by Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
Clinical practice requires a firm grasp of a body of knowledge with great breadth and depth. Mnemonics and other memory aids can be helpful when trying to recall information that requires memorization, such as physical exam findings and etiology of select diseases. Here are a few mnemonics I hope you find helpful.
Common Systolic Heart Murmurs: MR PASS
Mitral
Regurgitation
Physiologic (also known as functional, systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality)
Aortic
Stenosis
Systolic- All the above murmurs are heard during systole.
MR PASS wins the Most Valuable Player award.
Mitral
Valve
Prolapse- Add MVP as another systolic murmur.
MR PASS often hangs around with MS ARD.
Mitral
Stenosis
Aortic
Regurgitation
Diastolic- All the above murmurs are heard during diastole.
(Source- MR PASS MVP, MS ARD mnemonic developed by Margaret A. Fitzgerald. © 2008 Fitzgerald Health Education Associates, Inc. Permission required for reproduction. Email permissions@fhea.com.)
Aortic Stenosis Symptoms
A person with clinically significant aortic stenosis can be SAD.
Syncope
Angina
Dyspnea
(Source-, original attribution unknown).
Physiologic Split S2 Heart Sound
This is a normal finding in which the aortic and pulmonic components of the second heart sound are heard separately. This finding is present in the majority of children and adults, but becomes less common after age 55. The split is caused by a delay in the pulmonic component, and the degree of split IN-creases on IN-spiration and decreases on expiration.
Vocal or tactile fremitus: IN-creases with IN-creased tissue density (i.e., the area of lung consolidation found in
pneumonia).
(Source- Mnemonic developed by Margaret A. Fitzgerald. © 2008 Fitzgerald Health Education Associates, Inc. Permission required for reproduction. Email permissions@fhea.com).
For Delirium Etiology: DELIRIUMS
Drugs- When any medication is added or dose is adjusted. Particularly problematic medications include anticholinergics (TCA, 1st gen antihistamines), neuroleptics, (haloperidol, others), opioids (in particular, meperidine), long-acting benzodiazepines (diazepam, clonazepam), alcohol, others
Emotional (mood disorders, loss), Electrolyte disturbance
Low PO2 (hypoxemia from pneumonia, COPD, pulmonary embolias, MI) Lack of drugs (withdrawal from alcohol, or other habituating substances)
Infection - Urinary tract infection and pneumonia (most common delirium etiology)
Retention of urine or feces, Reduced sensory input (blindness, deafness, darkness, change in surroundings)
Ictal or postictal state - Alcohol withdrawal one of the most common reasons for an isolated seizure in an older adult.
Undernutrition- Protein/calorie malnutrition, vitamin B12 or folate deficiency, dehydration including postoperative volume disturbance
Metabolic (poorly controlled DM, under- or untreated hypo or hyperthyroidism), Myocardial problems (MI, heart failure, dysrhythmia)
Subdural hematoma- Can be as a result of relatively minor head trauma to brain atrophy, fragile vessels
(Source-Delirium, in Merck Manuel for Geriatrics, available at , accessed 6.20.08.)
Treatable Causes of Urinary Incontinence: DIAPPERS
Delirium
Infection—urinary (symptomatic)
Atrophic urethritis and vaginitis
Pharmaceuticals
Psychologic disorders, especially depression
Excessive urine output (heart failure, hyperglycemia)
Restricted mobility
Stool impaction
(Source: Resnick NM. Urinary incontinence in the elderly. Medical Grand Rounds. 1984;3:281-290.)
Presentation of Anticholinergic Overdose or Misuse
Examples of medications with significant anticholinergic effect include the first generation antihistamines (diphenhydramine {Benadryl}, chlorpheniramine {ChlorTrimeton}, others) and tricyclic antidepressants (amitriptyline {Elavil}, nortriptyline {Pamelor}. A list of other medications with significant anticholinergic effect can be found at:
, accessed 6.20.08.
With an overdose or misuse of medications with significant anticholinergic effect, the patient can be:
Blind as a bat (blurred vision)
Dry as a bone (dry mouth)
Red as a beet (flushing)
Mad as a hatter (confusion)
Hot as a hare (hyperthermia)
Can’t see (vision changes)
Can’t pee (urinary retention)
Can’t (do something that rhymes with “spit”, constipation)
Note that a milder form of these findings can be present in an elderly patient who has taken an over-the-counter sleep aid containing diphenhydramine (Benadryl), a first-generation antihistamine, or any medication know to have significant anticholinergic effect.
(Source- , original attribution unknown)
Causes of Acute Pancreatitis: I GET SMASHED
Idiopathic
Gallstones (most common reason for acute pancreatitis with amylase >1000 units/L)
Ethanol (alcohol)
Trauma (usually blunt abdominal injury)
Steroids
Mumps
Autoimmune
Scorpion bites
Hyperlipidemia (particularly hypertriglyceridemia)
Drugs (azathioprine, thiazide diuretics)
(Source- , original attribution unknown)
Healthcare mnemonics: A note of caution
While these memory aids are helpful, I must add a note of caution. Treatment mnemonics can be problematic because the learner might have memorized what to do but does not have a firm grasp on why a particular intervention is helpful. Safe clinical practice involves knowing the “why” as well as the “how.”
Please contact me (cs@fhea.com) with the mnemonics and memory aids you find helpful.
This article originally appeared in my quarterly certification column in Advance for Nurse Practitioners and is made available here by the courtesy of Advance. For other articles of interest to Nurse Practitioners, be sure to this outstanding journal.
Last updated 6.26.08