A

Air embolism: The presence of air in the vascular system that occurs when air is introduced into the venous system and travels to the right ventricle and/or pulmonary circulation. (Chapter 1.3, Chapter 4.2)

Allogeneic blood products: Blood products donated by other people. (Chapter 3.2)

Ampules: Glass containers in 1 mL to 10 mL sizes that hold a single dose of medication in liquid form. (Chapter 2.3)

Anastomosis: A surgical connection between parts of the intestine. (Chapter 5.2)

Anemia: A hematological condition where there is a lack of healthy red blood cells and/or hemoglobin to carry adequate oxygen to the body’s tissues. (Chapter 3.2)

Aorta: A large artery that carries oxygen-rich blood to the rest of the body. (Chapter 7.2)

Aortic valve: The valve that opens when blood flows out of the left ventricle to the aorta. (Chapter 7.2)

Arrhythmia: Also referred to as a dysrhythmia; a chronic deviation from the normal pattern of impulse conduction and contraction. (Chapter 7.2)

Arterial blood sampling: Blood is obtained via venipuncture into an artery. (Chapter 1.2)

Arteries: Vessels that carry oxygen-rich blood from the heart to the body’s tissues. (Chapter 7.2)

Artifact: Interference with the tracing of the cardiac pattern on an ECG. (Chapter 7.2)

Aseptic-impregnated catheter hub: A specific device or product that has an aseptic particulate embedded within it to prevent biological contaminants from entering a susceptible host. An example of an aseptic-impregnated device is a chlorhexidine impregnated CVAD dressing. (Chapter 4.3)

Aseptic nontouch technique (ANTT): A global standard used to prevent healthcare-acquired infections. ANTT identifies key parts and key sites throughout the preparation and implementation of the procedure. A key part is any sterile part of equipment used during an aseptic procedure, such as needle hubs and dressings. A key site is the insertion site, nonintact skin, or an access site for medical devices connected to clients. ANTT includes four underlying principles to keep in mind while performing invasive procedures:

• Always perform meticulous hand hygiene.
• Never contaminate key parts.
• Touch nonkey parts with confidence.
• Take appropriate infection control precautions. (Chapter 4.3)

Asystole: No cardiac pattern on the ECG and the client does not have a pulse. (Chapter 7.4)

Atrial fibrillation (A-fib): An irregular heart rhythm originating in the heart’s upper chambers (atria) characterized by atrial quivering, lack of clear P waves, and a wavy baseline on the ECG tracing. (Chapter 7.4)

Atrial flutter: A condition where the heart’s upper chambers (atria) beat too quickly. This causes the heart to beat in a fast, but usually regular, rhythm and is characterized by a sawtooth pattern on the ECG tracing. (Chapter 7.4)

Atrioventricular (AV) blocks: Conduction blocks that can occur anywhere between the SA node and Purkinje fibers. (Chapter 7.4)

Atrioventricular (AV) node: Node located in the lower part of the right atrium, which carries electrical signals from the SA node to the ventricles. (Chapter 7.2)

Atrioventricular (AV) valves: The valves located between the atria and ventricles within the heart. (Chapter 7.2)

Autologous blood transfusion: A procedure in which blood is removed from the patient and returned to their circulation at a later time, instead of relying on blood donated by others (i.e., allogeneic blood). (Chapter 3.2)

B

Basal infusion: Continuous rate of medication administration, regardless of demand attempts. (Chapter 1.7)

Biphasic: Two phases. (Chapter 7.5)

Blood product: Any therapeutic substance derived from human blood, including whole blood and other blood components for transfusion, as well as plasma-derived medicinal products. (Chapter 3.1)

Blown vein: A ruptured vein that is leaking blood. (Chapter 1.3)

Blunt needles: Needleless access devices. (Chapter 2.3)

Bowel obstruction: A mechanical blockage of intestinal contents by a mass, adhesion, hernia, impacted stool, or other physical blockage such as volvulus (i.e., twisting of the stomach or intestine) or intussusception (i.e., one segment of intestine telescopes inside another). Bowel obstructions block the normal passage of bodily fluids such as salivary, gastric, hepatobiliary, and enteric secretions, causing the fluids to build up, resulting in abdominal distension, pain, and nausea. (Chapter 5.2)

Bradycardia: Heart rate less than 60 beats per minute. (Chapter 7.2)

Breakthrough bolus dose: A dose of opioid or non-opioid medication administered by the nurse for breakthrough pain when a patient is receiving patient-controlled analgesia. (Chapter 1.7)

Bundle of His: A collection of cardiac cells found along the septum between the ventricles that sends electrical impulses from the AV node to the left and right bundle branches. (Chapter 7.2)

C

Capillaries: Small blood vessels where the body exchanges oxygen and carbon dioxide in the blood at the cellular level. (Chapter 7.2)

Capillary blood testing: A blood sample collected from the capillary blood vessels (i.e., tiny blood vessels located near the surface of the skin). (Chapter 1.2)

Catheter embolism: An embolism that occurs when a small part of the cannula breaks off and flows into the vascular system. (Chapter 1.3)

Catheter-related bloodstream infection (CR-BSI): An infection caused by microorganisms introduced into the bloodstream through the puncture site, the hub, or contaminated IV tubing or IV solution, leading to bacteremia or sepsis. A CR-BSI is a hospital-acquired preventable infection and considered an adverse event. (Chapter 1.3)

Central line-associated bloodstream infection (CLABSI): A laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of a central line placement. Most CLABSI cases are preventable with proper aseptic techniques, surveillance, and management strategies. (Chapter 4.2)

Central venous access device (CVAD): A type of vascular access that involves the insertion of a tube into a vein in the neck, chest, or groin and threaded into a central vein (most commonly the internal jugular, subclavian, or femoral) and advanced until the terminal lumen resides within the inferior vena cava, superior vena cava, or right atrium. (Chapter 1.2, Chapter 4.1)

Central venous pressure (CVP): Pressure observed within the central veins as the veins enter the right atrium. Central venous pressure is a good indicator of right heart function and is often monitored during fluid resuscitation. (Chapter 4.2)

Chest tube: A catheter inserted into the pleural space in the chest cavity (also referred to as the thoracic cavity or thorax) to remove air, blood, and/or fluids. (Chapter 6.1)

Chylothorax: A collection of lymph in the pleural space. (Chapter 6.2)

Coronary arteries: Blood vessels that run along the heart’s surface and carry oxygenated blood to heart tissue. (Chapter 7.2)

Crepitus: Puffiness or crackling that indicates subcutaneous emphysema, the leakage of air into the subcutaneous tissues surrounding the insertion site. (Chapter 6.3)

D

Decreased cardiac output: Lack of blood being pumped out of the heart by the ventricles causing signs and symptoms of decreased blood pressure, decreased pulses, increased capillary refill, dizziness, light-headedness, fainting, chest pain, or shortness of breath. (Chapter 7.4)

Demand dose: Medication dose given on activation of demand (pressing the demand button). (Chapter 1.7)

Dysfibrinogenemia: A coagulation (clotting) disorder characterized by abnormal fibrinogen. (Chapter 3.2)

Dysrhythmia: Also referred to as an arrhythmia; a chronic deviation from the normal pattern of impulse conduction and contraction. (Chapter 7.2)

E

Empyema: A pyogenic infection (pus) of the pleural space. (Chapter 6.2)

Endocardium: The inner layer of the heart. (Chapter 7.2)

Enteral tubes: Tubes placed in the gastrointestinal tract. (Chapter 5.1)

Epicardium: The protective outer layer of the heart. (Chapter 7.2)

Epidural: Administration of analgesics and anesthetics into the spinal fluid via an epidural catheter for severe pain management associated with surgical procedures or during labor and delivery. (Chapter 1.7)

Extravasation: A condition that occurs when vesicant solution (medication) is administered and inadvertently leaks into surrounding tissue, causing damage to surrounding tissue. It is characterized by the same signs and symptoms as infiltration but also includes burning, stinging, redness, blistering, or necrosis of the tissue. (Chapter 1.3, Chapter 2.2, Chapter 4.2)

F

First-pass effect: The action that occurs when a medication must be first metabolized or broken down prior to entering the blood. (Chapter 2.2)

Fluid resuscitation: Infusing a large volume of fluid through the intravenous venous access to restore hemodynamics and optimize tissue perfusion and, ultimately, tissue oxygen delivery. (Chapter 4.2)

Fluoroscopy: A medical procedure that makes a real-time video of the movements inside a part of the body by passing X-rays through the body over a period of time. (Chapter 4.2)

Flushing: A manual injection of 0.9% sodium chloride to clean the catheter. (Chapter 4.3)

H

Heart block: A conduction block that can occur due to any obstruction in the normal pathway of electrical conduction through the heart. The anatomical location of the block can be categorized as in the sinus node, atrioventricular node, or bundle branches. (Chapter 7.4)

Hemodynamic monitoring: The assessment of a critically ill client’s circulatory status and includes measurements of central venous pressure, cardiac output, and blood volume. (Chapter 4.2)

Hemolysis: Red blood cell destruction. (Chapter 3.2)

Hemothorax: A collection of blood in the space between the chest wall and the lung (called the pleural cavity). (Chapter 6.2)

Hydrothorax: Accumulation of serous fluid in the pleural space (Chapter 6.2)

Hypertonic solutions: IV fluids with a higher concentration of dissolved particles than blood. (Chapter 1.2)

Hypofibrinogenemia: A rare, autosomal dominant condition characterized by bleeding and obstetric problems such as abruption, postpartum hemorrhage, and recurrent pregnancy loss. (Chapter 3.2)

Hypotonic solutions: IV fluids with a lower concentration of dissolved solutes than blood. (Chapter 1.2)

I

Ileus: A nonmechanical decrease or stoppage of the flow of intestinal contents that is often an unavoidable consequence of abdominal or retroperitoneal surgery. (Chapter 5.2)

Inferior vena cava: Carries deoxygenated blood from the lower body. (Chapter 7.2)

Infiltration: A condition that occurs when a nonvesicant solution (IV solution) is inadvertently administered into surrounding tissue. Signs and symptoms include pain, swelling, redness, the skin surrounding the insertion site is cool to touch, there is a change in the quality or flow of IV, the skin is tight around the IV site, IV fluid is leaking from IV site, or there are frequent alarms on the IV pump. (Chapter 1.3)

Intravenous push (IV push): Process of introducing a medication or fluid substance directly into the bloodstream via the venous system. (Chapter 2.2)

Intravenous therapy (IV therapy): Administration of a substance directly into a person’s vein. (Chapter 1.2)

Isoelectric line: The baseline of the ECG tracing. (Chapter 7.2)

Isotonic solutions: IV fluids with a similar concentration of dissolved particles as blood. (Chapter 1.2)

IV lock: An IV cannula that has been inserted into a vein and saline locked or clamped. (Chapter 2.2)

L

Left atrium: The upper left chamber of the heart receives the oxygenated blood and pumps it through the mitral valve into the left ventricle. (Chapter 7.2)

Left bundle branch: Offshoots from the bundle of His that send electrical impulses to the left ventricle. (Chapter 7.2)

Left ventricle: The lower left chamber of the heart. (Chapter 7.2)

Loading dose: Ordered amount of medication administered at the time of PCA initiation. (Chapter 1.7)

Locking: The injection of a limited volume of a liquid following the catheter flush, for the period of time when the catheter is not used, to prevent intraluminal clot formation and/or catheter colonization. (Chapter 4.3)

Lockout interval: Time period in which no follow-up demand dose may be administered (even if demand button is activated). (Chapter 1.7)

Lockout maximum: The maximum dose of medication that can be administered within a certain period, commonly prescribed to 1 hour limit. (Chapter 1.7)

M

Microaggregate filter: A second-generation blood filter with a pore size of 20–40 µm that removes 75–90% of white cells, which is used to transfuse packed red cells. (Chapter 3.3)

Midline peripheral catheters: Larger peripheral catheters (i.e., 16-18 gauge) that allow for rapid infusions and blood sampling and can be used for longer duration that traditional peripheral catheters. They are ultrasound-guided and can be inserted by RNs with additional training or other trained professionals. (Chapter 1.2)

Mitral valve: The valve between the left atrium and left ventricle. (Chapter 7.2)

Multifocal: Dysrhythmias cause the waveforms to look different because the impulse is originating from different areas of the heart. (Chapter 7.4)

Myocardial infarction (MI): An emergency medical condition caused by a lack of blood flow to the heart muscle. (Chapter 7.2)

Myocardium: The muscular middle layer of the heart. (Chapter 7.2)

N

Nasogastric (NG) tube: A flexible plastic tube inserted through a nostril, down the posterior oropharynx, and into the stomach or the upper portion of the small intestine. It is typically used for decompression of the stomach for clients with an intestinal obstruction or ileus or for administration of nutrition or medication to clients who are unable to tolerate oral intake. (Chapter 5.2)

Negative pressure: During inspiration (also called inhalation), the diaphragm contracts and pulls downward, while the intercostal muscles between the ribs pull upward. This movement increases the size of the thoracic cavity, thus decreasing the pressure inside. This change in pressure on inspiration is referred to as negative pressure. As a result, a vacuum effect is created and air rushes into the lungs. (Chapter 6.2)

Normal sinus rhythm (NSR): Originates from the sinus node and describes the characteristic rhythm of the healthy human heart. (Chapter 7.4)

P

Patient-controlled analgesia (PCA): A method of pain management that allows hospitalized patients with severe pain to safely self-administer opioid medications using a programmed pump according to their level of discomfort. (Chapter 1.7)

Pericardium: The protective sac that covers the entire heart. (Chapter 7.2)

Peripheral IV (PIV): A short intravenous catheter inserted by percutaneous venipuncture into a peripheral vein and held in place with a sterile transparent dressing. (Chapter 1.2)

Phlebitis: The inflammation of the vein’s inner lining, the tunica intima. Clinical indications are localized redness, pain, heat, and swelling that can track up the vein leading to a palpable venous cord. (Chapter 1.3, Chapter 2.2)

Pleural effusion: Accumulation of fluid in the pleural space, often due to a medical condition such as cancer or heart, kidney, or liver failure. (Chapter 6.2)

Pleural space: Also referred to as the pleural cavity; the space between the membranes of the chest wall (i.e., visceral pleura membrane) and the lung (i.e., the parietal pleura membrane). (Chapter 6.2)

Pneumothorax: A collapsed lung that occurs when air leaks into the space between the lung and chest wall. (Chapter 6.2)

P-P interval: The interval that represents the duration between atrial heartbeats. (Chapter 7.2)

Precipitate: Formation of small crystals as the incompatible substances come into contact with one another. (Chapter 2.2)

Prefilled syringe: Syringes that contain prefilled volumes of medication within the device. (Chapter 2.3)

Premature ventricular contractions (PVCs): A random ventricular contraction stimulated by an area of the heart other than the SA node and characterized by a wide, bizarre QRS complex. (Chapter 7.4)

Pulmonary arteries: Arteries that carry deoxygenated blood to the lungs. (Chapter 7.2)

Pulmonary edema: A condition caused by excess fluid accumulation in the lungs due to excessive fluid in the circulatory system. It is characterized by decreased oxygen saturation; increased respiratory rate; fine or coarse crackles in the lung bases; restlessness; breathlessness; dyspnea; and coughing up pink, frothy sputum. Pulmonary edema requires prompt medical attention and treatment. (Chapter 1.3)

Pulmonary valve: The valve that opens when blood flows from the right ventricle into the pulmonary arteries (then to the lungs). (Chapter 7.2)

Pulmonary veins: Arteries that carry oxygenated blood back to the left atrium. (Chapter 7.2)

Purkinje fibers: A network of thin filaments that carry electrical impulses that cause the ventricles to contract and pump blood out of the heart. (Chapter 7.2)

R

Reservoir pocket: A small pocket, either a plastic or metal cylinder, usually placed just below the collar bone and connected to a catheter that enters a large vein such as the subclavian. (Chapter 4.2)

Right atrium: Two large veins called the superior vena cava and the inferior vena cava deliver oxygen-poor blood to the upper right chamber of the heart. (Chapter 7.2)

Right bundle branch: Offshoots from the bundle of His that send electrical impulses to the right ventricle. (Chapter 7.2)

Right ventricle: This lower right chamber of the heart pumps the oxygen-poor blood through the pulmonary valves and then through the pulmonary arteries to the lungs. (Chapter 7.2)

R on T phenomenon: When a PVC occurs on the T wave. (Chapter 7.4)

R-R interval: The interval that represents the duration between the ventricular heartbeats. (Chapter 7.2)

S

Saline locks: A short extension set that allows intermittent IV access without ongoing infusion. (Chapter 1.2)

Scrub hub: A scrubbing device with an embedded alcohol product such as chlorhexidine with alcohol or 70% alcohol to disinfect catheter hubs or needleless connectors. (Chapter 4.3)

Semilunar (SL) valves: Values that open when blood flows out of the ventricles. (Chapter 7.2)

Sinoatrial blocks: Failed conduction of the impulses beyond the SA node, resulting in prolonger PR intervals or dropped P waves on the ECG. (Chapter 7.4)

Sinoatrial (SA) node: Node located in the upper part of the right atrium and a major element of the conduction system. (Chapter 7.2)

Speed shock: An adverse systemic reaction when a foreign substance is introduced into the bloodstream. (Chapter 2.2)

Spontaneous pneumothorax: Collapse of a lung that occurs suddenly without any known cause. (Chapter 6.2)

ST elevation: An elevation of the ST segment on an ECG that can indicate myocardial infarction. (Chapter 7.2)

Stomach decompression: A medical term that refers to removing stomach contents by using suctioning. Stomach decompression is commonly used after surgery or trauma to reduce pressure from the buildup of fluids and gas that cause pain, nausea, and vomiting and can lead to potential aspiration of stomach contents into the lungs. (Chapter 5.1)

Subcutaneous emphysema: Air leakage into the subcutaneous tissues surrounding the chest tube insertion site. (Chapter 6.3)

Superior vena cava: Carries deoxygenated blood from the upper body. (Chapter 7.2)

Supraventricular tachycardia (SVT): An irregularly fast but regular heart rhythm that affects the heart’s upper chambers. SVT is also called paroxysmal supraventricular tachycardia. (Chapter 7.4)

T

Tachycardia: Heart rate greater than 100 bpm. (Chapter 7.2)

Telemetry: A portable device used to continuously monitor clients’ heart rhythms. (Chapter 7.2)

Tension pneumothorax: A medical emergency caused by large pneumothorax that affects cardiovascular functioning. (Chapter 6.2)

Thrombocytopenia: Platelet deficiency causing bleeding, bruising, and slow blood clotting after injury. (Chapter 3.2)

Tidaling: When water in the water seal chamber rises with inhalation and falls with exhalation. (Chapter 6.2)

Torsades de pointes: A life-threatening ventricular tachycardia that can be caused from long QT intervals or magnesium deficiency. (Chapter 7.4)

Transfusion reactions: Adverse events that are directly related to the transfusion of blood products and may range from mild to severe with life-threatening effects. Transfusion reactions may be acute or delayed (i.e., up to days or weeks after the transfusion). Immune-related reactions are often due to a mismatch or incompatibility of the transfused blood product and the recipient’s blood type or Rh factor. Non-immunologic reactions are typically caused by the physical effects of the blood component or the transmission of a disease. (Chapter 3.2)

Traumatic pneumothorax: Lung collapse caused by a chest injury, such as a bullet wound that pierces the pleural membranes, causing air to rush into the thoracic cavity. (Chapter 6.2)

Tricuspid valve: The valve between the right atrium and right ventricle. (Chapter 7.2)

12-lead electrocardiogram: A diagnostic test (referred to as an ECG or EKG) that uses leads attached to the client’s body to record the electrical activity of the heart on special graph paper. (Chapter 7.2)

U

Unifocal: Dysrhythmias causes the waveforms to look the same because the signal is originating from the same area in the heart. (Chapter 7.4)

V

Veins: Blood vessels that typically carry oxygen-deficient blood back to the heart. (Chapter 7.2)

Venipuncture: The process of introducing a needle into a patient’s vein to collect a blood sample or insert an IV catheter. (Chapter 1.2)

Ventricular fibrillation: An abnormal heart rhythm with disorganized electrical conduction signals causing the lower chambers of the heart (ventricles) to twitch (quiver) uselessly and not pump blood to the rest of the body. (Chapter 7.4)

Ventricular tachycardia: An abnormal heart rhythm originating in the lower chambers of the heart (ventricles) characterized by regular, wide QRS complexes, no P waves, and a rate of 150-300 per minute with or without a pulse. (Chapter 7.4)

Vesicant medications: Certain medications such as antineoplastic drugs, antibiotics, electrolytes, and vasopressors that can cause severe tissue injury or destruction. (Chapter 4.2)

Vial: A single- or multi-dose plastic container with a rubber seal and covered by a metal or plastic cap. (Chapter 2.3)