Early cancer warning signs — early detection saves lives
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.
Telling left from right heart failure: lungs vs body — the most testable distinction
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.
Left HF
Lungs — SOB, crackles, orthopnea
Right HF
Body — JVD, edema, weight gain
Monitor
Daily weight — >2 lb = call provider
Position
HOB elevated 30–45°
Coronary Arteries
RIGHT CAMP LEFT AC
Right Coronary Artery · Marginal Artery · Posterior Intraventricular · Left Anterior Descending · Circumflex Artery
I have a RIGHT to CAMP if you LEFT off the AC
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.
hARD
Aortic Regurgitation = Diastolic murmur
ASS
Aortic Stenosis = Systolic murmur
MRS.
Mitral Regurgitation = Systolic murmur
MSD
Mitral Stenosis = Diastolic murmur
Cardiac Valves
Toilet Paper My Ass
Tricuspid · Pulmonic · Mitral · Aortic
Order of blood flow through the four heart valves
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.
T
Tricuspid — right atrium to right ventricle
P
Pulmonic — right ventricle to pulmonary artery
M
Mitral — left atrium to left ventricle
A
Aortic — left ventricle to aorta and body
Heart Sounds
APE To Man
Aortic · Pulmonic · Erb's point · Tricuspid · Mitral
Auscultation sites for heart sounds in order
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 in the 5th left sternal border. Mitral (sounds like "mid") is at the midclavicular line.
A
Aortic — 2nd intercostal space, right sternal border
P
Pulmonic — 2nd intercostal space, left sternal border
E
Erb's point — 3rd intercostal space, left sternal border
T
Tricuspid — 5th intercostal space, left sternal border
M
Mitral — 5th intercostal space, 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.
P
Pain in right lower quadrant — rebound tenderness
A
Anorexia — loss of appetite
I
Increased temperature and WBC (15,000-20,000)
N
Nausea and vomiting
S
Signs — McBurney's point, Psoas sign
Hypercalcemia
GROANS MOANS BONES STONES OVERTONES
Constipation · Joint pain · Bone loss · Kidney stones · Psychiatric symptoms
Signs and symptoms of hypercalcemia — the rhymes make it stick
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.
Assessment findings of Addison's Disease — low adrenal hormones
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.
G
Glycols — ethylene glycol and propylene glycol poisoning
O
Oxoproline — accumulates with chronic acetaminophen use
L
L-lactate — lactic acidosis from shock or hypoxia
D
D-lactate — from short bowel syndrome
M
Methanol — toxic alcohol ingestion
A
Aspirin — salicylate toxicity
R
Renal failure or uremia — kidneys can't excrete acid
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.
Recognize epiglottitis — a life-threatening airway emergency
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.
A
Airway closed — obstructed by swollen epiglottis
I
Increased pulse — tachycardia from distress
R
Restlessness — agitation from hypoxia
R
Retractions — intercostal muscles pulling inward
A
Anxiety — air hunger and fear
I
Inspiratory stridor — turbulent airflow through larynx
Assess family history for genetically transmitted conditions
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.
B
Blood pressure — hypertension history
A
Arthritis — rheumatoid or osteoarthritis
L
Lung diseases — COPD, asthma, TB
D
Diabetes — Type 1 or Type 2
C
Cancers — any type in family history
H
Heart diseases — MI, CHF, arrhythmias
A
Alcoholism — substance use disorders
S
Stroke — CVA history
M
Mental health disorders — depression, schizophrenia
MR. DICE RUNS is a fun and memorable way to recall all 10 major body systems. Knowing these systems is foundational for med-surg nursing and essential for NCLEX preparation.
M
Muscular
R
Respiratory
D
Digestive
I
Integumentary — skin, hair, nails
C
Circulatory
E
Endocrine
R
Reproductive
U
Urinary
N
Nervous
S
Skeletal
MI — MONA
MI treatment: MONA — Morphine, Oxygen, Nitrates, Aspirin. 12-lead ECG within 10 min. Troponin is gold standard.
Myocardial Infarction
Recognizing and responding to MI — time is muscle, every minute counts
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 — 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.
M
Morphine — pain/anxiety
O
Oxygen — if SpO2 <90%
N
Nitrates — vasodilate, hold if BP low
A
Aspirin 325 mg chewed
Stroke — FAST
Stroke: FAST — Face drooping, Arm weakness, Speech difficulty, Time to call 911. tPA within 3–4.5 hours of onset.
Stroke Recognition and Care
Time-critical emergency — recognizing stroke and the nursing response
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.
Two obstructive lung diseases with important differences — NCLEX loves the oxygen question in COPD
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 2–3 L/NC, 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).
COPD O2
2–3 L, target SpO2 88–92%
Emphysema
Barrel chest, pursed lips, pink puffer
Chronic Bronchitis
Productive cough, blue bloater
Asthma
Reversible, wheezing, rescue before preventive
Pneumonia
Pneumonia assessment: fever, productive cough, crackles, decreased breath sounds. Position: semi-Fowler's. Encourage fluids and deep breathing.
Pneumonia Nursing
The most common hospital-acquired infection — assessment, positioning, and prevention
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).
Diabetes — Hypo vs Hyperglycemia
Hypoglycemia (<70): Cold and Clammy = give candy. Hyperglycemia (>180): Hot and Dry = sugar high.
Hypoglycemia vs Hyperglycemia
The quick way to distinguish and treat two dangerous blood sugar extremes
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.