First Semester Nursing Major Phrases and Vocab- Fall

Acuity

The level of a patient’s illness severity

Ex. Patient in ICU/CCU has a higher acuity than IRU (Rehab Unit)

Altered mental status:

sudden or gradual changes in behavior and thinking that can include disorientation, confusion, or coma.

Could be chronic (from dementia) or acute (low blood)

Acute

An illness with short duration but severe symptoms

Complication

A secondary disease, or a negative reaction,occurring during the course of an illness and usually aggravating the illness.

Chronic

persisting for a long time; indicates a disease or illness showing a slow progression over a long period. Examples: chronic obstructive pulmonary disease, osteoarthritis, congestive heart failure.

Constrict

To narrow or make smaller, to shrink or contract.

Dilate

to stretch or enlarge -assessments and physiological responses that are associated with the word"dilate" includes the pupils of the eyes; the vascular system can dilate as well (arteries and veins). When vasodilation happens, it causes pressure in the arteries to go DOWN(meaning, blood pressure lowers/drops/decreases).

"end-stage" disease

a disease that has reached an advanced stage and typically includes severe loss of function of the organ or organs involved (e.g., end stage kidney disease; end stage heart failure).

Emergent

Arising suddenly and unexpectedly, calling for quick clinical judgment and prompt action. Examples include a patient presenting with signs and symptoms of a myocardial infarction (heart attack); patient presenting with signs and symptomsof a stroke.

Exacerbate (verb) and Exacerbation (noun)

Increased severity of a disease or any of its signs or symptoms.Ex: "this patient is experiencing an asthma exacerbation" (meaning, they have the chronic condition of asthma, but it has worsened at this point in time). Ex: "running on a sprained ankle will only exacerbate the injury." (meaning, inflict more damage on the ankle, increase signs/symptoms of ankle discomfort like swelling, pain etc.)

Generalized or Systemic

Spreading through or affecting the entire body; not localized:for example,"this patient has ageneralized rash." (meaning, a rash across their entire body). "This patient has a systemic infection" (meaning, an infection that has spread throughout their entire body).

Invasive vs Non-‐Invasive

Invasive refers to a healthcare procedure that breaks the skin or introduces into a body cavity something that is foreign (e.g., does not naturally occur there like an endotracheal tube inserted into an airway to provide ventilation). This is a huge category and includes just about all major surgery and many diagnostic tests (e.g., biopsy). In contrast, non-‐invasive means that the skin is not broken -examples, include taking a blood pressure with a sphygmomanometer (non-‐invasive blood pressure cuff), performing a head-‐to-‐toe assessments, imaging studies (chest x-‐ray, MRI, CT scan).

Healthcare Provider (HCP):

refers to someone who is licensed/certified to administer interventions (directly or indirectly) to improve physical, psychological, and/or emotional status of patient. They have legal authority to prescribe medications as well. Examples include: medical doctors, nurse practitioners, physician assistants. On NCLEX, Registered Nurses are NOT considered HCPs.

Hand-‐off Report:

shift-‐to-‐shift report given between the nurse who was taking care of apatient and theirshift is over so they are giving the oncoming nurse information about the patient they will be taking over care of.

Level of Consciousness:

an indication of nervous system functioning -‐normal level of consciousness is awake, alert, aware of self and environment. Lethargy is mild reduction in alertness. Obtunded is moderate reduction in alertness.

Lethargy

is mild reduction in alertness.

Obtunded

is moderate reduction in alertness.

Stupor/Stuporous

means patient can only be awoken to repeated, vigorous stimulation. Comatose is unresponsive to all external stimuli.

Localized

Restricted or limited to a specific body part or region:"the patient had localized pain and numbness in their left hand."

Manifestation

a sign (objective data; measurable) or symptom(subjective; often patient-‐reported perceptions) of disease of illness.Manifestation (noun) and manifest (verb) examples: "Wheezing is a common manifestation of an asthma exacerbation." Or "Asthma often manifests as wheezing, dyspnea, low oxygen saturations in the blood."

sign

objective/measurable

symptom

subjective, patient reported

Outpatient vs Inpatient:

Inpatient care refers to healthcare services that require a client to be admitted by a healthcare provider into a hospital or other health care facility so they can stay overnight for medical observation. Inpatient care typically involves serious conditions (e.g., heart attacks, major surgery, exacerbations of chronic conditions) or involves recovering from life-‐threatening traumas that require monitoring by physicians or nurses over more than one day. Outpatient centers or procedures are typically used by patients undergoing treatments and medical procedures that do not require overnight stays (e.g., diagnostic procedures like a colonoscopy, hemodialysis, scheduled blood transfusions).

post-op or pre-op

"op" refers to "operative"-‐referring to care of patient before surgery(pre-‐op)and after surgery(post-‐op).

Perfusion

blood flow through vascular system to cells, tissues, and organs

Parenteral:

by some route other than through the gastrointestinal tract/alimentary canal, such as by subcutaneous, intramuscular, intraosseous, or intravenous injection. Since a needle is usually used at some point in this route of administration, the memory aide people use is "parenteral = poke."Enteral, therefore, means "involving/using the GI tract" as in "enteral feedings."

stable vs. unstable

"stable" is a patient or patient situation that does not change substantially over time. Another way to think about stable is the patient is at their baseline for whatever piece of data you are considering. Example: a patient who has asystolic blood pressure of 100 and their blood pressure NORMALLY rangesfrom 90-‐110is considered stable with regards to this blood pressure, whereas a patient who has a blood pressure that is typically 160-‐170, this blood pressure of 100 could indicate an UNSTABLE situation because it is not the USUAL/TYPICAL for this SPECIFIC patient. Very important, must always ask yourself,"is this expected or unexpected for this SPECIFIC patient?" Unstable patients are critically ill or have a condition/situation that is changing rapidly over time -for example, a patient admitted with chest pain and is shortly thereafter found to be having a heart attack/myocardial infarction, and then experiences a cardiac arrest as a result (i.e., their heart stop beating).

Triage Nurse

this is the nurse, oftentimes working in the Emergency Dept. or Urgent Care, who screens patients to determine their relative priority for treatment order. Shown here is just one example of a Triaging framework.

Cardiovascular: No pulse or pulseless

having no perceptible/palpable pulse and therefore no heartbeat (cardiac arrest).

Respiratory: Adventitious

breath sounds: "Breath sounds" refer to what we hear when we auscultate (listen to) the lungs with a stethoscope, but there are different ways to describe what we hear that you will learn about in your Health Assessment class. "Adventitiousbreath sounds" are abnormal sounds we hear when listening to the chest (e.g., crackles, stridor, wheezes -again, more description of these to come in your coursework).

Respiratory: Expectorate

To clear out the chest and lungs by coughing up and spitting out matter, like phlegm, sputum, or saliva -expectorating is what people might call "spit/spitting."

Respiratory: Wheeze

to breathe with difficulty and with a whistling sound on auscultation. Associated with bronchoconstriction (narrowed small airways in the lungs). Example:Asthma caused him to wheeze.

GI: Excrete

(not just a GI term): to discharge (waste matter, such as urine, sweat, carbon dioxide, feces) from the body through the kidneys, skin, lungs, bowels, etc.

GI: Secrete

(not just a GI term): To generate and release (a substance) from a cell or a gland. Example: the adrenal glands secrete hormones; the pancreas secretes enzymes.

GI: Drool

To let saliva run from the mouth.

GI: Bowel movement/BM

evacuation from feces/stool from the gastrointestinal tract through the rectum.

GI: Bloating

abdominal distention from swallowed air or intestinal gas.

GI: Tarry Stool

stool that is black from oxidized blood associated with conditions such as GI bleeding.

GI: Melena

passage of black, tarry stool composed of blood, often from an upper GI bleed.

GI: Borborygmi

rumbling/gurgling in the stomach -what people commonly call "stomach growling."

GI: Ileus

lack of movement/peristalsis of the intestines.

GI: Hypoactive

soft, low, widely separated bowel sounds

GI: Hyperactive

loud, gurgling, frequent bowel sounds.

GI: Absent bowels sounds

no sounds after 3 minutes of auscultating; Can't use GI tractif this is the case (can't feed patient because GI tract is clearly not functioning).

Genitourinary (GU): Overactive bladder

frequent and sudden urge to urinate that is hard to control.

Genitourinary (GU): Incontinence

can refer to bowel or bladder -unintentional loss of urine or stool.Non-‐healthcare workers also refer to urine as "pee."

Musculoskeletal: Hyperreflexia:

over-‐reactive reflexes.

Musculoskeletal: Hyporreflexia

less than normal or absent reflexes. Can also give reflexes a numerical value as well -3 and 4 or hyperreflexia, 2 is normal reflexes, 1 is diminished, and 0 is absent reflexes.

Integumentary: Angioedema

swelling of the soft tissue, commonly the tissue in the neck, face, lips, tongue; associated with severe allergic reactions

Integumentary: edema

Swelling

Integumentary: Erythema

Redness

Integumentary: Pallor

paleness-no necessarily "white," depends on person's natural skin tone -think "it looks like their skin tone/color is dulled/muted."

Integumentary: Jaundice

Yellowing of the skin, sclera of the eyes, mucous membranes, secretions associated with bilirubin buildup seen with liver failure or liver cirrhosis.Patients with darker skin pigmentation, jaundice can still be assessed (if not prominent in skin, look at mucous membranes, sclera, secretions, palms of hands to assess).

Integumentary: Urticaria

hives (red, raised, itchy bumps on skin associated with allergies)

Integumentary: Pruritus

Itching

Integumentary: Diaphoresis/Diaphoretic

Sweating/sweaty

Administer:

to give a medication to a patient by it specific route of administration (intramuscular injection, intravenous administration, subcutaneous injection, by mouth [called "PO"]).

Contraindicated:

often used referring to drugs, means a drug should not be given to a client-variety of reasons allergic reactions, organ failure, pregnancy status. In contrast, to say "a drug is indicated for this condition" means "this is the reason we give this drug." For example, a patient having a seizure may be given the drug Lorazepam because it is indicated for seizure disorders (it is an anticonvulsant and works by reducing electrical activity in the brain that causes seizures).Alternatively, a procedure or diagnostic test might be indicated, for example, "a patient had an abnormal red blood cell count so additional testing is indicated."

Dilute:

To make thinner or less concentrated by adding a liquid such as sterile water or normal saline (NaCl/sodium chloride).

Dispense:

To give out, especially in parts or portions. Example, a medication machine that dispenses medications (see image of nurse dispensing a medication from an automated dispensing unit [ADU]).

"Hold a medication:"

this expression means that a medication is due to be given but, for some reason, the nurse is deciding not to give at the exact time it is due, but instead "hold" the medication and take another action, oftentimes calling the HCP for clarification of the order. This is often due to patient-‐specific factors and known/anticipated therapeutic effects and side effects of the medication. For example, a medication is due that has the therapeutic effect of lowering heart rate. Prior to giving the medication, the nurse assesses the patient's heart rate and it is low. RECOGNIZING that this medication will lower the heart rate even FURTHER, the nurse decides to not give the medication as ordered/at the time prescribed and instead calls the HCP for clarification on whether or not the medication should be given.For example, "a HCP wrote the order 'Hold Medication X and call the HCP if heart rate is less than 60 beats per minute'."

Infuse:

To introduce (a solution) into the body through a vein for therapeutic purposes (see image of patient receiving aninfusion of chemotherapy at an infusion clinic). We do NOT infuse medications into arteries-think of the route of administration called "intravenous" NOT "intra-‐arterial.

Taper or Wean:

to gradually reduce or decrease. There are certain medications, for example, that patient's cannot just stop taking suddenly or there will be negative consequences. For example, blood pressure medications that a patient has been taking for months or years should not be stopped suddenly but rather must be decreased in dosage over time until the patient is completed "weaned" or "tapered" off that medication (meaning, they do not take the medication any more).

Parameters:

instructions that tell you when or when not to give a medication. For example, "Hold Digoxin for apical heart rate of < 60 bpm -> this is a hold parameter...instruction that tells you when to not give a medications. Many PRN meds include parameters so you know in what circumstances they are to be given.

Medication Administration Record(MAR or eMAR):

this is the paper or electronic report that serves as a legal record of the drugs administered to a patient at a facility by someone licensed/certified to administer those medications (RN, LPN, other HCP). The MAR is a part of a patient's permanent record on their medical chart. The MAR includes such information as patient name, allergies, demographic information and drug details (prescriber, drug name, dose, route of administration, frequency of administration, indication[i.e., therapeutic reason we are administer-to lower blood pressure, reduce pain, etc.], places to indicate when the medication has been given and by whom). The MAR is part of the patient's Electronic Health Record (EHR).

back/return to baseline"

"baseline" is patient data that represents the normal level of a measurable quality, used for comparison with values representing response to an intervention. For example, a patient's baseline systolic blood pressure may be 120 mm Hg -this is where the systolic blood pressure is typically measured to before this patient, over time. However, if the same patient is assessed to have an elevated blood pressure, HCPs intervene to help return that patient to their "baseline."

"question an order"or "call into question"

-this expression is commonly used when a nurse is evaluating whether or not a HCP order is appropriate for a patient -could be any prescription, not just drugs. When a nurse "questions an order" that means that the nurse thinks there is something WRONG/INAPPROPRIATE with the order for this specific patient, and it is necessary to speak to the HCP before carrying the order out. For example, an order for Penicillin for a patient allergic to Cephalosporins should be questioned because patients allergic to Cephalosporins tend to ALSO be allergic to Penicillin(a concept call called cross-‐sensitivity).Another example: "The nurses questioned the order for Penicillin because of the patient'sCephalosporin allergy so they called the HCP for clarification."

"the nurse suspects"-

suspecting is equivalent to hypothesizing -based on the data available the nurse THINKS that X is happening with the patient (examples of data include head-‐to-‐toe assessment, lab values, diagnostics, patient subjective reports, past medical history, etc.). For example, patient describing severe substernal chest pain and shortness of breath and has a history of coronary artery disease, then the nurse should SUSPECT a myocardial infarction is happening.Nurse uses the data available to make a clinical judgment about what is happening, and then acts on that judgment.

"the nurse anticipates doing X(an action)next"-

means that, given the patient-‐specific situation, the nurse knows what actions, prescriptions, HCP orders are coming up next. So, a patient is short of breath and has very low oxygen levels according to the monitoring equipment (pulse oximeter), the nurse anticipates supplemental oxygen being ordered and applied to the patient by the nurse as soon as possible because the nurse knows the human body cannot survive long without adequate oxygen delivery (cells in the body start to die, organ systems shutdown, etc.).

"discharge a patient"-

often times means the patient who is currently in an inpatient setting (i.e., was admitted to the hospital, on a specific unit or floor) and is now being sent back home or to another facility that is for lower acuity patients(e.g., long-‐term care facility, rehabilitation facility).Ex. Patient X was discharged at 10:05am.

"Hypo-‐" and "Hyper-‐" prefixes

low and high, respectively

"Dys-‐"prefix means

"difficult"or "bad"

dyspnea

difficulty breathing

dysphagia-

difficulty swallowing

-‐rhea"suffix refers

to runny or running

diarrhea-

loose, frequent stools

rhinorrhea-

running nose/nasal discharge

-‐rhaggia" or "rhage" suffix means

"to burstforth"

hemorrhage

blood bursting forth/excessive bleeding

‐itis" means

infammation

the one exception to -itis is...

one exception, osteoarthritis (not inflammatory, refers to breakdown of bone/joint from excessive use, age-‐related changes, injury)

-‐penia" suffix

reduction in number

thrombocytopenia

reduced platelet count

"-‐algia" refers

to pain

neuralgia

nerve-based pain

"brady-‐" means

slow

"tachy-‐" means

fast

bradypnea

slow breathing

tachypnea

fast breathing

"‐centesis"

a surgical puncture to remove fluid

thoracentesis

fluid collection in or around the lungs

paracentesis

fluid collection in the peritoneal/abdominal space

"supra-‐" means

above

supraventricular -

above the ventricles of the heart (in the atria)

"-‐uria" means

in the urine

Oliguria

reduced urine output

Anuria

Minimal urine or no urine output

Poly

many

polyuria

excessive urination

Hematuria

bloody urine