Nursing Health Assessment Mnemonics & Tips

Assessment is the first step of the nursing process, and everything you do afterward rests on it. Gather the right information and your care plan and interventions follow. These mnemonics give you a fast, systematic way to assess patients across conditions and settings.

1. Level of Consciousness Assessment: "AVPU"

AVPU records a patient's responsiveness and level of consciousness. It is a simplification of the Glasgow Coma Scale, which grades eyes, voice, and motor skills. Work from best (A) to worst (U) so you do not run unnecessary tests on a clearly conscious patient. Do not use it for longterm tracking of neurological status.

• A: Alert
• V: Responds to verbal stimuli
• P: Responds to pain
• U: Unresponsive

2. Health History Assessment: "SAMPLE"

Do not chase a detailed history until life-threatening injuries are identified and treated. The secondary survey is a head-to-toe assessment of progress and vital signs. SAMPLE covers the key history elements.

• S: Symptoms
• A: Allergies
• M: Medications
• P: Past medical history
• L: Last oral intake
• E: Events leading up to the illness or injury

3. Rapid Trauma Assessment: "DCAP-BTLS"

DCAP-BTLS lists the soft-tissue injuries to look for after trauma.

• D: Deformities, malformations or distortions of the body.
• C: Contusions, tissue injury with skin discoloration and no break in the skin (a bruise).
• A: Abrasions, a scrape that denudes the skin surface.
• P: Punctures or penetrations, a small opening that is deep relative to its width, from a narrow pointed object.
• B: Burns from heat, friction, electricity, radiation, or chemicals.
• T: Tenderness, soreness to the touch.
• L: Lacerations, a torn or jagged wound from blunt trauma.
• S: Swelling, a sign of inflammation as fluid exudes from the capillaries into the tissue.

4. Alcoholism Screening: "CAGE"

CAGE is a validated screen for alcoholism. Two "yes" answers warrant further investigation. The Eye Opener question carries the most weight; a "yes" there alone points to dependence, since needing a morning drink signals overnight withdrawal.

• C: Have you ever felt you should CUT down on your drinking?
• A: Have you been ANNOYED by criticism of your drinking?
• G: Have you felt GUILTY about your drinking?
• E: Have you had a morning EYE OPENER to steady yourself?

5. Emergency Trauma Assessment: "ABCDEFGHI"

ABCDEFGHI is a fast primary assessment for trauma, especially in emergencies. Preserve the patient's life first, then move to secondary assessment once life threats are addressed.

• A: Airway, keep it open so the body can take in oxygen and expel carbon dioxide. Use the head-tilt chin-lift and clear obstructions. A blocked airway leads to respiratory or cardiac arrest.
• B: Breathing, with the airway open, look, listen, and feel for normal breathing. If breathing is absent or abnormal, start CPR with 2 breaths.
• C: Circulation, blood cannot circulate oxygen without breathing, so start CPR immediately when breathing is absent rather than delaying for a pulse check.
• D: Disability, check neurological status and obvious deformities.
• E: Expose and examine, remove clothing to assess fully, and keep the patient warm.
• F: Full set of vital signs, note pulse (carotid, brachial, radial), pupils, breathing, level of consciousness, blood pressure, and skin color and temperature.
• G: Give comfort measures, rest, reassure, and prevent further injury.
• H: History and head-to-toe assessment, use SAMPLE for the history, then assess head to toe.
• I: Inspect posterior surface for wounds, deformities, and discolorations.

6. Seven Warning Signs of Cancer: "CAUTION"

The American Cancer Society uses CAUTION for the early warning signs. One sign alone does not mean cancer, but it earns a workup.

• C: Change in bowel or bladder habits
• A: A sore that does not heal
• U: Unusual bleeding or discharge
• T: Thickening or lump in the breast or elsewhere
• I: Indigestion or dysphagia
• O: Obvious change in a wart or mole
• N: Nagging cough or hoarseness

7. Family History Assessment: "BALD CHASM"

Family history drives the risk of inherited and chronic disease. Diagram age, health, or cause of death for siblings, parents, and grandparents, and document which illnesses are present or absent. BALD CHASM names the diseases to investigate.

• B: Blood pressure, African Americans carry higher risk for hypertension, and inherited lifestyle and diet patterns add to it.
• A: Arthritis, some types run in families through genes that raise susceptibility to environmental triggers.
• L: Lung diseases, cystic fibrosis is a common inherited lung disease, with thick mucus, frequent infections, and coughing.
• D: Diabetes, a family history of type 2 diabetes raises the patient's risk.
• C: Cancers, breast and colon cancer appear more often in some families.
• H: Heart diseases, genes pass on cardiovascular risk along with hypertension and high cholesterol.
• A: Alcoholism, genetic factors play a role; children of alcoholics are about 4 times more likely than the general population to develop alcohol problems.
• S: Stroke, risk rises with a direct family history, and some strokes stem from genetic disorders like CADASIL.
• M: Mental health disorders (depression, bipolar, schizophrenia), which can run in families through a mix of genes and other factors.

8. Breast Assessment: "LMNOP"

Breast masses range from fibroadenomas, cysts, and abscesses to mastitis and breast cancer. Every mass warrants careful evaluation and definitive diagnostics.

• L: Lump, inspect and palpate for lumps and masses.
• M: Mammary changes, check for dimpling, tenderness, and abnormal contours.
• N: Nipple changes, check for retraction, lesions, and discharge.
• O: Other symptoms, note size, symmetry, skin appearance, direction of pointing, rashes, and ulceration.
• P: Patient risk factors, gather predisposing factors and family history, or use the Breast Cancer Risk Assessment Tool.

9. Eyes Abbreviation

The eye abbreviations trip people up. OU (Oculus Uterque) means both eyes, OD (Oculus Dexter) the right eye, and OS (Oculus Sinister) the left.

• YOU look with BOTH eyes.
• The RIGHT dose won't OD [overdose].
• The only one LEFT is OS.

10. Signs vs. Symptoms

A sign is objective and found by the clinician on exam. A symptom is subjective, experienced and reported by the patient, and cannot be measured directly.

• sIgn: something I can detect even if the patient is unconscious.
• sYMptom: something only hYM knows about.

11. Pain Assessment: "OPQRSTU"

Pain is subjective, so assess it deliberately. It is an unpleasant sensory and emotional experience tied to actual or potential tissue damage.

• O: Onset, when did it start, how long does it last, how often, and what were you doing when it began?
• P: Provoking or palliating factors, what brings it on, what helps, what makes it worse?
• Q: Quality, what does it feel like (throbbing, stabbing, dull)?
• R: Region and radiation, where is it, does it spread, and where does it go?
• S: Severity, what is the intensity on a 1 to 10 scale, now and at worst, and what other symptoms come with it?
• T: Time and treatment, when did symptoms begin, what medications are you taking, and how well do they work?
• U: Understanding and impact, what do you think is causing it, and how does it affect your ADLs and family?
• V: Values, what is your comfort goal or acceptable level, and any other concerns?