Mental retardation: nursing care plan—"three Rs"
Regularity (provide routine and structure)
Reward (positive reinforcement)
Myocardial infarction: treatment—"M2 ONA"
MONA greets every M.I.:
Newborn assessment components—"APGAR"
Obstetric (maternity) history—"GTPAL"
Abortions (SAB, TAB)
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)
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?
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"
Water (urinary tract infection)
Preterm infant: anticipated problems—"TRIES"
Temperature regulation (poor)
Resistance to infections (poor)
Elimination problems (necrotizing enterocolitis [NEC])
Sensory-perceptual functions (retinopathy of prematurity [ROP])
Psychotropic medications: common antidepressives (tricyclics)—"VENT"
Schizophrenia: primary symptoms—"four As"
Sprain: nursing care plan—"RICE"
Tracheoesophageal fistula: assessment—"three Cs"
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)
Nutrition (alteration related to immobility)
Transient ischemic attacks: assessment—"three Ts"
Temporary unilateral visual impairment
Transient paralysis (one-sided)
Tinnitus = vertigo
Trauma care: complications—"T2 RAUMA"
Thromboembolism; Tissue perfusion, altered
Anxiety related to pain and prognosis
Urinary elimination, altered
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:
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)
Korsakoff 's psychosis