Whitney McKinnon RN

Airway, Breathing, Circulation. Problems with the airway come before everything else.

Teach it: "A client can live a few minutes without blood flow problems fixed, but not without air."

Assess, Diagnose, Plan, Implement, Evaluate. Assess before you act.

Teach it: "Never treat what you haven't checked."

Physical needs first (food, air, elimination), then safety, then love and belonging, then self-esteem, then self-actualization.

Teach it: "A hungry, scared client can't work on feelings yet — feed and calm first."

Pick the client with the new, changing, or unstable problem over the chronic, steady one — even when the chronic one sounds sicker.

Teach it: "New trouble outranks old trouble."

Morphine, Oxygen (if saturation is low), Nitrates, Aspirin — the classic first drugs for chest pain from a heart attack.

Teach it: "MONA greets chest pain at the door."

Left-sided failure backs up into the lungs (crackles, cough, trouble breathing). Right-sided backs up into the rest of the body (swollen legs, big liver, neck veins).

Teach it: "LEFT ends in T — think lungs; RIGHT pumps to the Rest of the body."

Tachycardia, Irritability, Restlessness, Excessive hunger, Diaphoresis (sweating). Give fast sugar — juice, glucose tabs — if the client can swallow.

Teach it: "A starving brain throws a tantrum: TIRED."

Convulsions, Arrhythmias, Tetany, Spasms and stridor. Watch for Chvostek's sign (cheek twitch) and Trousseau's sign (hand spasm with a blood pressure cuff).

Teach it: "When calcium drops, the CATS get twitchy."

Vitamins A, D, E, K need fat to absorb. Clients who can't absorb fat (gallbladder disease, pancreas problems) need these replaced.

Teach it: "ADEK rides the fat bus — no fat, no ride."

Infections that cross the placenta: Toxoplasmosis, Others (syphilis, chickenpox), Rubella, CMV, Herpes. Pregnant nurses avoid live contact with these clients.

Teach it: "A pregnant nurse keeps a TORCH away from her belly."

Variable — Cord compression. Early — Head compression. Accelerations — OK! Late — Placenta trouble. Late and variable decelerations need action now.

Teach it: "CHOP tells you WHY the baby's heart changed."

First day of last period, subtract 3 months, add 7 days, add 1 year.

Teach it: "Minus 3, plus 7, plus a year."

Hyperthyroid: hot, fast, shaky, thin, hungry. Hypothyroid: cold, slow, tired, puffy, constipated. Everything speeds up or slows down together.

Teach it: "Thyroid is the body's gas pedal — stuck down or stuck to the floor."

SIADH keeps water (soaked: low sodium, concentrated urine, puffy). Diabetes insipidus dumps water (dry: extreme thirst, huge amounts of pale urine).

Teach it: "SIADH Soaks Inside; DI is Dry Inside."

Measles, Chickenpox, Herpes zoster (disseminated), TB. N95 mask and negative-pressure room.

Teach it: "These germs float in the air, so the room pulls air in and the mask filters it."

Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis. Antidote: atropine.

Teach it: "Everything leaks — atropine dries it up."

Rescue, Alarm, Contain, Extinguish. Use PASS for the extinguisher: Pull, Aim, Squeeze, Sweep.

Teach it: "People first, then the fire."

Turn, Cough, Deep breathe every 1–2 hours while awake. It opens the lungs and prevents pneumonia after anesthesia.

Teach it: "Move the air, or pneumonia moves in."

Right task, circumstance, person, direction, supervision. Don't delegate assess, teach, evaluate, or unstable clients.

Teach it: "If it needs nursing judgment, the RN keeps it."

Too low or too high can stop the heart. Never give IV potassium as a push.

Teach it: "Potassium protects the heartbeat — guard both ends."

Oh Oh Oh To Touch And Feel Very Good Velvet, Such Heaven! — Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal.

Teach it: "Some Say Marry Money But My Brother Says Big Brains Matter More" — Sensory, Motor, Both, in that same order.

Respiratory Opposite, Metabolic Equal. If pH and CO2 move in opposite directions the problem is respiratory; if pH and bicarbonate move the same way it is metabolic.

Teach it: "CO2 is an acid, so it always pushes the pH the other way."

pH 7.35–7.45, CO2 35–45, bicarbonate 22–26. Learn these and every blood gas becomes a simple comparison instead of a puzzle.

Teach it: "Know the normal before you judge the patient."

Tall, peaked T waves mean potassium is high. Flat T waves with an extra U wave mean potassium is low. Either one can turn into a deadly rhythm.

Teach it: "The heart complains about potassium before the lab reports it."

Count the big boxes between beats: 1 box = 300, 2 = 150, 3 = 100, 4 = 75, 5 = 60.

Teach it: "The rhythm strip already knows the rate — you just count boxes."

About 1 kg (2.2 lb) of weight is 1,000 mL of held fluid. Weigh at the same time, on the same scale, in the same clothes.

Teach it: "The scale tells the truth the swelling hides."

Urine output under 30 mL an hour (under 0.5 mL/kg/hour) means the kidneys are not being perfused. Assess, then call.

Teach it: "Thirty is the floor — below it the kidneys are asking for help."

An AV fistula should have a buzz you can feel (thrill) and a whoosh you can hear (bruit). No blood pressures, IVs, or blood draws on that arm.

Teach it: "No buzz means the access is clotted — that call comes first."

Suspect sepsis, draw cultures, give broad-spectrum antibiotics, push IV fluids, and check lactate — all inside the first hour.

Teach it: "The clock starts when you suspect it, not when you are sure."

A loud wheeze means air is still moving. In a struggling client, no wheeze means almost no air is moving — that is respiratory failure.

Teach it: "Silence is not better than noise. Silence is worse."

A barking seal cough with a hoarse voice is croup. Drooling, muffled voice, fever, and leaning forward is epiglottitis — keep the child calm, do not look in the throat, and get help.

Teach it: "A drooling, tripod-standing toddler gets nobody's tongue depressor."

The right main airway is wider and more vertical, so inhaled food or secretions usually settle in the right lower lobe. Keep the head of the bed up for meals.

Teach it: "Gravity takes the food down the right-hand road."

Before each magnesium dose for preeclampsia check respirations (12 or more), urine output (at least 30 mL/hour), and knee reflexes. Calcium gluconate is the antidote at the bedside.

Teach it: "Three checks before every dose, and the antidote stays in the drawer."

Rising pressure inside the skull shows as a widening pulse pressure, a falling heart rate, and irregular breathing. It is a late warning — call now.

Teach it: "The skull is squeezing: pressure climbs, pulse drops, breathing goes wild."

Write down the exact time the client was last known well, and check face droop, arm drift, and speech. Clot-dissolving treatment is on a clock.

Teach it: "The watch, not the scan, decides who gets the drug."

A soft, boggy uterus is the most common cause of bleeding after birth. Massage the fundus first, empty the bladder, and call for help.

Teach it: "A firm uterus is the best tourniquet — massage before you panic."

Count an apical pulse for a full minute before digoxin; hold and call if it is under 60 in an adult. Low potassium makes toxicity likely — watch for nausea, blurred or yellow-green vision, and a new irregular pulse.

Teach it: "Count the pulse, check the potassium — the dose waits for both."

Warfarin, the pill, is reversed with vitamin K. Heparin, the shot, is reversed with protamine. Vitamin K takes hours; protamine works fast.

Teach it: "Vitamin K is the long game; protamine is the quick fix."

Steroids raise blood glucose, hide fever and infection, hold sodium and water, thin the skin, and change mood — and they must be tapered, never stopped.

Teach it: "Steroids make you feel great while the sugar climbs and the infection hides."

Loop diuretics (furosemide) and thiazides flush potassium out; potassium-sparing ones (spironolactone) hold it. Give morning doses so the client sleeps.

Teach it: "The drug that pulls the water also pulls the potassium."

Check respirations and sedation before giving an opioid; hold and call below 12 breaths a minute, and keep naloxone available.

Teach it: "Count the breaths, not just the pain score."

Beta blockers mask the fast pulse and shakes of a falling blood sugar, leaving sweating as the only clue. Check the glucose — do not rely on the symptoms.

Teach it: "The drug steals the alarm bells, so trust the meter."

Lisinopril and the rest of the ACEs cause a dry nagging cough, raise potassium, and can swell the lips and tongue — that swelling is an emergency.

Teach it: "The ACE three: cough, potassium, and swelling."

COPD clients usually get 1–2 L by nasal cannula; their drive to breathe comes from low oxygen, so too much oxygen can slow them down. Titrate to the saturation, not the dial.

Teach it: "Their brain runs on low oxygen — don't flood it and let it drift."

Never recap, bend, or break a needle. Activate the safety shield one-handed and drop it in the sharps container at the bedside.

Teach it: "The needle going back into the cap is the one that finds your thumb."

Only sterile touches sterile. The 1-inch edge of the field, anything below waist level or above chest level, and anything you reach over are contaminated.

Teach it: "When in doubt, it's out — start a new field."

Two people check the blood against the client's identifiers, the transfusion starts slowly, and the client stays watched for the first 15 minutes — that is when a reaction shows up.

Teach it: "Two checks at the bedside, then stay for the first fifteen."

Fever, chills, low back or chest pain, or trouble breathing during blood: stop the transfusion, keep the vein open with normal saline, recheck the tags, and call the blood bank.

Teach it: "Stop the blood, keep the vein, keep the client."

The drainage bottle stays below the client and the water seal moves with breathing. Never clamp the tube — clamping can build a tension pneumothorax. If the tube comes out, cover the site with its plastic wrapper and call.

Teach it: "Gravity is the pump; a clamp turns a drain into a trap."

The obturator stays taped at the bedside so the tube can go back in if it falls out. Suction for 10–12 seconds at a time with oxygen in between.

Teach it: "If the tube can come out, the key stays within arm's reach."

Confirm a feeding tube with an x-ray or the pH of the aspirate — listening for a whoosh is not proof. Keep the head of the bed 30–45 degrees and flush before and after.

Teach it: "A whoosh isn't proof; the film or the pH is."

A healthy stoma looks pink-to-red and wet, like the inside of a lip. Dusky, grey, or black means the blood supply is failing — call.

Teach it: "Compare it to your lip: pink is fine, black is urgent."

With a very low white count, keep fresh flowers and potted plants out of the room, and serve no raw or undercooked food. Visitors clean hands and stay home when sick.

Teach it: "Pretty and poisonous — pollen and soil carry germs the body can't fight."

With a radioactive implant, limit time at the bedside, keep your distance, and use the lead shield. Pregnant staff and children usually cannot visit.

Teach it: "Shorter, farther, shielded — and read the sign on the door."

Confidentiality has limits: you must report plans to harm self or others. Say the limits up front, ask directly about suicidal thoughts, and pass on what you hear.

Teach it: "Asking about suicide doesn't plant the idea — keeping the secret can cost a life."

SSRIs take two to four weeks, and physical energy often returns before mood lifts, so risk can rise early in treatment. Watch for agitation and restlessness.

Teach it: "The body wakes up before the mind does — that's the risky window."

Aged, cured, fermented, pickled, and soy-heavy foods carry tyramine, which with an MAOI can drive blood pressure into a crisis — sudden headache, stiff neck, racing pulse.

Teach it: "Old cheese, new headache — the pressure can climb fast."

Baby blues — tearfulness and mood swings in the first days — fade within about two weeks. Depression that lasts longer, or thoughts of harming the baby, needs help now.

Teach it: "Two weeks is the line: blues pass, depression stays."

Lying flat lets the uterus press the large vein, dropping blood pressure and the baby's supply. Lie on the left side, or tilt one hip up.

Teach it: "Left side means flow; flat means squeeze."

Give thiamine before or with glucose to prevent permanent brain injury, and treat withdrawal with benzodiazepines on a scored protocol. Watch for hallucinations and seizures 2–3 days after the last drink.

Teach it: "Thiamine first — sugar without it can do the damage."

Absolute words — always, never, all, must, every — usually make a choice wrong. Qualified words — usually, often, may, some — are usually true.

Teach it: "Nursing rarely deals in absolutes, and neither do the right answers."

Judge each option on its own and check every one you would actually do at the bedside. Scoring gives partial credit, so decide one box at a time.

Teach it: "'Some of them' is a real answer — don't hunt for a perfect row."