Mnemonics and Memory Aids
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC, FNAP
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 that may be helpful.
Recalling Common Systolic Heart Murmurs: MR PASS
- Physiologic (also known as functional systolic flow murmur, a heart murmur heard in the absence of cardiac abnormality)
All the above murmurs are heard during systole.
MR PASS wins the Most Valuable Player award.
Add MVP as another systolic murmur.
MR PASS often hangs around with MS ARD.
All the above murmurs are heard during diastole.
Aortic Stenosis Symptoms
A person with clinically significant aortic stenosis can be SAD.
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 (ie, the area of lung consolidation found in pneumonia).
For Delirium Etiology: DELIRIUMS
- Drugs – When any medication is added or dose is adjusted. Particularly problematic medications include anticholinergics (tricyclic antidepressants, first-generation antihistamines), neuroleptics, (halo peridol, others), opioids (in particular, meperidine), long-acting benzodiazepines (diazepam, clonazepam), alcohol, others.
- Emotional (mood disorders, loss), electrolyte disturbance
- Low PO2 (hypoxemia from pneumonia, chronic obstructive pulmonary disease, pulmonary embolus, MI), lack of drugs (withdrawal from alcohol, other habituating substances)
- Infection – Urinary tract infection or 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 is 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 diabetes mellitus, under- or untreated hypo- or hyperthyroidism), myocardial problems (myocardial infarction, heart failure, dysrhythmia)
- Subdural hematoma – Can result from relatively minor head trauma to brain due to atrophy, fragile vessels
Treatable Causes of Urinary Incontinence: DIAPERS
- Infection (urinary)
- Atrophic urethritis and vaginitis
- Pharmaceuticals (diuretics, others), psychologic disorders (depression)
- Excessive urine output (heart failure, hyperglycemia due to undetected or poorly controlled diabetes mellitus)
- Restricted mobility
- Stool impaction
Presentation of Anticholinergic Overdose or Misuse
Examples of medications with significant anticholinergic effects include the first-generation antihistamines (diphenhydramine [Benadryl], chlorpheniramine [Chlor-Trimeton], others) and tricyclic antidepressants (amitriptyline [Elavil], nortriptyline [Pamelor]). A list of other medications with significant anticholinergic effects can be found at FPNotebook.com (accessed August 25, 2021).
With an overdose or misuse of medications with significant anticholinergic effects, 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 known to have significant anticholinergic effects.
Causes of Acute Pancreatitis: I GET SMASHED
- Idiopathic (thought to be result of a hypertensive sphincter or microlithiasis)
- Gallstones (usually traveling down common bile duct and becoming trapped in the ampulla of Vater)
- Ethanol (alcohol intake, usually excessive)
- Trauma (usually blunt abdominal trauma)
- Steroids (systemic corticosteroid use)
- Mumps (paramyxovirus) and other viruses (Epstein-Barr virus, cytomegalovirus)
- Autoimmune disease (polyarteritis nodosa, systemic lupus erythematosus)
- Scorpion sting, select snake bites
- Hypercalcemia, hyperlipidemia, particularly hypertriglyceridemia and hyponatremia
- ERCP (post endoscopic retrograde cholangiopancreatography)
- Drugs (sulfonamides, azathioprine, NSAIDs, diuretics [loop and thiazide], didanosine, DDP-4 inhibitor [-gliptin] use) and duodenal ulcers
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.”