They say that the best nurses are excellent at obtaining assessment, and this is true! If nurses would look at the nursing process, assessment is the first step. Gathering information about the client will provide clues for what care you can give and what you can do. If you have a weak foundation in assessment, the rest of the process follows. But with the many ways to assess a Patient, assessment has become an overwhelming process. To be more systematic, here are nursing health assessment mnemonics and tips you can use to accurately and quickly assess variety of patients in with different conditions and in various situations.
- Management of Heart Failure: “DAD BOND CLASH”
Management of heart failureis to relieve patient symptoms, to improve functional status and quality of life, and to extend survival. Medical management depends on the type, severity, and cause of HF. It can include reducing the workload of the heart by reducing preload and afterload; elimination of contributing factors such as hypertension. Remember the mnemonic “DAD BOND CLASH” for the medical management of heart failure.
D: Digitalis
Increases the force of myocardial contraction and slows conduction through the atrioventricular node; improves contractility, increasing left ventricular output, and enhances diuresis.
A: ACE Inhibitors
Promotes vasodilation and diuresis by decreasing afterload and preload, ultimately decreasing the workload of the heart.
D: Dobutamine
IV medication administered to patients with significant left ventricular dysfunction and hypoperfusion; stimulates the beta-1-adrenergic receptors.
B: Beta-blockers
Reduces mortality and morbidity in HF by reducing the adverse effects from constant stimulation of the sympathetic nervous system.
O: Oxygen – Oxygen may be necessary as HF progresses; need is based on the degree of pulmonary congestion and resulting hypoxia.
N: Nitrates
Causes venous dilation, which reduces the amount of blood return to the heart and lowers preload.
D: Diuretics
To remove excess extracellular fluid by increasing the rate of urine produced in patients with fluid overload.
C: Calcium Channel Blockers
Causes vasodilation, reducing Systemic Vascular Resistance.
L: Lifestyle Changes
Restriction of dietary sodium, avoidance of excess fluid intake, weight reduction, and regular exercise.
A: Angiotensin II Receptor Blockers
ARBs block the effects of angiotensin II at its receptor; have similar hemodynamic effects as of ACE inhibitors. Serves as alternative for for patients who cannot tolerate ACE inhibitors.
S: Sodium restriction
A low-sodium diet (2 to 3 g/day) diet and avoidance of drinking excess amounts of fluid is recommended.
H: Hydralazine
Lowers systemic vascular resistance and left ventricular afterload.
- Level of Consciousness Assessment: “AVPU”
The AVPU scale is a system where you can measure and record a patient’s responsiveness to indicate their level of consciousness. It is a simplification of the Glasgow Coma Scale, which assesses a patient response in three measures: eyes, voice, and motor skills. The AVPU scale should be assessed during these three identifiable traits, looking for the best response for each. It has four possible outcomes for recording and the nurse should always work from best (A) to worst (U) to avoid unnecessary tests on patients who are clearly conscious.
A: Alert
V: Response to Verbal Stimuli
P: Response to Pain
U: Unresponsive
- Health History Assessment: “SAMPLE”
In general, do not obtain a detailed history until life-threatening injuries have been identified and therapy has been initiated. The secondary survey is essentially a head-to-toe assessment of progress, vital signs, etc. SAMPLE is often useful as a mnemonic for remembering key elements of the patient’s health history.
S: Symptoms
A: Allergy
M: Medications
P: Past Medical History
L: Last Oral Intake
E: Events leading up to the illness or injury
As a nurse, you always need to have the right answers to a problem at the right time. You are not allowed to make any mistakes, or the time to peruse through books seeking for clarification. With so much to cram into your head, mastering disease conditions and their treatment options is quite the challenge. Taking a different approach other than just trying to remember the facts as they are would make the job simpler and more bearable.
