Open RN Nursing Skills 2e — Master Glossary
All 414 glossary terms from Nursing Skills, 2nd edition (2e), copied word for word and verified against the source.
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0–9
15-15 Rule
A rule in an agency’s hypoglycemia protocols that includes providing 15 grams of carbohydrate, and then repeating the blood glucose reading in 15 minutes, and then repeating as needed until the patient’s blood glucose reading is above 70. (Chapter 19.2)
A
ABCDE
A mnemonic for assessing for melanoma developing in moles: Asymmetrical, Borders are irregular in shape, Color is various shades of brown or black, Diameter is larger than 6 mm., and the shape of the mole is Evolving. (Chapter 14.2)
Abduction
Joint movement away from the midline of the body. (Chapter 13.2)
Accessory muscles
Muscles other than the diaphragm and intercostal muscles that may be used for labored breathing. (Chapter 10.3)
Accommodation
The ability of the eye to adjust from near vision to far vision. Pupils constrict at near vision and dilate at far vision. (Chapter 6.5)
Acne
A skin disturbance that typically occurs on areas of the skin that are rich in sebaceous glands, such as the face and back. (Chapter 14.3)
Active range of motion
The degree of movement a patient can voluntarily achieve in a joint without assistance. (Chapter 13.4)
Activities of daily living
Daily basic tasks fundamental to everyday functioning (e.g., hygiene, elimination, dressing, eating, ambulating/moving). (Chapter 2.8)
Acute otitis media
The medical diagnosis for a middle ear infection. (Chapter 8.2)
Adduction
Joint movement toward the middle line of the body. (Chapter 13.2)
Affect
Outward display of one’s emotional state. A “flat” affect with little display of emotion is associated with depression. (Chapter 1.4)
AIDET
Mnemonic for introducing oneself in health care that includes Acknowledge, Introduce, Duration, Explanation, and Thank You. (Chapter 1.2)
Airborne precautions
Infection prevention and control interventions to be used in addition to standard precautions for diseases spread by airborne transmission, such as measles and tuberculosis. (Chapter 4.2)
Ampules
Small glass containers of liquid medication ranging from 1 mL to 10 mL sizes. (Chapter 18.2)
Angiogenesis
The development of new capillaries in a wound base. (Chapter 20.2)
Anosmia
Partial or complete loss of smell. This symptom can be related to underlying cranial nerve dysfunction or other nonpathological causes such as a common cold. (Chapter 6.5)
Apnea
Absence of respirations. (Chapter 10.3)
Apocrine sweat gland
Sweat glands associated with hair follicles in densely hairy areas that release organic compounds subject to bacterial decomposition causing odor. (Chapter 14.2)
Around the Clock (ATC) order
An order that reflects that medication should be administered at regular time intervals, such as every six hours, to maintain consistent levels of the drug in the patient’s bloodstream. (Chapter 15.2)
Arterial blood gas (ABG)
A sample of arterial blood that measures the oxygen, carbon dioxide, and bicarbonate levels. (Chapter 11.2)
Arterial blood sampling
Blood is obtained via puncture into an artery by specially trained registered nurses and other health care personnel, such as respiratory therapists, physicians, nurse practitioners, and physician assistants. (Chapter 23.2)
Arterial ulcers
Ulcers caused by lack of blood flow and oxygenation to tissues and typically occur in the distal areas of the body such as the feet, heels, and toes. (Chapter 20.2)
Arthroplasty
Joint replacement surgery. (Chapter 13.3)
Arthroscopic surgery
A surgical procedure involving a small incision and the insertion of an arthroscope, a pencil-thin instrument that allows for visualization of the joint interior. Small surgical instruments are inserted via additional incisions to remove or repair ligaments and other joint structures. (Chapter 13.3)
Articular cartilage
Smooth, white tissue that covers the ends of bones where they come together at joints, allowing them to glide over each other with very little friction. Articular cartilage can be damaged by injury or normal wear and tear. (Chapter 13.2)
Asepsis
A state of being free of disease-causing microorganisms. (Chapter 4.3)
Aseptic non-touch technique
A standardized technique, supported by evidence, to maintain asepsis and standardize practice. (Chapter 4.3)
Aseptic technique (medical asepsis)
The purposeful reduction of pathogen numbers while preventing microorganism transfer from one person or object to another. This technique is commonly used to perform invasive procedures, such as IV starts or urinary catheterization. (Chapter 4.3)
Aspiration pneumonia
A type of lung infection caused by material from the stomach or mouth inadvertently entering the lungs that can be life-threatening. (Chapter 7.3, Chapter 12.3)
Atelectasis
Alveoli or an entire lung is collapsed, allowing no air movement. (Chapter 10.3)
Atrial fibrillation
An irregular heartbeat that is often fast and increases the risk of heart attack or stroke. (Chapter 9.3)
Auricle
The large, fleshy structure of the ear on the lateral aspect of the head. (Chapter 8.2)
Auscultation
Listening to sounds, such as heart, lung, and bowel sounds, created by organs using a stethoscope. (Chapter 1.1)
B
Babinski response
A reflex demonstrated as fanning of 4 toes with great toe bending towards top of foot when object slid along sole of foot. Normal in children under 2. Older than 2 through adulthood, all five toes should curl downward. (Chapter 6.9)
Barrel-chested
An equal AP-to-transverse diameter that often occurs in patients with COPD due to hyperinflation of the lungs. (Chapter 10.3)
Belief
Something accepted as true with a sense of certainty. (Chapter 2.8)
Bladder scan
A bedside test using a noninvasive tool used to measure the volume of urine in the bladder. (Chapter 21.6)
Blanching
To make white or pale by applying pressure. (Chapter 9.3, Chapter 14.4)
Bleb
A small, raised circle that appears after administration of an intradermal medication indicating correct placement into the dermis. (Chapter 18.4)
Body image
A mental picture of one’s body related to appearance and function. (Chapter 2.8)
Body Mass Index (BMI)
A standardized reference range to gauge a patient’s weight status. (Chapter 1.4)
Borborygmus
Hyperperistalsis, often referred to as “stomach growling.” (Chapter 12.3)
Bradycardia
A resting heart rate of fewer than 60 beats per minute (bpm) in adults. (Chapter 9.3)
Bradypnea
Decreased respiratory rate or slow breath less than normal range according to the patient’s age. (Chapter 10.3)
Broca’s area
An area located in the frontal lobe that is responsible for the production of language and controlling movements responsible for speech. (Chapter 6.2)
Bronchial breath sounds
High-pitched hollow sounds heard over trachea and the larynx. (Chapter 10.3)
Bronchovesicular sounds
Mixture of low- and high-pitched sounds heard over major bronchi. (Chapter 10.3)
Bruit
A swishing sound heard upon auscultation. (Chapter 6.10, Chapter 9.3)
C
Candidiasis
A fungal infection often referred to as “thrush” when it occurs in the oral cavity in children. (Chapter 7.3)
Capillary blood testing
Blood collected from capillaries located near the surface of the skin. (Chapter 23.2)
Capillary refill
The time it takes for color to return after pressure is applied to tissue causing blanching. (Chapter 9.3)
Care partners
Family and friends who are involved in helping to care for the patient. (Chapter 2.2)
Catheter embolism
Occurs when a small part of the cannula breaks off and flows into the vascular system. (Chapter 23.4)
CAUTI
Catheter-associated urinary tract infection. (Chapter 21.3)
Central nervous system
The part of the nervous system that includes the brain (the interpretation center) and the spinal cord (the transmission pathway). (Chapter 6.2)
Central venous access device (CAVD)
A type of vascular access that involves the insertion of a catheter into a large vein in the arm, neck, chest, or groin. (Chapter 23.2)
Cerebellum
The part of the brain that coordinates skeletal and smooth muscle movement and maintains equilibrium and balance. (Chapter 6.2)
Cerebral cortex
The cerebrum is covered by a wrinkled outer layer of gray matter. (Chapter 6.2)
Cerumen impaction
A buildup of earwax causing occlusion of the ear canal. (Chapter 8.2)
Chief complaint
The reason a patient is seeking health care during a visit to a clinic or on admission to a health care facility. (Chapter 2.5)
Cleft lip
A birth defect caused by a partial or complete failure of the right and left portions of the upper lip to fuse together, leaving a gap in the lip. (Chapter 7.3)
Cleft palate
A birth defect caused when two halves of the hard palate fail to completely come together and fuse at the midline, leaving a gap between them, and making it very difficult for an infant to generate the suckling needed for nursing. (Chapter 7.3)
Click
Clicking sound heard on auscultation of the precordium; often heard in patients with heart valve abnormalities. (Chapter 9.3)
Clubbing
A change in the configuration where the tips of the nails curve around the fingertips, usually caused by chronic low levels of oxygen in the blood. (Chapter 10.3, Chapter 11.2)
Clubfoot
A congenital condition that causes the foot and lower leg to turn inward and downward. (Chapter 13.3)
Colostomy
The colon is attached to a stoma to bypass the rectum and the anus. (Chapter 21.7)
Comatose
A decreased level of consciousness with a score of less than 8 on the Glasgow Coma Scale. (Chapter 6.4)
Concussion
A type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. This sudden movement can cause the brain to bounce around or twist in the skull, creating chemical changes in the brain and damaging brain cells. (Chapter 7.3)
Conductive hearing loss
Hearing loss that occurs when something in the external or middle ear is obstructing the transmission of sound. (Chapter 8.2)
Congenital condition
A condition present at birth. (Chapter 13.3)
Conjunctiva
Inner surface of the eyelid. (Chapter 8.2)
Conjunctivitis
A viral or bacterial infection in the eye causing swelling and redness in the conjunctiva and sclera. (Chapter 8.2)
Contact precautions
Infection prevention and control interventions to be used, in addition to standard precautions, for diseases spread by contact with the patient, their body fluids, or their surroundings, such as C-diff, MRSA, VRE, and RSV. (Chapter 4.2)
Contracture
A fixed or permanent tightening of muscles, tendons, ligaments, or the skin that prevents normal movement of the body part. (Chapter 13.3)
Convergence
The action of both eyes moving inward as they focus on a close object using near vision. (Chapter 6.5)
Cornea
The transparent front part of the eye that covers the iris, pupil, and anterior chamber. (Chapter 8.2)
Coude catheter
A catheter specifically designed to maneuver around obstructions or blockages in the urethra such as with enlarged prostate glands in males. Coude originates from the French word that means “bend.” (Chapter 21.2)
Crackles
Also referred to as “rales”; sound like popping or crackling noises during inspiration. Associated with inflammation and fluid accumulation in the alveoli. (Chapter 10.3)
Cranium
Eight bones that protect the brain in the cranial cavity. (Chapter 7.2)
Crepitus
A crackling, popping noise heard on joint movement. It is considered normal when it is not associated with pain. (Chapter 10.3, Chapter 13.2)
Cultural safety
The creation of safe spaces for patients to interact with health professionals without judgment, racial reductionism, racialization, or discrimination. (Chapter 1.2, Chapter 2.2)
Cyanosis
Bluish discoloration of the skin, lips, and nail beds. It is an indication of decreased perfusion and oxygenation. (Chapter 9.3, Chapter 10.3, Chapter 11.2, Chapter 14.4)
D
Debridement
The removal of nonviable tissue in a wound. (Chapter 20.4)
Deep Vein Thrombosis (DVT)
A blood clot that forms in a vein deep in the body. (Chapter 9.3)
Dehiscence
The separation of the edges of a surgical wound. (Chapter 20.2)
Deltoid
Commonly used for intramuscular vaccinations in adults because it has a triangular shape and is easy to locate and access. The injection site is in the middle of the deltoid muscle, about 1 to 2 inches below the acromion process. (Chapter 18.6)
Dermatome
An area of the skin that is supplied by a single spinal nerve. (Chapter 6.6)
Dermis
The inner layer of skin with connective tissue, blood vessels, sweat glands, nerves, hair follicles, and other structures. (Chapter 14.2)
Developmental stages
A person’s life span can be classified into nine categories of development, including Prenatal Development, Infancy and Toddlerhood, Early Childhood, Middle Childhood, Adolescence, Early Adulthood, Middle Adulthood, Late Adulthood, and Death and Dying. (Chapter 1.2)
Diabetic ulcers
Ulcers that typically develop on the plantar aspect of the feet and toes of patients with diabetes due to lack of sensation of pressure or injury. (Chapter 20.2)
Diaphoretic
Excessive, abnormal sweating. (Chapter 14.4)
Diastole
The phase between each contraction of the heart when the ventricles are filling with blood. (Chapter 3.2)
Diastolic blood pressure
The resting pressure of blood on the arteries between each cardiac contraction. (Chapter 3.2)
Dimensional analysis
Dimensional analysis is a problem-solving technique where measurements are converted to a different (but equivalent) unit of measure by multiplying with a fractional form of 1 to obtain a desired unit of administration. (Chapter 5.6)
Diplopia
Double vision (i.e., seeing two images of a single object). (Chapter 6.5)
Dislocation
A joint injury that forces the ends of bones out of position; often caused by a fall or a blow to the joint. (Chapter 13.3)
Distention
An expansion of the abdomen caused by the accumulation of air or fluid. Patients often report “feeling bloated.” (Chapter 12.3)
Doff
To take off or remove personal protective equipment, such as gloves or a gown. (Chapter 4.2)
Don
To put on equipment for personal protection, such as gloves or a gown. (Chapter 4.2)
Drop factor
The number of drops in one mL of solution when fluids or medications are administered using gravity IV tubing. (Chapter 5.14)
Droplet precautions
Infection prevention and control interventions to be used in addition to standard precautions; used for diseases spread by large respiratory droplets such as influenza, COVID-19, or pertussis. (Chapter 4.2)
Dry powder inhaler (DPI)
An inhaler with medication provided in a powder form that is inhaled from the mouth into the lungs using a quick breath to activate the medication and move it into the lungs. An example of a DPI is tiotropium (Spiriva). (Chapter 16.2)
Ductus arteriosus
Shunt that connects the pulmonary artery and aorta in the developing fetus. (Chapter 9.3)
Dysphagia
Difficulty swallowing. (Chapter 6.10, Chapter 7.2, Chapter 7.3, Chapter 12.3, Chapter 15.2)
Dyspnea
A feeling of shortness of breath. (Chapter 9.3, Chapter 10.3, Chapter 11.2)
Dysuria
Painful urination. (Chapter 2.8, Chapter 12.3)
E
Ecchymosis
Bruising that occurs when small veins and capillaries under the skin break. (Chapter 14.4, Chapter 20.2)
Eccrine sweat gland
Sweat gland that produces hypotonic sweat for thermoregulation. (Chapter 14.2)
Edema
Swelling in tissues caused by fluid retention. (Chapter 9.3, Chapter 20.2)
Elimination
Refers to the removal of waste products through the urine and stool. (Chapter 2.8)
eMAR
Electronic medication administration record contained in a patient’s electronic chart. (Chapter 15.2)
Enhanced barrier precautions
An infection control intervention designed to reduce transmission of multidrug-resistant organisms (MDRO’S) in nursing homes. (Chapter 4.2)
Enteral medications
Medications that are administered directly into the gastrointestinal tract orally, rectally, or through a tube such as a nasogastric (NG) tube, nasointestinal (NI) tube, or percutaneous endoscopic gastrostomy (PEG) tube. (Chapter 15.1)
Enteral nutrition (EN)
Nutrition provided directly into the gastrointestinal (GI) tract through an enteral tube that bypasses the oral cavity. (Chapter 17.2)
Epidermis
The thin, uppermost layer of skin. (Chapter 14.2)
Epiglottis
A flexible piece of cartilage that covers the opening of the trachea during swallowing to prevent ingested material from entering the trachea. (Chapter 7.2)
Epistaxis
Nosebleed. (Chapter 7.3)
Epithelialization
The development of new epidermis and granulation tissue. (Chapter 20.2)
Equivalency
Two values or quantities that are the same amount. For example, one cup is equivalent to eight ounces. (Chapter 5.4)
Erythema
Redness. (Chapter 14.4, Chapter 20.2, Chapter 20.3)
Eschar
Dark brown/black, dry, thick, and leathery dead tissue in a wound base that must be removed for healing to occur. (Chapter 20.2)
Eustachian tube
The tube connecting the middle ear to the pharynx that helps equilibrate air pressure across the tympanic membrane. (Chapter 8.2)
Extension
Joint movement causing the straightening of limbs (increase in angle) at a joint. (Chapter 13.2)
Extraocular muscles
Six muscles that control the movement of the eye within the orbit. Extraocular muscles are innervated by three cranial nerves, the abducens nerve, the trochlear nerve, and the oculomotor nerve. (Chapter 8.2)
Extravasation
The infiltration of damaging intravenous medications, such as chemotherapy, into the extravascular tissue around the site of infusion, causing tissue injury and possible necrosis. (Chapter 23.4)
Exudate
Fluid that oozes out of a wound; also commonly called pus. (Chapter 20.2)
F
Facial drooping
An asymmetrical facial expression that occurs due to damage of the nerve innervating a particular part of the face. (Chapter 7.2)
Family dynamics
Patterns of interactions between family members that influence family structure, hierarchy, roles, values, and behaviors. (Chapter 1.4)
Fenestrated cannula
Type of tracheostomy tube that contains holes so the patient can speak if the cuff is deflated and the inner cannula is removed. (Chapter 22.2)
FiO2
Fraction of inspired oxygen (i.e., the concentration of oxygen inhaled). Room air contains 21% oxygen levels, and oxygenation devices can increase the inhaled concentration of oxygen up to 100%. However, FiO2 levels should be decreased as soon as feasible to do so to prevent lung injury. (Chapter 11.2)
First-degree burn
A superficial burn that affects only the epidermis. (Chapter 14.3)
Five moments of hand hygiene
Hand hygiene should be performed during the five moments of patient care: immediately before touching a patient; before performing an aseptic task or handling invasive devices; before moving from a soiled body site to a clean body site on a patient; after touching a patient or their immediate environment; after contact with blood, body fluids, or contaminated surfaces (with or without glove use); and immediately after glove removal. (Chapter 4.2)
Flange
The end of the tracheostomy tube that is placed securely against the patient’s neck. (Chapter 22.2)
Flexion
Joint movement causing the bending of the limbs (reduction of angle) at a joint. (Chapter 13.2)
Fluid volume overload (hypervolemia)
A condition when there is too much fluid in the blood. Patients may present with shortness of breath, edema to the extremities, and weight gain. (Chapter 23.2)
Foot drop
The inability to raise the front part of the foot due to weakness or paralysis of the muscles that lift the foot. (Chapter 13.3)
Fourth-degree burn
Severe burn damaging the dermis and the underlying muscle and bone. (Chapter 14.3)
Fracture
A broken bone. (Chapter 13.3)
Functional health
The patient’s physical and mental capacity to participate in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). (Chapter 2.8)
G
Gastric residual volume (GRV)
Stomach contents aspirated with a 60-mL syringe, typically performed for patients receiving enteral feeding to assess aspiration risk with associated interventions such as slowing or stopping tube feeding. GRVs in the range of 200–500 mL should raise concern and lead to the implementation of measures to reduce risk of aspiration. (Chapter 17.2)
Gauge
Refers to the diameter of a needle. Gauges can vary from very small diameter (25 to 29 gauge) to large diameter (18 to 22 gauge). (Chapter 18.2)
Gender expression
Characteristics in appearance, personality, and behavior, culturally defined as masculine or feminine. (Chapter 2.8)
Gender identity
One’s basic sense of being male, female, or other gender. (Chapter 2.8)
General survey assessment
A component of a patient assessment that observes the entire patient as a whole. Observation includes using all five senses to gather cues that provide a guideline for additional focused assessments in areas of concern. (Chapter 1.1)
Goiter
An abnormal enlargement of the thyroid gland that can occur with hypothyroidism or hyperthyroidism. (Chapter 7.3)
Gout
A type of arthritis that causes swollen, red, hot, and stiff joints due to the buildup of uric acid, commonly starting in the big toe. (Chapter 13.3)
Granulation tissue
New connective tissue in a wound base with fragile, thin-walled capillaries that must be protected. (Chapter 20.2)
Guarding
Voluntary contraction of abdominal wall musculature; may be related to fear, anxiety, or presence of cold hands. (Chapter 12.3)
H
Hand hygiene
A way of cleaning one’s hands to substantially reduce the number of pathogens and other contaminants (e.g., dirt, body fluids, chemicals, or other unwanted substances) to prevent disease transmission or integumentary harm, typically using soap, water, and friction. An alcohol-based hand rub solution may be appropriate hand hygiene for hands not visibly soiled. (Chapter 4.1)
HCO3
Bicarbonate level reflected in arterial blood gas results. Normal range is 22-26 meq/L. (Chapter 11.2)
Health history
The process of using directed interview questions to obtain symptoms and perceptions about a patient’s illness or life condition. The purpose of obtaining a health history is to gather subjective data from the patient and/or the patient’s family so that the health care team and the patient can collaboratively create a plan that will promote health, address acute health problems, and minimize chronic health conditions. (Chapter 2.1)
Healthcare-Associated Infections (HAIs)
Unintended infections caused by care received in a health care setting. (Chapter 4.1)
Heave or lift
Palpable lifting sensation under the sternum and anterior chest wall to the left of the sternum; it suggests severe right ventricular hypertrophy. (Chapter 9.3)
Hematemesis
Blood-tinged mucus secretions from the lungs. (Chapter 12.3)
Hematochezia
Passage of bloody stool. (Chapter 12.3)
Hematoma
An area of blood that collects outside of larger blood vessels. (Chapter 7.2, Chapter 20.2)
Hemoptysis
Blood-tinged mucus secretions from the lungs. (Chapter 10.3)
Hemosiderin staining
Dark-colored discoloration of the lower legs due to blood pooling. (Chapter 20.2)
Hemostasis phase
The first phase of wound healing that occurs immediately after skin injury. Blood vessels constrict and clotting factors are activated. (Chapter 20.2)
Hyperactive bowel sounds
Increased peristaltic activity; may be related to diarrhea, obstruction, or digestion of a meal. (Chapter 12.3)
Hypercapnia
Elevated carbon dioxide levels in the blood, indicated by PaCO2 level greater than 45 in an ABG test. (Chapter 10.3, Chapter 11.2)
Hyperglycemia
Elevated blood glucose reading with associated signs and symptoms such as frequent urination and increased thirst. (Chapter 19.2)
Hypertension
Elevated blood pressure over 130/80 mmHg in an adult. (Chapter 3.2)
Hypertonic solutions
Solutions that have a higher concentration of dissolved particles than blood. (Chapter 23.2)
Hypoactive bowel sounds
Decreased peristaltic activity; may be related to constipation following abdominal surgery or with an ileus. (Chapter 12.3)
Hypodermis
The layer of skin beneath the dermis composed of connective tissue and used for fat storage. (Chapter 14.2)
Hypoglycemia
A blood glucose reading less than 70 associated with symptoms such as irritability, shakiness, hunger, weakness, or confusion. If not rapidly treated, hypoglycemia can cause seizures and a coma. (Chapter 19.2)
Hypotension
Decreased blood pressure less than 90/60 mmHg in an adult. (Chapter 3.2)
Hypothalamus
The autonomic control center of the brain that controls functions such as blood pressure, heart rate, digestive movement, and pain perception. (Chapter 6.2)
Hypotonic solutions
Solutions that have a lower concentration of dissolved solutes than blood. (Chapter 23.2)
Hypoxemia
Decreased dissolved oxygen in the arterial blood, indicated by a PaO2 level less than 80 mmHg in an ABG test. (Chapter 10.3, Chapter 11.2)
Hypoxia
A reduced level of tissue oxygenation. (Chapter 11.2)
I
Ileostomy
The lower end of the small intestine (ileum) is attached to a stoma to bypass the colon, rectum, and anus. (Chapter 21.7)
Incident report
A report submitted per agency policy used to document the events surrounding a medication error. (Chapter 15.2)
Induration
Area of hardened tissue. (Chapter 20.3)
Indwelling catheter
A device often referred to as a “Foley catheter” that is inserted into the neck of the bladder and remains in place for continual collection of urine into a collection bag. (Chapter 21.2)
Infiltration
Infiltration occurs when the tip of the IV catheter slips out of the vein, the catheter passes through the wall of the vein, or the blood vessel wall allows part of the fluid to infuse into the surrounding tissue, resulting in the leakage of IV fluids into the surrounding tissue. (Chapter 23.4)
Inflammatory phase
The second phase of wound healing when vasodilation occurs so that white blood cells in the bloodstream can move into the wound to start cleaning the wound bed. (Chapter 20.2)
Inner cannula
The cannula inside the outer cannula that is removed during tracheostomy care by the nurse. Inner cannulas can be disposable or reusable with appropriate cleaning. (Chapter 22.2)
Inspection
The observation of a patient’s anatomical structures. (Chapter 1.1)
Instrumental activities of daily living
Complex daily tasks that allow patients to function independently such as managing finances, paying bills, purchasing and preparing meals, managing one’s household, taking medications, and facilitating transportation. (Chapter 2.8)
Intermittent catheterization
The insertion and removal of a straight catheter for relief of urinary retention. (Chapter 21.2)
Intradermal injection
Medication administered in the dermis just below the epidermis. (Chapter 18.1)
Intramuscular injection
Medication administered into a muscle. (Chapter 18.1)
Intravenous injection
Medication administered directly into the bloodstream. (Chapter 18.1)
Intravenous therapy (IV therapy)
Involves the administration of substances such as fluids, electrolytes, blood products, nutrition, or medications directly into a client’s vein. (Chapter 23.2)
Inunction
A medication that is massaged or rubbed into the skin. (Chapter 16.2)
Involuntary guarding
The reflexive contraction of overlying abdominal muscles as the result of peritoneal inflammation. (Chapter 12.3)
Iris
Colored part of the eye. (Chapter 8.2)
Isotonic solutions
IV fluids that have a similar concentration of dissolved particles as found in the blood. (Chapter 23.2)
J
Jaundice
A yellowing of the skin or sclera caused by underlying medical conditions. (Chapter 14.3, Chapter 14.4)
Joints
The location where bones come together. (Chapter 13.2)
Jugular Vein Distension (JVD)
Occurs when the increased pressure of the superior vena cava causes the jugular vein to bulge, making it most visible on the right side of a person’s neck. (Chapter 9.3)
K
Keloid
A raised scar caused by overproduction of scar tissue. (Chapter 14.3)
Ketoacidosis
A life-threatening complication of hyperglycemia that can occur in patients with type 1 diabetes mellitus that is associated with symptoms such as fruity-smelling breath, nausea, vomiting, severe thirst, and shortness of breath. (Chapter 19.2)
Key part
Any sterile part of equipment used during an aseptic procedure, such as needle hubs, syringe tips, dressings, etc. (Chapter 4.3)
Key site
The site contacted during an aseptic procedure, such as nonintact skin, a potential insertion site, or an access site used for medical devices connected to the patients. Examples of key sites include the insertion or access site for intravenous (IV) devices, urinary catheters, and open wounds. (Chapter 4.3)
Kinesthesia
A person’s sense of movement. (Chapter 6.2)
Korotkoff sounds
The audible sounds of blood pressure named after Dr. Korotkoff who discovered them. (Chapter 3.2)
Kyphosis
Outward curvature of the back; often described as “hunchback.” (Chapter 10.3, Chapter 13.3)
L
Lacrimal duct
Tears produced by the lacrimal gland flow through this duct to the medial corner of the eye. (Chapter 8.2)
Laryngopharynx
The portion of the pharynx inferior to the oropharynx and posterior to the larynx that is a passageway for ingested material and air until its inferior end where the digestive and respiratory systems diverge into the esophagus and the larynx. (Chapter 7.2)
Larynx
The structure connecting the pharynx to the trachea that helps regulate the volume of air that enters and leaves the lungs and contains the vocal cords. (Chapter 7.2)
Lens
An inner part of the eye that helps the eye focus. (Chapter 8.2)
Lesion
An area of abnormal tissue. (Chapter 14.2)
Level of consciousness
A patient’s level of arousal and alertness, commonly assessed by asking them to report their name, current location, and time. (Chapter 6.4)
LGBTQ
An acronym standing for lesbian, gay, bisexual, transgender, and queer is an umbrella term that generally refers to a group of people who are diverse with regard to their gender identity and sexual orientation. There are expanded versions of this acronym. (Chapter 2.8)
Ligaments
Strong bands of fibrous connective tissue that connect bones and strengthen and support joints by anchoring bones together and preventing their separation. (Chapter 13.2)
Lordosis
An inward curve of the lumbar spine just above the buttocks. A small degree of lordosis is normal, but too much curving is called swayback. (Chapter 13.3)
Lymph nodes
Structures in the lymphatic system that filter pathogens. (Chapter 7.2)
Lymphadenopathy
Enlarged lymph nodes. (Chapter 7.3)
Lymphedema
A type of swelling that occurs when lymph fluid builds up in the body’s soft tissues due to damage to the lymph system. (Chapter 14.3)
M
Maceration
The softening and wasting away of skin due to excess fluid. (Chapter 20.2)
Macrodrip tubing
Gravity IV tubing with drop factors of 10, 15, or 20 drops per milliliter that are typically used to deliver general IV solutions for adults. (Chapter 5.14)
Main health care needs
Term used to classify what needs the patient feels are most important to address after admission to a health care agency. (Chapter 2.5)
Mandible
Lower jawbone. (Chapter 7.2)
MAR
Medication administration record contained in a patient’s chart. (Chapter 15.2)
Masseter
Main muscle used for chewing because it elevates the mandible to close the mouth. (Chapter 7.2)
Maturation phase
The final phase of wound healing as collagen continues to be created to strengthen the wound, causing scar tissue. (Chapter 20.2)
Maxilla
Bone that forms the upper jaw and supports the upper teeth. (Chapter 7.2)
Medical asepsis
Measures to prevent the spread of infection in health care agencies. (Chapter 1.2)
Medication cup
A small plastic or paper cup used to dispense oral medications. Some plastic medication cups have calibration marks for measuring medication amounts. (Chapter 5.2)
Medication reconciliation
A comparison of a list of current medications with a previous list and is completed at every hospitalization and clinic visit. (Chapter 2.6)
Melanin
Skin pigment produced by melanocytes scattered throughout the epidermis. (Chapter 14.2)
Melanoma
Skin cancer characterized by the uncontrolled growth of melanocytes that commonly develops from a mole. Melanoma is the most fatal of all skin cancers because it is highly metastatic. Melanomas usually appear as asymmetrical brown and black patches with uneven borders and a raised surface. (Chapter 14.3)
Melena
Dark, tarry-looking stool due to the presence of digested blood. (Chapter 2.8, Chapter 12.3)
Mental health
A state of well-being in which every individual realizes their own potential, can cope with normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community. (Chapter 2.8)
Metered dose inhaler (MDI)
An inhaler that provides a mist of medication that is inhaled through the mouth into the lungs. An example of an MDI is albuterol. Optimal administration is achieved with a spacer attached to the inhaler. (Chapter 16.2)
Microdrip tubing
Gravity IV tubing with a drop factor of 60 drops per milliliter. (Chapter 5.14)
Midline peripheral catheters
A larger catheter (i.e., 16-18 gauge) that allow for rapid infusions but does not terminate in the central vasculature. (Chapter 23.2)
Military time
A method of measuring the time based on the full 24 hours of the day rather than two groups of 12 hours indicated by AM and PM. (Chapter 5.3)
Mobility
A patient’s ability to move around (e.g., sit up, sit down, stand up, walk). (Chapter 2.8)
Motor nerves
Nerves in the peripheral nervous system that transmit motor signals from the brain to the muscles to cause movement. (Chapter 6.2)
Murmur
A blowing or whooshing sound heard on auscultation of the precordium that signifies turbulent blood flow in the heart often caused by a valvular defect. (Chapter 9.3)
Muscle atrophy
The thinning or loss of muscle tissue that can be caused by disuse, aging, or neurological damage. (Chapter 13.2)
Myopia
Impaired vision, also known as nearsightedness, that makes far-away objects look blurry. (Chapter 8.2)
N
Nares
Nostril openings into the nasal cavity. (Chapter 7.2)
Nasal septum
Bone and cartilage that separate the nasal cavity into two compartments. (Chapter 7.2)
Nasopharynx
The upper region of the pharynx that connects to the nasal cavity and is a passageway for air. (Chapter 7.2)
Necrosis
Tissue death. (Chapter 23.2)
Necrotic
Black tissue color due to tissue death from lack of oxygenation to the area. (Chapter 20.2)
Nonblanchable erythema
Skin redness that does not turn white when pressure is applied. (Chapter 20.2)
Nursing
Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity. (Chapter 2.1)
Nystagmus
Involuntary, shaky eye movements. (Chapter 6.5)
O
Objective data
Information observed through your sense of hearing, sight, smell, and touch while assessing the patient. (Chapter 1.1, Chapter 2.2)
Obstructive sleep apnea (OSA)
Characterized by repeated occurrences of complete or partial obstructions of the upper airway during sleep, resulting in apneic episodes. (Chapter 11.2)
Older adults
People over the age of 65. (Chapter 1.2)
One-time order
A prescription for a medication to be administered only once. An example of a one-time order is a prescription for an IV dose of antibiotics to be administered immediately prior to surgery. (Chapter 15.2)
Open fracture
A type of fracture when the broken bone punctures the skin. (Chapter 13.3)
Optic nerve
Cranial nerve II that conducts visual information from the retina to the brain. (Chapter 8.2)
Oral syringe
A specific type of syringe used to measure and/or administer medications via the oral route. (Chapter 5.2)
Orbit
The bony socket that houses the eyeball and muscles that move the eyeball. (Chapter 7.2)
Oropharyngeal suctioning
Suction of secretions through the mouth, often using a Yankauer device. (Chapter 22.4)
Oropharynx
The part of the throat at the back of the mouth behind the oral cavity. It includes the back third of the tongue, the soft palate, the side and back walls of the throat, and the tonsils. (Chapter 7.2, Chapter 19.4)
Orthopnea
Breathlessness or a feeling of shortness of breath when lying in a reclined position. (Chapter 9.3, Chapter 10.3)
Orthostatic hypotension
A decrease in blood pressure by at least 20 mmHg systolic or 10 mmHg diastolic within three minutes of standing from a seated or lying position. (Chapter 3.2)
Osteoarthritis
The most common type of arthritis associated with aging and wear and tear of the articular cartilage that covers the surfaces of bones at the synovial joint. (Chapter 13.3)
Osteomyelitis
Bone infection. (Chapter 20.2)
Osteoporosis
A disease that thins and weakens bones, especially in the hip, spine, and wrist, causing them to become fragile and break easily. (Chapter 13.3)
Ostomy
The surgical procedure that creates the opening from the stoma outside the body to an organ such as the small intestine, colon, rectum, or bladder. A stoma can be permanent, such as when an organ is removed, or temporary, such as when an organ requires time to heal. (Chapter 21.7)
Otitis externa
The medical diagnosis for external ear inflammation and/or infection. (Chapter 8.2)
Ototoxic medications
Medications that cause the adverse effect of sensorineural hearing loss by affecting the hair cells in the cochlea. (Chapter 8.2)
Outer cannula
The outer cannula placed by the provider through the tracheostomy stoma and continuously remains in place. (Chapter 22.2)
P
Pallor
A reduced amount of oxyhemoglobin in the skin or mucous membranes. Skin and mucous membranes present with a pale skin color. (Chapter 9.3, Chapter 10.3, Chapter 14.4)
PaO2
The partial pressure of dissolved oxygen in the blood measured by arterial blood gas samples. (Chapter 11.2)
Paralysis
The partial or complete loss of strength, movement, or control of a muscle or group of muscles within a body part that can be caused by brain or spinal injury. (Chapter 6.5)
Paroxysmal nocturnal dyspnea
An attack of severe shortness of breath that generally occurs at night. (Chapter 9.3)
Passive range of motion
The degree of range of motion a patient demonstrates in a joint when the examiner is providing the movement. (Chapter 13.4)
Percussion
An advanced physical examination technique where body parts are tapped with fingers to determine their size and if fluid is present. (Chapter 1.1)
Perfusion
The amount of blood flow to tissue. (Chapter 9.3)
Pericardial friction rub
Uncommon heart sounds produced when the parietal and visceral pericardium become inflamed, generating a creaky-scratchy noise as they rub together. (Chapter 9.3)
Peripheral edema
Swelling due to an accumulation of fluid in tissues perfused by the peripheral vascular system. (Chapter 9.3)
Peripheral inserted central catheter
A thin, flexible tube inserted into a vein in the upper arm and guided into the superior vena cava. (Chapter 23.2)
Peripheral IV
An intravenous catheter inserted by percutaneous venipuncture into a peripheral vein and held in place with a sterile transparent dressing. (Chapter 23.2)
Peripheral nervous system
The part of the nervous system that includes the cranial and spinal nerves. (Chapter 6.2)
Peripheral neuropathy
A condition that causes decreased sensation of pain and pressure, typically in the lower extremities. (Chapter 20.2)
Periwound
The skin around the outer edges of a wound. (Chapter 20.3)
Personal Protective Equipment (PPE)
Includes gloves, gowns, goggles, face shields, and masks, along with environmental controls, to prevent the transmission of infection for patients who are diagnosed or suspected of having an infectious disease. (Chapter 1.2, Chapter 4.1)
Petechiae
Tiny red dots caused by bleeding under the skin. (Chapter 14.3)
Pharyngitis
Infection and/or inflammation in the back of the throat (pharynx). (Chapter 7.3)
Pharynx
A tube lined with mucous membrane that begins at the nasal cavity and is divided into three major regions: the nasopharynx, the oropharynx, and the laryngopharynx. (Chapter 7.2)
Phlebitis
Inflammation of a vein. (Chapter 23.4)
Physical examination
A systematic data collection method of the body that uses the techniques of inspection, auscultation, palpation, and percussion. (Chapter 1.1)
Pitting edema
An accumulation of fluid in tissue and causes an indentation when the area is pressed. (Chapter 9.3)
Pleural rub
Uncommon sound heard when there is inflammation of the lung pleura, resulting in friction as the surfaces rub against each other. (Chapter 10.3)
Precordium
The region of the thorax in front of the heart. (Chapter 9.3)
Presbycusis
Sensorineural hearing loss that occurs with aging due to gradual nerve degeneration. (Chapter 8.2)
Presbyopia
Impaired near vision that commonly occurs in middle-aged and older adults. (Chapter 8.2)
Prescriptions
Orders, interventions, remedies, or treatments ordered or directed by an authorized primary health care provider. (Chapter 15.2)
Pressure injury
Skin breakdown caused when a patient’s skin and soft tissue press against a hard surface for a prolonged period of time, causing reduced blood supply and resulting in damaged tissue. (Chapter 14.3, Chapter 20.2)
Primary intention
Wound healing that occurs with surgical incisions or clean-edged lacerations that are closed with sutures, staples, or surgical glue. (Chapter 20.2)
Primary source of data
Information obtained directly from the patient. (Chapter 1.1, Chapter 2.2)
Primary survey
A brief observation at the start of a shift or visit to verify the patient is stable by assessing mental status, airway, breathing, and circulation. (Chapter 1.4)
PRN order
A prescription for medication to be administered when it is requested by, or as needed by, the patient. PRN orders are usually administered based on patient symptoms such as pain medications. An example of a PRN order is a prescription for pain medication, such as “Acetaminophen 500 mg PO every 4-6 hours as needed for pain.” (Chapter 15.2)
Proliferative phase
The third phase of wound healing that includes epithelialization, angiogenesis, collagen formation, and contraction. (Chapter 20.2)
Proprioception
A person’s sense of their body position. (Chapter 6.2, Chapter 6.8)
Prostate hypertrophy
A common medical condition of the enlargement of the prostate gland in males as they age, causing uncomfortable urinary symptoms such as urgency and frequency. (Chapter 12.3)
Protuberant
Convex or bulging appearance. (Chapter 12.3)
Ptosis
Drooping of the eyelid. (Chapter 6.5)
Pulmonary embolism
A blood clot that lodges in one of the arteries that go from the heart to the lung. (Chapter 9.3)
Pupil
The hole at the center of the eye that allows light to enter. (Chapter 8.2)
Purulent drainage
Wound exudate that is thick and opaque and can be tan, yellow, green, or brown in color. It is never considered normal in a wound, and new purulent drainage should always be reported to the health care provider. (Chapter 20.3)
R
Rales
Another term used for crackles. (Chapter 10.3)
Rebound tenderness
Pain when hand is withdrawn during palpation. (Chapter 12.3)
Reconstitution
The process of adding a liquid diluent to a dry ingredient to make a liquid in a specific concentration. (Chapter 5.10)
Respiration
Includes ventilation and gas exchange at the alveolar level where blood is oxygenated and carbon dioxide is removed. (Chapter 10.2)
Retina
The nervous tissue and photoreceptors in the eye that initially process visual stimuli. (Chapter 8.2)
Retractions
The “pulling in” of muscles between the ribs or in the neck when breathing, indicating difficulty breathing or respiratory distress. (Chapter 10.3)
Rheumatoid arthritis
A type of arthritis that causes pain, swelling, stiffness, and loss of function in joints due to inflammation caused by an autoimmune disease. (Chapter 13.3)
RICE
A mnemonic for treatment of sprains and strains that stands for: Resting the injured area, Icing the area, Compressing the area with an ACE bandage or other device, and Elevating the affected limb. (Chapter 13.3)
Rigidity
Involuntary contraction of the abdominal musculature in response to peritoneal inflammation. (Chapter 12.3)
Rotation
Circular movement of a joint around a fixed point. (Chapter 13.2)
Routine order
A written prescription that is followed until another order cancels it. An example of a routine order is a prescription for daily medication such as “Lisinopril 10 mg PO daily.” (Chapter 15.2)
Rule of Nines
A tool used in the emergency department to assess the total body surface area burned to quickly estimate intravenous fluid requirements. (Chapter 14.3)
S
Safety culture
A culture established in health care agencies to empower staff to speak up about risks to patients and to report errors and near misses, all of which drive improvement in patient care and reduce the incident of patient harm. (Chapter 15.2)
Saline lock
Refers to the use of a short extension set that allows IV access without requiring ongoing IV infusions. (Chapter 23.2)
Sanguineous drainage
Wound drainage that is fresh bleeding. (Chapter 20.3)
SaO2
Calculated arterial oxygen saturation level. (Chapter 11.2)
Scaphoid
Sunken appearance. (Chapter 12.3)
Sclera
White area of the eye. (Chapter 8.2)
Scoliosis
A sideways curve of the spine that commonly develops in late childhood and the early teens. (Chapter 13.3)
Second-degree burn
Burn affecting both the epidermis and a portion of the dermis, resulting in swelling and a painful blistering of the skin. (Chapter 14.3)
Secondary intention
Wound healing that occurs when the edges of a wound cannot be approximated (brought together), so the wound fills in from the bottom up by the production of granulation tissue. Examples of wounds that heal by secondary intention are pressure injuries and chainsaw injuries. (Chapter 20.2)
Secondary source of data
Information from the patient’s chart, family members, or other health care team members. (Chapter 1.1, Chapter 2.2)
Self-concept
Knowledge a person has about themselves that makes up who they are (i.e., their identity). (Chapter 2.8)
Self-esteem
A person’s self-evaluation of their self-concept as being worthy or unworthy. (Chapter 2.8)
Sensation
The function of receiving information about the environment. The major senses are taste, smell, touch, sight, and hearing. (Chapter 6.2)
Sensorineural hearing loss
Hearing loss caused by pathology of the inner ear, cranial nerve VIII, or auditory areas of the cerebral cortex. (Chapter 8.2)
Sensory nerves
Nerves in the peripheral nervous system that carry impulses from the body to the brain for processing. (Chapter 6.2)
Serosanguinous drainage
Wound exudate contains serous drainage with small amounts of blood present. (Chapter 20.3)
Serous drainage
Wound drainage that is clear, thin, watery plasma. It is considered normal in minimal amounts during the inflammatory stage of wound healing. (Chapter 20.3)
Sexual orientation
The preferred term used when referring to an individual’s physical and/or emotional attraction to the same and/or opposite gender. (Chapter 2.8)
Shear
A mechanical force that occurs when tissue layers move over the top of each other, causing blood vessels to stretch and break as they pass through the subcutaneous tissue. (Chapter 20.2)
Sign
Objective data found by the nurse or health care provider when assessing a patient. (Chapter 2.2)
Sinusitis
Inflamed sinuses caused by a viral or bacterial infection. (Chapter 7.3)
Skeletal muscle
Voluntary muscle that produces movement, assists in maintaining posture, protects internal organs, and generates body heat. (Chapter 13.2)
Skin tears
Wounds caused by mechanical forces, typically in the nonelastic skin of older adults. (Chapter 20.2)
Skin turgor
The skin’s elasticity and its ability to change shape and return to normal when gently grasped between two fingers. (Chapter 14.4)
Slough
Inflammatory exudate that is light yellow, soft, and moist and must be removed for wound healing to occur. (Chapter 20.2)
Small-volume nebulizers
Devices that provide a fine mist using oxygen or compressed air to transport the medication from a nebulizer cup into the mouth and into the lungs as the patient breathes normally through a mask or pipe device. (Chapter 16.2)
Snellen chart
A chart used to test far vision. (Chapter 8.2)
Sphygmomanometer
A device used to measure blood pressure and is commonly referred to as a blood pressure cuff. (Chapter 3.2, Chapter 9.3)
Spirituality
A way of living that comes from a set of meanings, values, and beliefs that are important to a person. (Chapter 2.8)
SpO2
An estimated oxygenation level based on the saturation level of hemoglobin measured by a pulse oximeter. (Chapter 11.2)
Sprain
A stretched or torn ligament caused by an injury. (Chapter 13.3)
Standard precautions
The minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where health care is delivered. (Chapter 4.2)
Standardized sliding-scale insulin protocol
Standardized instructions for administration of adjustable insulin dosages based on a patient’s premeal blood glucose readings. (Chapter 19.2)
Standing order
Standing orders are standard prescriptions for nurses to implement for patients in clearly defined circumstances without the need to notify a provider. They may also be referred to as an “order set” or a “protocol.” An example of a standing order/protocol is a standard prescription for all patients coming into an urgent care reporting chest pain to immediately receive four chewable aspirin, the placement of an IV, and an electrocardiogram (ECG). (Chapter 15.2)
STAT order
A one-time prescription that is administered without delay. An example of a STAT order is the prescription for a dose of Benadryl to be administered to a patient having an allergic reaction. (Chapter 15.2)
Stereognosis
The ability to perceive the physical form and identity of an object based on tactile stimuli alone. (Chapter 6.6)
Sterile technique (surgical asepsis)
Techniques used to eliminate every potential microorganism in and around a sterile field while maintaining objects and areas as free from microorganisms as possible. This technique is the standard of care for surgical procedures, invasive wound management, and central line care. (Chapter 4.3)
Sternocleidomastoid
The major muscle that laterally flexes and rotates the head. (Chapter 7.2)
Stoma
An opening on the abdomen that is connected to the gastrointestinal or urinary systems to allow waste (urine or feces) to be collected in a pouch. (Chapter 21.7)
Stomach decompression
Using suctioning through a nasogastric tube to remove the contents of the stomach. (Chapter 17.1)
Straight catheter
A catheter used for intermittent urinary catheterization; it does not have a balloon at the insertion end. (Chapter 21.2)
Strain
A stretched or torn muscle or tendon. (Chapter 13.3)
Striae
White or silver markings from stretching of the skin. (Chapter 12.3)
Stridor
High-pitched crowing sounds heard over the upper airway and larynx indicating obstruction. (Chapter 10.3)
Subcutaneous injection
Medication administered into the subcutaneous tissue just under the dermis. (Chapter 18.1)
Subjective data
Information obtained from the patient and/or family members that offers important cues from their perspectives. (Chapter 1.1, Chapter 2.2)
Suction canister
A container for collecting suctioned secretions that is attached to a suction source. (Chapter 22.4)
Suction catheter
A soft, flexible, sterile catheter used for nasopharyngeal and tracheostomy suctioning. (Chapter 22.4)
Suture
An interlocking joint between adjacent bones of the skull. (Chapter 7.2)
Symptom
Subjective data that the patient reports, such as “I feel dizzy.” (Chapter 2.2)
Syncope
A temporary loss of consciousness usually related to insufficient blood flow to the brain. (Chapter 9.3)
Synovial fluid
A thick fluid that provides lubrication in joints to reduce friction between the bones. (Chapter 13.2)
Synovial joints
A fluid-filled joint cavity where the articulating surfaces of the bones contact and move smoothly against each other. The elbow and knee are examples of synovial joints. (Chapter 13.2)
Syringe
A medical device used to administer parenteral medication into tissue or into the bloodstream. Syringes can also be used to withdraw blood or fluid. (Chapter 5.2)
Systole
The phase of the heartbeat when the left ventricle contracts and pumps blood into the arteries. (Chapter 3.2)
Systolic blood pressure
The maximum pressure of blood on the arteries during the contraction of the left ventricle of the heart referred to as systole. (Chapter 3.2)
T
Tachycardia
A resting heart rate greater than 100 beats per minute (bpm) in adults. (Chapter 9.3)
Tachypnea
Rapid and often shallow breathing greater than normal range according to the patient’s age. (Chapter 10.3)
Temporalis
Muscle that assists in chewing by retracting the mandible. The temporalis muscle can be felt moving by placing fingers on the patient’s temple as they chew. (Chapter 7.2)
Tendons
Strong bands of dense, regular connective tissue that connect muscles to bones. (Chapter 13.2)
Tertiary intention
Wound healing that occurs when a wound must remain open or has been reopened, often due to severe infection. (Chapter 20.2)
Thalamus
Relays sensory information and motor information in collaboration with the cerebellum. (Chapter 6.2)
Third-degree burn
Severe burn that fully extends into the epidermis and dermis, destroying the tissue and affecting the nerve endings and sensory function. (Chapter 14.3)
Thrill
A vibration felt with palpation of the precordium. (Chapter 9.3)
Tinnitus
Ringing, buzzing, roaring, hissing, or whistling sound in the ears. (Chapter 8.2)
Titration order
An order in which the medication dose is either progressively increased or decreased by the nurse in response to the patient’s status. (Chapter 15.2)
Topical medications
Medications administered via the skin or mucous membranes for direct local action, as well as for systemic effects. (Chapter 16.2)
Total parenteral nutrition (TPN)
A very concentrated solution that must be administered via a central line. (Chapter 23.2)
Trachea
A tube lined with mucus membrane that carries air from the larynx to the lungs. (Chapter 7.2)
Tracheostomy
A surgically created opening that goes from the front of the neck into the trachea. (Chapter 22.2)
Tracheostomy dressing
A manufactured dressing used with tracheostomies that does not shed fibers, which could potentially be inhaled by the patient. (Chapter 22.4)
Transdermal route
Patches or disks applied to the skin that deliver medication over an extended period of time. (Chapter 16.2)
Trapezius
The muscle that elevates the shoulders (shrugs), pulls the shoulder blades together, and tilts the head backwards. (Chapter 7.2)
Tunneling
Passageways underneath the surface of the skin that extend from a wound and can take twists and turns. (Chapter 20.2)
Tympanic membrane
The membrane at the end of the external ear canal, commonly called the eardrum, that vibrates after it is struck by sound waves. (Chapter 8.2)
U
Undermining
A condition that occurs in wounds when the tissue under the wound edges becomes eroded, resulting in a pocket beneath the skin at the wound’s edge. (Chapter 20.2)
Unstageable
Occurs when slough or eschar obscures the wound so that tissue loss cannot be assessed. (Chapter 20.2)
Urinary catheterization
The insertion of a catheter tube into the urethral opening and placing it in the neck of the urinary bladder to drain urine. (Chapter 21.2)
Urinary frequency
Urination every hour or two. (Chapter 12.3)
Urinary incontinence
Involuntary leakage of urine. (Chapter 12.3)
Urinary tract infection (UTI)
An infection in the urinary system causing symptoms such as burning on urination (dysuria), frequent urination, malodorous urine, fever, and change in level of consciousness. (Chapter 21.2)
Urinary urgency
An intense urge to urinate that can lead to urinary incontinence. (Chapter 12.3)
Urostomy
The ureters (tubes that carry urine from the kidney to the bladder) are attached to a stoma to bypass the bladder. (Chapter 21.7)
Uvula
A small, teardrop-shaped structure located at the apex of the soft palate that swings upward during swallowing to close off the nasopharynx and prevent ingested materials from entering the nasal cavity. (Chapter 7.2)
V
Value
An accepted principle or standard of an individual or group. (Chapter 2.8)
Vastus lateralis
A muscle located on the anterior lateral aspect of the thigh and extends from one hand’s breadth above the knee to one hand’s breadth below the greater trochanter. It is commonly used for immunizations in infants and toddlers because the muscle is thick and well-developed. (Chapter 18.6)
Venipuncture
The process of introducing a needle into a client’s vein to collect a blood sample or insert an IV catheter. (Chapter 23.2)
Venous insufficiency
A medical condition where the veins in the legs do not adequately send blood back to the heart, resulting in a pooling of fluids in the legs that can cause venous ulcers. (Chapter 20.2)
Venous ulcers
Ulcers caused by the pooling of fluid in the veins of the lower legs when the valves are not working properly, causing fluid to seep out, macerate the skin, and cause an ulcer. (Chapter 20.2)
Ventilation
The mechanical movement of air into and out of the lungs. (Chapter 10.2, Chapter 11.3)
Ventrogluteal
The safest intramuscular injection site for adults and children because it provides the greatest thickness of gluteal muscles, is free from penetrating nerves and blood vessels, and has a thin layer of fat. (Chapter 18.6)
Vertigo
A type of dizziness often described by patients as “the room feels as if it is spinning.” (Chapter 8.2)
Vesicular sounds
Low-pitched soft sounds like “rustling leaves” heard over alveoli and small bronchial airways. (Chapter 10.3)
Vestibulocochlear nerve
Cranial nerve VIII that transports neural signals from the cochlea and the vestibule to the brain stem regarding hearing and balance. (Chapter 8.2)
Voiding
Medical terminology used for urinating. (Chapter 2.8)
Voluntary guarding
Voluntary contraction of abdominal wall musculature; may be related to fear, anxiety, or presence of cold hands. (Chapter 12.3)
W
Y
Yankauer suction tip
Rigid device used to suction secretions from the mouth. (Chapter 22.4)
Z
Z-track method
A method for administering intramuscular injections that prevents the medication from leaking into the subcutaneous tissue, allows the medication to stay in the muscles, and minimizes irritation. (Chapter 18.6)