium levels exceed 10.5 mg/dL. Common causes: hyperparathyroidism, malignancy, prolonged immobility, excess vitamin D. The rhyming words make these symptoms impossible to forget — and they're high yield for NCLEX.

Addison's Disease is caused by LOW secretion of adrenal hormones — glucocorticoids, mineralocorticoids, and androgens. The body lacks the hormones it needs to maintain blood pressure, blood sugar, and electrolyte balance. Addisonian crisis is a life-threatening emergency.

Multiple sclerosis causes demyelination in the central nervous system — destroying the protective myelin sheath around nerves. DEMYELINATION spells out its own symptoms, making this one of the most elegant mnemonics in nursing. Symptoms worsen with heat (Uhthoff's phenomenon).

GOLDMARK helps you remember the causes of anion gap metabolic acidosis — when the kidneys are not removing enough acid from the body. Essential for med-surg and critical care nursing.

SLUDGE helps identify a cholinergic crisis — when the body fails to break down acetylcholine properly. This can occur with organophosphate poisoning or certain medications. Antidote is atropine.

AIR RAID helps identify epiglottitis — inflammation of the epiglottis blocking the airway. This is a medical emergency requiring immediate intervention. Do NOT attempt to visualize the throat — it can cause complete airway obstruction.

BALD CHASM helps you systematically assess a patient's family medical history for hereditary conditions. A thorough family history can reveal risk factors that shape your entire care plan.

MR. DICE RUNS is a fun and memorable way to recall 10 major body systems (most texts add an 11th: lymphatic/immune). Knowing these systems is foundational for med-surg nursing and essential for NCLEX preparation.

Classic MI symptoms: crushing chest pain (may radiate to jaw, left arm, back), diaphoresis, nausea, shortness of breath. Women/diabetics: atypical — jaw pain, fatigue, nausea only. MONA: Morphine (reduces preload/pain — now questioned in STEMI), Oxygen (if SpO2 <90%), Nitrates (vasodilation — hold if systolic <90 or recent sildenafil use), Aspirin (antiplatelet — 162–325 mg chewed). ECG: within 10 minutes of arrival. ST elevation = STEMI — needs cath lab within 90 min. Troponin: gold standard biomarker, rises 3–4 hr after MI. Give nothing by mouth (NPO) — may need procedure.

FAST: Face drooping (ask to smile — asymmetry), Arm weakness (raise both arms — one drifts down), Speech difficulty (slurred or unable to speak), Time — call 911 immediately. Two types: Ischemic (87% — clot) and Hemorrhagic (13% — bleed). Treatment: Ischemic → tPA (alteplase) if within 3–4.5 hours of LAST KNOWN WELL, no hemorrhage on CT. Hemorrhagic → no tPA, manage BP, possible surgery. Nursing: NIH Stroke Scale assessment, position HOB 30°, NPO until swallow evaluation, falls precautions, BP management (allow permissive hypertension in ischemic unless giving tPA). Time is brain — 1.9 million neurons lost per minute.

Upper GI bleeds (esophagus, stomach, duodenum) present as hematemesis (bright red or coffee-ground vomit) and melena (black, tarry, foul-smelling stool from digested blood). Lower GI bleeds present as hematochezia (bright red blood per rectum). Common causes: peptic ulcer disease (often from H. pylori infection or NSAID use), esophageal varices in cirrhosis, Mallory-Weiss tears. Priority nursing: ABCs, large-bore IV access, type and crossmatch, monitor H&H and vital signs for shock (tachycardia first, hypotension later), NPO status, prepare for endoscopy. PUD from H. pylori is treated with bismuth quadruple therapy — a PPI, bismuth, and two antibiotics — and patients are taught to avoid NSAIDs, alcohol, and smoking, all of which worsen ulcer healing.

Cirrhosis is irreversible liver scarring that disrupts nearly every liver function at once. Portal hypertension from scarring causes ascites and esophageal varices (bleeding risk). Reduced albumin production contributes to ascites and peripheral edema. Reduced clotting factor synthesis raises bleeding risk further. Reduced ammonia clearance leads to hepatic encephalopathy — confusion, asterixis (flapping hand tremor), and altered LOC as ammonia builds up and affects the brain. Nursing priorities: daily weights and abdominal girth measurements to track ascites, monitoring for bleeding and avoiding straining/hard foods (varices risk), and administering lactulose, which traps ammonia in the gut and promotes its excretion through stool — titrated to produce 2–3 soft stools per day.

Seizure types include tonic-clonic (generalized convulsions with loss of consciousness), absence (brief staring spells, common in children), and focal (affecting one brain area, may or may not impair awareness). During a seizure: protect the patient from injury by padding/removing nearby objects, never restrain the patient or put anything in their mouth, time the seizure, and turn the patient to a side-lying position once possible to protect the airway. After the seizure: reorient the patient, monitor level of consciousness, and assess for injury. Status epilepticus — a seizure lasting longer than 5 minutes, or repeated seizures without return to baseline between them — is a medical emergency requiring IV benzodiazepines (typically lorazepam) and close airway management.

Normal ICP: 5–15 mmHg. Early ICP signs: headache (worse with straining), nausea/vomiting (projectile), altered LOC, pupil changes (unequal, sluggish). Late sign — Cushing's Triad (EMERGENCY): Bradycardia + Hypertension (widening pulse pressure) + Irregular/slow respirations → impending brainstem herniation. Nursing: HOB 30°, head midline (no neck rotation — impairs venous drainage), avoid clustering care, dim lights/quiet environment, avoid Valsalva (no straining), monitor pupil response. Do NOT: suction vigorously, hip flexion >90°, prone positioning.

COPD (emphysema + chronic bronchitis): irreversible airway obstruction. Emphysema: barrel chest, pursed-lip breathing, decreased breath sounds, 'pink puffer' (fights to breathe). Chronic bronchitis: productive cough >3 months/2 years, 'blue bloater.' O2 in COPD: hypoxic drive — give O2 1–2 L/NC or Venturi mask, target SpO2 88–92% (not 95–100%). High O2 may suppress respiratory drive. Asthma: reversible bronchospasm, triggered (allergens, exercise, cold). Wheezing on expiration. Peak flow meter: green >80%, yellow 50–80%, red <50%. Rescue inhaler (albuterol) before preventive (corticosteroid inhaler).

Signs: fever and chills, productive cough (yellow/green/rust-colored sputum), pleuritic chest pain (worse with breathing), crackles and decreased breath sounds in affected lobe, tachypnea, hypoxia. Community-acquired (CAP): S. pneumoniae most common. Hospital-acquired (HAP): gram-negative organisms, MRSA. Nursing care: semi-Fowler's position (HOB 30–45°), encourage fluids (2–3 L/day unless restricted — thins secretions), deep breathing and coughing exercises, incentive spirometer, turn every 2 hours, ambulate early. Prevention: pneumococcal vaccine, hand hygiene, oral care in ventilated patients (VAP bundle).

Hypoglycemia (<70 mg/dL): Cold and Clammy — diaphoresis, tremors, tachycardia, confusion, seizure. Cause: too much insulin, missed meal, excess exercise. Treatment: 15-15 rule — 15g fast carbs (4 oz juice, glucose tablets), recheck in 15 min. If unconscious: IV dextrose (D50) or glucagon IM. Hyperglycemia (>180–250): Hot and Dry — polyuria (3 Ps: Polyuria, Polydipsia, Polyphagia), fruity breath (DKA), Kussmaul respirations (deep, rapid — blowing off CO2 in DKA). DKA (Type 1): ketones, pH <7.3. HHS (Type 2): extreme hyperglycemia, no ketones, elderly. Treatment: insulin drip, IV fluids, K+ replacement.

AKI: rapid decline in kidney function over hours to days. Stages (KDIGO): 1 to 3 (older RIFLE: Risk, Injury, Failure, Loss, ESKD). Oliguric phase: urine output <0.5 mL/kg/hr, BUN and creatinine rise, K+ rises (hyperkalemia — most dangerous). AEIOU urgent dialysis indications: Acidosis (metabolic), Electrolyte imbalance (hyperkalemia → EKG changes, peaked T-waves → cardiac arrest), Intoxication (dialyzable toxins — lithium, ethylene glycol, methanol, salicylates), Overload (fluid), Uremia (N/V, pericarditis, pruritus). Nursing: strict I&O, daily weights, low K+ diet, BP monitoring, dialysis access care. Fluid challenge: 500 mL NS bolus if pre-renal cause.

Immediate post-op (PACU): Airway — maintain, suction if needed. Breathing — respiratory rate, SpO2, breath sounds. Circulation — BP, HR, bleeding at surgical site. Drugs — anesthesia reversal, pain management. Temperature — hypothermia common (warm blankets, forced air). Early complications: respiratory depression (opioids — give Narcan), airway obstruction (tongue, secretions), hemorrhage (increasing HR, decreasing BP), emergence delirium. Late complications: atelectasis (encourage deep breathing, IS), DVT (SCDs, early ambulation, anticoagulants), wound infection (3–5 days post-op fever), paralytic ileus (listen for bowel sounds).

Potassium (normal 3.5–5.0): Hypo (<3.5): muscle weakness, cramps, U waves on EKG, constipation. Causes: diuretics, vomiting, NG suction. Replace slowly (never IV push — fatal). Hyper (>5.0): peaked T waves, wide QRS, muscle weakness, cardiac arrest. Treat: calcium gluconate (protect heart), insulin+dextrose (shift K+ into cells), Kayexalate. Sodium (normal 135–145): Hypo (<135): headache, confusion, seizures — restrict fluids, hypertonic saline (slowly or osmotic demyelination). Hyper (>145): thirst, dry mucosa, restlessness, seizures — free water replacement. Calcium: Hypo — Trousseau's and Chvostek's signs, tetany. Magnesium: Hypo — cardiac dysrhythmias.

Stage I: intact skin, non-blanchable redness. Intervention: relieve pressure, moisturize. Stage II: partial thickness skin loss — shallow open ulcer or blister. Stage III: full thickness skin loss, subcutaneous tissue visible, no bone/tendon. Stage IV: full thickness, bone/tendon/muscle exposed. Unstageable: covered by eschar — cannot stage until debrided. Deep tissue injury (DTI): purple/maroon discoloration, intact skin. Prevention: turn every 2 hours, pressure-relieving mattress, keep dry (moisture = skin breakdown), adequate nutrition (protein + vitamin C + zinc), assess Braden scale. Never massage over bony prominences — increases breakdown.

Normal values: pH 7.35–7.45, PaCO2 35–45 mmHg (respiratory), HCO3 22–26 mEq/L (metabolic). Step 1: pH — acidosis (<7.35) or alkalosis (>7.45)? Step 2: PaCO2 — if it matches pH direction (opposite), it's respiratory. Step 3: HCO3 — if it matches pH direction (same), it's metabolic. ROME: Respiratory Opposite (pH up, CO2 down = alkalosis), Metabolic Equal (pH up, HCO3 up = alkalosis). Compensation: the system NOT causing the problem tries to correct pH. Respiratory acidosis (hypoventilation, COPD): pH↓, CO2↑. Metabolic acidosis (DKA, renal failure): pH↓, HCO3↓. Metabolic alkalosis (vomiting, NG suction): pH↑, HCO3↑.

DVT risk (Virchow's Triad): Stasis (immobility, bedrest, long travel), Vessel damage (trauma, surgery, IV access), Hypercoagulability (pregnancy, cancer, clotting disorders, OCP). DVT signs: unilateral leg swelling, warmth, redness, pain — Homan's sign (calf pain with dorsiflexion) unreliable but still tested. PE signs: sudden dyspnea, pleuritic chest pain, tachycardia, hypoxia, hemoptysis, anxiety — can cause sudden death. PE triad: dyspnea + chest pain + hemoptysis. Prevention: early ambulation, SCDs (sequential compression devices), Ted hose, hydration, anticoagulation. Treatment: heparin → warfarin or LMWH → DOAC. Nursing: never massage a suspected DVT (embolization risk), elevate extremity, warm compresses, monitor anticoagulation levels, bleeding precautions. NCLEX: sudden onset dyspnea post-op = PE until proven otherwise.

Thyroid Storm (thyrotoxic crisis): severe hyperthyroidism — triggered by stress, infection, surgery. Signs: hyperthermia (high fever), tachycardia (often A-fib), HTN, agitation, diaphoresis, tremor, diarrhea, vomiting — can progress to heart failure and death. Treatment: propylthiouracil (PTU) or methimazole (block new hormone), propranolol (control HR), glucocorticoids, cooling measures, treat precipitating cause. Myxedema Coma: severe hypothyroidism — triggered by cold, infection, sedatives. Signs: hypothermia, bradycardia, hypotension, hypoventilation, hyponatremia, altered LOC, myxedema (non-pitting facial/extremity edema). Treatment: IV levothyroxine, warming blankets (slowly — rapid rewarming causes vasodilation), airway management, corticosteroids. NCLEX: both are emergencies. Storm = everything elevated. Coma = everything depressed.

Burn depth: Superficial (1st degree) — epidermis only, red, painful, no blisters (sunburn). Partial thickness (2nd degree) — epidermis + dermis, blisters, moist, very painful — most painful burn. Full thickness (3rd degree) — all layers, leathery, dry, painless (nerve destruction), requires grafting. 4th degree — bone/muscle involvement. Rule of Nines (adults): Head/neck = 9%, Each arm = 9%, Chest = 18%, Back = 18%, Each leg = 18%, Perineum = 1%. Fluid resuscitation (Parkland formula): 4 mL x kg x %TBSA burned. Give 1/2 in first 8 hours from time of injury (NOT from hospital arrival), remaining 1/2 over next 16 hours. Use Lactated Ringer's. Monitor urine output (goal 0.5–1 mL/kg/hr adults). Airway is priority — inhalation injury kills. Circumferential burns may need escharotomy.

DIC is not a disease — it's a complication of: sepsis (most common), obstetric emergencies (abruption, amniotic fluid embolism, PPH), trauma, massive transfusion, cancer. Pathophysiology: massive coagulation cascade activation → consumes all clotting factors and platelets → simultaneous microvascular clotting AND uncontrolled bleeding. Signs: bleeding from all sites (IV sites, gums, nose, petechiae, purpura, hematuria, GI bleed) AND organ ischemia from microthrombi (necrosis, renal failure). Labs: PT↑, PTT↑, platelets↓, fibrinogen↓, D-dimer↑ (markedly), schistocytes on smear. Treatment: treat underlying cause, replace clotting factors (FFP, cryoprecipitate, platelets), RBC transfusion, heparin controversial. Nursing: assess all body systems for bleeding, pad side rails, gentle handling, no IM injections, pressure on puncture sites.

All shock = inadequate tissue perfusion → cellular hypoxia → organ failure. Hypovolemic: low volume (hemorrhage, burns, dehydration) — cold/clammy, tachycardia, low BP. Treat: fluids, blood, control bleeding. Cardiogenic: pump failure (MI, heart failure) — cold/clammy, elevated JVD, pulmonary edema. Treat: inotropes, diuretics (not fluids!). Distributive (septic, neurogenic, anaphylactic): vasodilation → maldistribution — warm/flushed early. Septic: fever, tachycardia, hypotension, altered LOC — sepsis bundle (blood cultures, broad antibiotics, fluids, vasopressors). Neurogenic (spinal injury): hypotension + bradycardia (no tachycardia — lost sympathetic tone) + warm/dry skin. Anaphylactic: epinephrine IM first, airway, diphenhydramine, steroids. Obstructive: mechanical obstruction (PE, tension pneumo, cardiac tamponade) — treat cause. Universal shock nursing: large-bore IV x2, fluid challenge (except cardiogenic), O2, VS Q15min, urine output, elevate legs (except cardiogenic/neuro).

Normal ICP: 5–15 mmHg. Causes: head trauma, hemorrhage, tumor, hydrocephalus, meningitis, stroke. Early signs: headache (worse in morning, with Valsalva), nausea/vomiting (projectile, without nausea), changes in LOC (earliest sign — restlessness, confusion), pupil changes (sluggish), blurred/double vision. Late signs (herniation imminent): Cushing's Triad = hypertension + bradycardia + irregular respirations. Decorticate posturing (arms flexed = cortical damage), Decerebrate posturing (arms extended = brainstem damage — worse). Nursing interventions: HOB 30–45° (promotes venous drainage), neck in neutral alignment, minimize stimulation, avoid Valsalva (no straining, coughing — stool softeners), space out care (avoid clustering), avoid hyperthermia, monitor neuro status Q1h, avoid hypotonic fluids (worsens cerebral edema). Medications: mannitol (osmotic diuretic), hypertonic saline, corticosteroids (tumor only).

Pain out of proportion, pain unrelieved by opioids, and pain with passive stretch are the earliest compartment syndrome signs — act on these, don't wait for a diminished pulse. Keep the limb at heart level, never elevate above it. Fat embolism syndrome appears 24-72 hours after a long bone fracture (femur, pelvis): respiratory distress, confusion, petechial rash — the classic triad.

Lupus: malar rash, photosensitivity, nonerosive arthritis, kidney/heart/CNS involvement — anti-Sm/anti-dsDNA most specific. RA: symmetric polyarthritis, progressive deformities (ulnar deviation, swan-neck, boutonnière) — anti-CCP most specific. Both cause morning stiffness that improves with activity (an hour or more is classic for RA) — that alone doesn't distinguish them. Methotrexate (RA first-line): monitor CBC/LFTs, folic acid, avoid alcohol and pregnancy.

CKD = GFR under 60 or kidney damage (e.g., albuminuria) for 3+ months; Stage 5/ESRD = GFR under 15. Start dialysis access planning at Stage 4 — an AV fistula takes 6 weeks to 3+ months to mature. Assess fistula patency every shift: palpate for thrill, auscultate for bruit. Never take BP, draw blood, or start an IV in that arm. Peritoneal dialysis: cloudy effluent = peritonitis until proven otherwise. Dialysis disequilibrium syndrome (new patients): headache, confusion, twitching, possible seizures.

Small bowel obstruction: rapid onset, frequent early vomiting, minimal distension. Large bowel: gradual onset, significant distension, late/minimal vomiting, ribbon-like stools. Fever + tachycardia + sudden severe pain = suspect strangulation/perforation. Pancreatitis: Cullen's sign (periumbilical) and Grey Turner's sign (flank) both indicate retroperitoneal hemorrhage. Lipase more specific than amylase. Hypocalcemia from fat necrosis binding calcium (saponification). Both conditions: NPO + NG decompression to rest the GI tract.

Sepsis = life-threatening organ dysfunction from dysregulated response to infection. qSOFA (2 of 3 = high risk; not for use alone as a screen): Altered mental status, Respiratory rate ≥22, Systolic BP ≤100. Septic shock = sepsis + vasopressors needed to maintain MAP ≥65 + lactate >2 despite fluids. Hour-1 Bundle (Surviving Sepsis Campaign): Measure lactate (>2 = tissue hypoperfusion), Obtain blood cultures x2 before antibiotics, Administer broad-spectrum antibiotics, Begin 30 mL/kg crystalloid for hypotension or lactate ≥4, Apply vasopressors (norepinephrine first-line) for MAP <65. Nursing: recognize early (subtle LOC change, tachycardia, fever or hypothermia, tachypnea), act fast, large-bore IV access, urine output monitoring (goal >0.5 mL/kg/hr), repeat lactate at 2 hours if initial >2. Document time of all bundle elements.

Pneumothorax = air in pleural space → lung collapse. Simple: spontaneous (tall thin young males) or traumatic. Tension: air enters but cannot escape → mediastinal shift → compresses heart and great vessels → obstructive shock. EMERGENCY — tracheal deviation AWAY from affected side, absent breath sounds, JVD, hypotension, tachycardia. Treatment: needle decompression (4th/5th ICS anterior axillary line, or 2nd ICS MCL) → chest tube. Chest tube nursing: keep drainage system below chest level, keep tubing free of kinks, tidaling normal (fluid rises with inspiration, falls with expiration — means patent), bubbling in water seal = air leak (continuous = bad, intermittent normal during coughing). Clamping = dangerous — do not clamp without order. If tube dislodges: cover with petroleum gauze taped on 3 sides (flutter valve). Monitor drainage — notify if >100 mL/hr (hemorrhage).

Stroke is a "Time = Brain" emergency — 1.9 million neurons die every minute without treatment. The thrombolytic window for tPA is 3–4.5 hours from last known well; thrombectomy can extend to 24 hours in selected clients. FAST helps bystanders AND nurses recognize stroke fast. In hospital, use the NIH Stroke Scale. New onset facial droop + arm drift + slurred speech = stroke until proven otherwise — call a rapid response immediately.

Virchow's Triad explains every DVT. Post-op patients hit all three: immobility (stasis), trauma (vessel injury), surgical stress response (hypercoagulability). Prevention bundle: early ambulation, sequential compression devices (SCDs), anticoagulants. Never massage a suspected DVT — risk of pulmonary embolism. Homan's sign is unreliable — don't rely on it.

The key differentiator: ONSET. Delirium = hours to days, fluctuates, has a cause (infection, meds, pain, hypoxia). Dementia = months to years, steady decline. A delirious patient with known dementia is common — always look for the NEW reversible cause. Use I WATCH DEATH to find it. Treat the cause, not just the symptoms.