Journal of Gerontological Nursing

CLINICAL OUTLOOK 

Mnemonics: Use in Gerontological Nursing Practice

Karen Devereaux Melillo, PhD, RN, C

Abstract

Mnemonic devices are techniques for memorization that organize and inter-relate new information in memory for recall.1 The following article describes a number of mnemonics for use in gerontologicai nursing practice. These mnemonics are not substitutes for understanding, but are aids to enhance the gerontologi cai nurse's clinical decision-making and problem-solving abilities. The type of organizational mnemonic described in this article is an acronym. Webster's New World Dictionary defines an acronym as a "word formed from the first letter of a series of words."

CLINICAL DECISION MAKING/SYMPTOM ANALYSIS

PQRST:

P-Palliative/provocative factors

Q-Quality

R-Region/radiation

S-Severity/impact on lifestyle/ performance of activities of daily living

T-Timing/Temporal nature of complaint

Additionally, the health history information and physical assessment data to be elicited should also address the clinician's problem-solving ability regarding body systems that reflect the specific complaint, potential causation, and potential complications.2

AEIOU TIPS- Causes of unconsciousness3-4:

A-Alcoholism

E-Epilepsy

I-lnsulin

O-Overdose

U-Uremia

T-Trauma or tumor

I- Infection

P- Psych i atri c

S-Stroke (or other cerebrovascular problem)

five F's of Abdominal Masses (D. Anderson, personal communication, 1978):

F-Fat

F-Fluid

F-Flatus

F-Feces

F-Fatal growth

Nine D's of Weight Loss in the Elderly5:

D- Dentition

D-Dysgeusia (age-related decline in smell and taste)

D-Dysphagia

D-Diarrhea

D-Disease (chronic)

D-Depression

D- Dementi a

D-Dysfunction (social causes, widowhood, limited finances, lack of transportation, poor eyesight)

D-Drugs

"Weight loss is considered significant when ? % to 2% of body weight is lost in 1 week; 5% in 1 month; 7.5% in 3 months; and 10% in 6 months; greater losses are considered severe."6 Cancer is the most common medical diagnosis in elderly patients with weight loss, yet it only accounts for 20% of such patients.7 Poverty, inability to shop because of immobility, depression, poor dentition, and decreased enjoyment of food because of decreased taste and smell are all important factors contributing to decreased food intake, and decreased intake is the most common cause of weight loss in the elderly.8

SELF-CARE DEFICIT: FUNCTIONAL IMPAIRMENT

PULSES Profile9:

P-Physical condition

U-Upper limb functions (selfcare activities, eg, drinking and feeding self, dressing, grooming, that are dependent on upper limb function)

L-Lower limb function (mobility - including transfer to chair, toilet, tub, or shower, walking, climbing stairs, and maneuvering a wheelchair - that depends mainly on lower limb function)

S-Sensory components (relating to communication, ie, speech and hearing, and vision)

E-Excretory functions (bowel and bladder)

S-Support factors (intellectual and emotional adaptability, support from family unit, and financial ability)

Each component is rated on a four-point scale from 1 (independent) to 4 (dependent). Total PULSES scores range from 6 (best score) to 24 (worst score).

"Unlike young persons, when elderly persons become ill, the first sign of new or exacerbation of chronic disease is rarely a single specific symptomatic complaint that helps to localize the organ system or tissue in which the disease occurs. Rather, older patients usually announce active illness with one or more nonspecific disabilities, which rapidly produce functional impairment."10 The reasons for disease presenting first with functional loss in older patients, usually in organ systems unrelated to the locus of the disease, are complex and incompletely understood.11 The mnemonic PULSES provides an assessment for functional loss, whether originating from reversible disease or to determine the kind and amount of services required to compensate for functional losses.

POTENTIAL FOR TRAUMA- FALLS

DDROPP- Essential history to elicit regarding falls and syncope12:

D- Diseases

D-Drugs

R- Recovery

O-Onset

P- Prodrome

P-Precipitants

Accidents are the fifth leading cause of death in those over age 65; approximately two thirds of those accidents are falls.13 Falls are the most frequent cause of fatal injury in the aged.14 Falls and their attendant…

Mnemonic devices are techniques for memorization that organize and inter-relate new information in memory for recall.1 The following article describes a number of mnemonics for use in gerontologicai nursing practice. These mnemonics are not substitutes for understanding, but are aids to enhance the gerontologi cai nurse's clinical decision-making and problem-solving abilities. The type of organizational mnemonic described in this article is an acronym. Webster's New World Dictionary defines an acronym as a "word formed from the first letter of a series of words."

CLINICAL DECISION MAKING/SYMPTOM ANALYSIS

PQRST:

P-Palliative/provocative factors

Q-Quality

R-Region/radiation

S-Severity/impact on lifestyle/ performance of activities of daily living

T-Timing/Temporal nature of complaint

Additionally, the health history information and physical assessment data to be elicited should also address the clinician's problem-solving ability regarding body systems that reflect the specific complaint, potential causation, and potential complications.2

AEIOU TIPS- Causes of unconsciousness3-4:

A-Alcoholism

E-Epilepsy

I-lnsulin

O-Overdose

U-Uremia

T-Trauma or tumor

I- Infection

P- Psych i atri c

S-Stroke (or other cerebrovascular problem)

five F's of Abdominal Masses (D. Anderson, personal communication, 1978):

F-Fat

F-Fluid

F-Flatus

F-Feces

F-Fatal growth

Nine D's of Weight Loss in the Elderly5:

D- Dentition

D-Dysgeusia (age-related decline in smell and taste)

D-Dysphagia

D-Diarrhea

D-Disease (chronic)

D-Depression

D- Dementi a

D-Dysfunction (social causes, widowhood, limited finances, lack of transportation, poor eyesight)

D-Drugs

"Weight loss is considered significant when ? % to 2% of body weight is lost in 1 week; 5% in 1 month; 7.5% in 3 months; and 10% in 6 months; greater losses are considered severe."6 Cancer is the most common medical diagnosis in elderly patients with weight loss, yet it only accounts for 20% of such patients.7 Poverty, inability to shop because of immobility, depression, poor dentition, and decreased enjoyment of food because of decreased taste and smell are all important factors contributing to decreased food intake, and decreased intake is the most common cause of weight loss in the elderly.8

SELF-CARE DEFICIT: FUNCTIONAL IMPAIRMENT

PULSES Profile9:

P-Physical condition

U-Upper limb functions (selfcare activities, eg, drinking and feeding self, dressing, grooming, that are dependent on upper limb function)

L-Lower limb function (mobility - including transfer to chair, toilet, tub, or shower, walking, climbing stairs, and maneuvering a wheelchair - that depends mainly on lower limb function)

S-Sensory components (relating to communication, ie, speech and hearing, and vision)

E-Excretory functions (bowel and bladder)

S-Support factors (intellectual and emotional adaptability, support from family unit, and financial ability)

Each component is rated on a four-point scale from 1 (independent) to 4 (dependent). Total PULSES scores range from 6 (best score) to 24 (worst score).

"Unlike young persons, when elderly persons become ill, the first sign of new or exacerbation of chronic disease is rarely a single specific symptomatic complaint that helps to localize the organ system or tissue in which the disease occurs. Rather, older patients usually announce active illness with one or more nonspecific disabilities, which rapidly produce functional impairment."10 The reasons for disease presenting first with functional loss in older patients, usually in organ systems unrelated to the locus of the disease, are complex and incompletely understood.11 The mnemonic PULSES provides an assessment for functional loss, whether originating from reversible disease or to determine the kind and amount of services required to compensate for functional losses.

POTENTIAL FOR TRAUMA- FALLS

DDROPP- Essential history to elicit regarding falls and syncope12:

D- Diseases

D-Drugs

R- Recovery

O-Onset

P- Prodrome

P-Precipitants

Accidents are the fifth leading cause of death in those over age 65; approximately two thirds of those accidents are falls.13 Falls are the most frequent cause of fatal injury in the aged.14 Falls and their attendant complications are often preventable. Factors that can contribute to or cause falls are multiple, and very often more than one of these factors play an important role.15 fifty percent of all falls are due to environmental hazards, such as poor lighting, loose carpets, or icy sidewalks. Other contributing factors include inappropriate or excessive medications, gait disturbance, vestibular dysfunction, podiatry problems, muscloskeletal problems, poor hearing or vision, syncope, and unfamiliar surroundings.16 Knowledge of the risk factors associated with falls and a complete history regarding the fall incident are important steps in preventing future falls.

ALTERATION IN THOUGHT PROCESS: IMPAIRED COGNITION

FROMAJE Test for Mental Status Evaluation17:

F-Function

R-Reasoning

O-Orientation

M-Memory

A-Arithmetic

J-Judgment

E-Emotional state

Each component of the FROMAJE test is scored from 1 (no impairment) to 3 (significant impairment). The overall rating is:

* 7 to 8 - no impairment;

* 9 to 10 - mild dementia or depression ;

* 1 1 to 1 2 - moderate to severe dementia or depression;

* 1 3 and over - severe dementia or depression.

FACT (set test to screen mental status quickly):

F-Fruits

A-Animals

C-Colors

T-Towns

The test is performed by asking the patient to name 1 0 items in each of the four categories; one point is given for each correct item and scoring is from O to 40. A score less than 15 corresponds closely to a clinical diagnosis of dementia; scores from 1 5 to 24 show some association with dementia; no one scoring more than 25 was found to be demented.18'19

DELIRIUM- Search for contributing factors for delirium20:

D-Drugs

E-Electrolyte disturbance, emotional problems, environmental changes

L-Lack of sleep

I-Infection

R-Reduced sensation

I -I m pact! on

U-Urinary retention

M-Myocardial (congestive heart failure, myocardial infarction, arrythmias), miscellaneous (right parietal cerebrovascular accident)

The differential diagnosis of confusion is difficult to make. Dementia is primarily characterized by a progressive course and normal consciousness with cognitive impairment. Delirium is commonly believed to be a transient organic brain syndrome of acute onset characterized by concurrent disorders of attention, perception, thinking, memory, psychomotor behavior, and the sleep-wake cycle.21 It is often referred to as an acute confusional state (K. ReMIy, personal communication, 1 990).

Gerontological practitioners are in a unique position to assess the client, formulate an initial diagnosis, refer for further evaluation, and institute a treatment plan.22 Because a hallmark of both delirium and dementia is altered cognitive status, it is imperative for the clinician to gather information from multiple sources to make an appropriate differential diagnosis between a reversible delirium and dementia.

INEFFECTIVE INDIVIDUAL COPING- DEPRESSION

ABC Triad for Depression Assessment23:

A-Affect

B- Behavior

C-Cognition

SIC E CAPS- Depression21:

S-Sleep disturbance

I- Interest

G-Guilt

E-Energy

C-Concentration

A-Appetife

P- Psychomotor

S-Suicide

Depression is the most common psychiatric disorder of later life.24 Gordon defines depression as an "acute decrease in self-esteem or worth related to a threat to self- competency."25 The defining characteristics of depression relate to the two mnemonics presented.

CAGE - Screening Test for Alcoholism26-29:

C-Cut down on drinking? (Have you ever felt the need to)

A-Annoyed by criticism of drinking? (Have you ever felt)

G-Guilty feelings about drinking? (Have you ever had)

E-Eye opener? (Have you ever taken a morning drink)

Alcoholism among the elderly has generally been ignored or minimized. In recent years, there has been greater awareness and understanding of alcoholism in all segments of the population, including the elderly. The extent of the problem is estimated, roughly, at 2% to 10% of the elderly population.30 Alcohol is by far the most serious drug problem among the elderly. Thus, there is an increasing expectation that health-care professionals be alert to the problems of alcoholism and knowledgeable in their care.31

ALTERATION IN URINARY ELIMINATION- INCONTINENCE

FAUM4 - Assessment for new onset of urinary incontinence32:

F-Fecal impaction

A-Atrophic urethritis/vaginitis

U-Urinary Tract Infection

M-Musculoskeletal problems/ mobility impairment

M-Metabolic disturbance

M-Medications

M-Mental status change

DIAPPERS - For transient incontinence:

D-Delirium

l-lmpaction

A-Atrophic urethritis/vaginitis

P- Psychological

P-Psychotropics or pharmaceuticals

E-Endocrine

R-Restricted mobility

S-Stool impaction

The NIH Consensus Development Conference Statement of Urinary Incontinence reports that at least 1 0 mi Ilion Americans suffer from urinary incontinence, including approximately 15% to 30% of community-dwelling older people and at least half of all nursing home residents.33 Urinary inconti nence is a symptom rather than a disease. Thus, these two mnemonics may be helpful in recognizing contributing factors and reversible causes for this symptom.

SUMMARY

This article has presented 14 mnemonics for use in geronto logical nursing practice. Each mnemonic represents the clinical decision-making process for five commonly encountered nursing diagnoses (self-care deficit: functional impairment; potential for trauma: falls; alteration to thought processes: impaired cognition; ineffective individual coping: depression/alcoholism; and alteration in urinary elimination: incontinence).

It has been suggested that the learning and application of these mnemonics in practice may facilitate the assessment, diagnosis, intervention, and evaluation for each of these nursing diagnoses.

REFERENCES

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10.3928/0098-9134-19910701-13

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