PEDIAOKE by Sir Renchie Cainglet

Tila INFANT kung maglaroSolitary lagi, Stranger anxietyWeaning 6 monthsAspiration risk precaution

On TODDLERHOOD namanNega at Tantrums ginagawaSeparation PRODESDENMay physio-logic anorexia pa

Push pull toys like tarak tarakAutonomy vs. Shame and DoubtFirst dental visit ay 2 and a halfRisk for poisoning problema jan

PRESCHOOL naman ay PHALLICAssociative Play lagi ang gimikCommon fear is mutilationFear of dark and ghost din yun

Behavior ay gender specificAt may magi-cal thinkingAng patay is sleepingInitiative vs. guilt

Ang SCHOOL AGE latent yanConcrete thinking, Logic reasoningSame sex stage, normal na badingHeroworship and plays competitive

Schooler starts to have a bestfriendTakot parati control niya ay mag endPermanent ang concept of deathIndustry vs inferiority

Formal ang adolescentSa body image may disturbanceAng thelarche ang first sign sa girlsAt last sign yan ang menarche!

MI Management (MONA)

MorphineO2 therapyNitropglycerine!Aspirin

HYPOGLYCEMIA – TIRED!!!!

T – TiredI – Irritability (Nightmares)R – Restlessness E – Excessive Hunger (Polyphagia)D – Depression/Diaphoresis

HYPERNATREMIA “You are FRIED!”

F - Fever (low grade), flushed skin

R - Restless (irritable) I - Increased fluid retention

and increased BP E - Edema

(peripheral and pitting) D - Decreased urinary output,

dry mouth

Pressure Ulcer Staging

Stage I erythemaStage II breakdown of the

dermisStage III full thickness skin

BreakdownStage IV bones, muscles

HEART MURMURS: SPASM!!

S Stenosis P Partial obstruction A Aneurysms S Septal defect M Mitral regurgitation

Miotic: Little word= Little pupil (constrict)Mydriatic: Big word=

Big pupil (dilated)

Anticholingergics Side

Effects: Can't see Can't pee Can't spit Can't sh*t

Hyperthyroidism (s/s) “THYROIDISM”

Tremor Heart rate up Yawning (fatigueability) Restlessness Oligomenorrhea & amenorrhea Intolerance to heat Diarrhea Irritability Sweating Muscle wasting & weight loss

5W's of common causes of post-op fever

Wind (think pneumonia, splinting, incentive spirometer exercises not done, DB+ coughing NOT DONE) Water (dehydration...) Wound (infection, dehiscence...) Walking (PE...) Wonder drug (approriate antibiotic...)

To apply a telemetry monitor:

White over right (top right shoulder) Black beside the white (Over lt shoulder) Checkers (red below the black) Christmas (Green beside the red) Then ofcourse, the brown will be in the middle!

SALT

S – Skin flushedA - AgitationL - Low-grade feverT - Thirst

The HYPERKALEMIA "Machine" - Causes of Increased Serum K+

M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism, hemolysis I - Intake - Excesssive N - Nephrons, renal failure E - Excretion - Impaired

Signs and Symptoms of Increased Serum K+: MURDER !!

M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

HYPOKALEMIA (SUCTION)

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

General rules regarding psychiatry drugs:

1) Cannot be taken with alcohol, stimulants,depressants.2) Cannot be given to pregnant, lactatingand patients with glaucoma.3) Cannot be abruptly stooped but mus be tapered slowly4) All are given after meals except anti anxiety agents( because food interferes with their absorption)

5) All psychiatry drugs have anti cholinergic side effects:Dizziness, drowsiness, dry mouth, constipation, urinary retention

"CATS" of "HYPOCALCEMIA"

C - Convulsions A- Arrhythmias T - Tetany S - Spasms and stridor

BLEEDING - S/Sx BEEP

B - Bleeding gums E - Ecchymoses (bruises)E - Epistaxis (nosebleed) P - Petechiae (tiny purplish spots)

TETRALOGY OF FALLOT

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

RESPIRATORY DEPRESSION - inducing drugsSTOP breathing

S - Sedatives and hypnotics T - Trimethoprim O - Opiates P - Polymyxins

PNEUMOTHORAX - S/SxP-THORAXP - Pleuretic pain T - Trachea deviation H - Hyperresonance O - Onset sudden

R - Reduced breath sounds (& dypsnea) A - Absent fremitus X - X-ray shows collapse

PNEUMONIA - risk factors INSPIRATION I - Immunosuppression N - Neoplasia S - Secretion retention P - Pulmonary oedema I - Impaired alveolar macrophages R - RTI (prior) A - Antibiotics & cytotoxics T - Tracheal instrumentation I - IV dug abuse O - Other (general debility, immobility) N - Neurologic impairment of cough reflex, (eg NMJ disorders)

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

SHORTNESS OF BREATH - CausesAAAA PPPP A - Airway obstruction A - Angina A - Anxiety A - Asthma P - Pneumonia P - Pneumothorax P - Pulmonary Edema P - Pulmonary Embolus

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/ HIV Drugs

EMERGENCY MEDICINE ACTIVATED CHARCOAL: CONTRAINDICATIONSCHEMICAL CamP:

Cyanide Hydrocarbons Ethanol Metals Iron Caustics Airway unprotected Lithium CAMphor Potassium

IPECAC: CONTRAINDICATIONS 4 C's:

Comatose Convulsing Corrosive hydroCarbon

COMPLICATIONS OF FALCIPARUM MALARIA (CHAPLIN) Cerebral malaria/ Coma Hypoglycemia Anaemia Pulmonary edema

Lactic acidosis Infections Necrosis of renal tubules (ATN)

ET TUBE DELIVERABLE DRUGS O NAVEL: Oxygen Naloxone Atropine Ventolin (albuterol) Epinephrine Lidocaine

ATRIAL FIBRILLATION: CAUSES OF NEW ONSET THE ATRIAL FIBS:

Thyroid Hypothermia Embolism (P.E.) Alcohol Trauma (cardiac contusion) Recent surgery (post CABG) Ischemia Atrial enlargement Lone or idiopathic Fever, anemia, high-output states Infarct Bad valves (mitral stenosis)Stimulants (cocaine, theo, amphet, caffeine)

SHOCK: S/SX (TV SPARC CUBE)

Thirst Vomiting Sweating Pulse weak Anxious Respirations shallow/rapid Cool Cyanotic Unconscious BP low Eyes blank

VENTRICULAR FIBRILLATION: TREATMENT

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

Shock= Defibrillate Everybody= Epinephine Little= Lidocaine Big= Bretylium Momma= MgSO4 Poppa= Pocainamide

VFIB/VTACH DRUGS USED ACCORDING TO ACLS

"Every Little Boy Must Pray": Epinephrine Lidocaine Bretylium Magsulfate Procainamide

DIABETIC KETOACIDOSIS MANAGEMENT (KING UFC)

K+ (potassium) Insulin (5u/hour. Note: sliding scale no longer recommended in the UK) Nasogastic tube (if patient comatose) 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 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

Acid-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 (15,000–20,000) Nausea Signs (McBurney's, Psoas)

Neurovascular Occlusion: symptoms— "6 P's"

Pain Pale Pulseless Paresthesia Poikilothermic 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 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

Diabetes: signs and symptoms—"3P's,"

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

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)

Diet: low cholesterol—avoid the "3C's"

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

Dystocia: etiology—"3P's" PowePassageway Passenger

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

Psych Placenta Position

Episiotomy assessment—"REEDA"

Redness Edema Ecchymosis Discharge Approximation of skin

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

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 chillsString missing

Manipulation: nursing plan—promote the "3C's"

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—"3R's"

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

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"

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—"ABCs"

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—"4W's"

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—"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"

CoughingChoking Cyanosis

Transient ischemic attacks: assessment—"3Ts"

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

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)

Trauma care: complications—"TRAUMA"

Thromboembolism; Tissue perfusion, altered Respiration, altered Anxiety related to pain and prognosisUrinary elimination, altered Mobility impaired Alterations in sensory-perceptual functions and skin integrity (infections)

Wernicke-Korsakoff syndrome (alcohol-associated neurological disorder)—"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 CANCERChange in bowel /bladder habits A sore that doesn’t heal Unusual bleeding/ DischargeThickening 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 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)

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

Aortic Pulmonary Tricuspid Mitral

"Cut C4, breathe no more"

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

"Point and Shoot!"

For remembering that Parasympathetics are involved with erection and Sympathetics with ejaculation.

Layers of the scalp - "SCALP"

Skin Connective tissue Aponeurosis Loose areolar tissue Pericranium

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

Proximal row: Scaphoid Lunate Triquetrum Pisiform

Distal row: Trapezium Trapezoid Capitate Hamate

Bronchodilators - "TO A SIS"

Terbutaline Orciprenaline Adrenaline Salbutamol Isoprenaline Salmeterol

Viruses causing diarrhea - "ACNE CAR"

Adeno virus Corana virus Norwak virus

Entero virus Calci virus Astro virus Rota virus

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 - "In Philippines, Men Are Talented"

Interphase Prophase Metaphase Anaphase Telophase

Signs of cor pulmonale - "Please Read His Text"

Peripheral edema Raised JVP Hepatomegaly Tricuspid incompetence

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

Neutrophils Lymphocytes Monocytes Eosinophils Basophils

10 essential amino acids - "PVT. TIM HALL"

Phenylalanine Valine Tryptophan Threonine Isoleucine Metheonine Histidine(semi-essential) Arginine(semi-essential) Leucine Lysine

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

Rheumatoid arthritis Extra intestinal amoebiasis Discoid lupus erythematosus Lepra reaction Infectious mononucleosis Photogenic reactions

Portal hypertension features - "ABCDE"

Ascites Bleeding (hematemesis, piles) Caput medusae Diminished liver Enlarged spleen

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

Allergies Medication Past medical history Last meal Events and environment related to injury

Malignancies that metastisize to bone - "Laging Panalo Kung Taga Bulacan"

Lung ProstateKidney Thyroid Breast

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 Defecation

Causes of huge spleen - "3M's"

Myelofibrosis Malaria Myelogenous leukemia

Cardinal Symptoms of Parkinson's Disease - "TRAP"

Tremor Rigidity Akinesia and bradykinesia Postural Instability

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

1st dayScarlet fever

2nd dayPox(smallpox)

3rd dayMumps

4th dayTyphus

5th dayDengue

6th dayEnteric fever(typhoid)

SHOCK – HYPOTACHYTACHY

HYPOTENSIONTACHYPNEATACHYCARDIA

INCREASE ICP – HYPERBRADYBRADY

CUSHINGS TRIAD:HYPERTENSION (WIDE PULSE PRESSURE)BRADYCARDIABRADYPNEA

EARLY SIGNS OF HYPOXIARESTLESSNESSAGITATIONTACHYCARDIA

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

NEUROVASCULAR CHECK

PAINPULSELESSNESSPARESTHESIAPARALYSISPALLOR

VIRCHOW’S 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 URINE

ISONIAZID – PERIPHERAL NEURITIS

PYRAZINAMIDE – INCREASE URIC ACID

ETHAMBUTOL – EYE PROBLEMS

STREPTOMYCIN – OTOTOXIC

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