Appendix B – Overall Glossary
This section contains an overall glossary of terms used in this book and the location where the content can be found.
A
A1C: A lab test used to assess long-term blood glucose levels over three months. The general A1C target level is less than 7%. (Chapter 9.4)
Absorption: The first stage of pharmacokinetics where medications enter the body and travel from site of administration into the body’s circulation. (Chapter 1.2, Chapter 1.3)
Acetylcholine (ACh): Binds to both nicotinic receptors and muscarinic receptors in the PNS. (Chapter 4.2)
Action potential: A change in voltage of a cell membrane in response to a stimulus that results in transmission of an electrical signal; unique to neurons and muscle fibers. (Chapter 8.2)
Acute dystonia: Painful muscle spasms. (Chapter 8.9)
Acute pain: Pain that usually starts suddenly and has a known cause, like an injury or surgery. It normally gets better as your body heals and lasts less than three months. (Chapter 10.3)
ADME: Four basic stages of pharmacokinetics a medication goes through within the human body: absorption, distribution, metabolism, and excretion. (Chapter 1.2)
Adjuvant analgesics: Drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes such as gabapentin (an anticonvulsant) or amitriptyline (a tricyclic antidepressant). (Chapter 10.5)
Adrenal cortex: A component of the hypothalamic-pituitary-adrenal (HPA) axis that produces the steroid hormones important for the regulation of the stress response, blood pressure and blood volume, nutrient uptake and storage, fluid and electrolyte balance, and inflammation. (Chapter 9.2)
Adrenal medulla: Neuroendocrine tissue composed of postganglionic sympathetic nervous system (SNS) neurons that are stimulated by the autonomic nervous system to secrete hormones epinephrine and norepinephrine. (Chapter 9.3)
Adrenergic: Postganglionic neuron where neurotransmitters norepinephrine and epinephrine are released. Includes alpha (α)-receptors and beta (β)-receptors. (Chapter 4.2)
Adrenergic agonist: Mimics the effects of the body’s natural SNS stimulation on alpha (α)- and beta (β)-receptors. Also called sympathomimetics. (Chapter 4.2)
Adrenergic antagonist: Blocks the effects of the SNS receptors. (Chapter 4.2)
Adsorption: The adhesion of molecules to a surface. For example, bismuth salicylate coats the walls of the GI tract and binds the causative bacteria or toxin for elimination from the GI tract through the stool. (Chapter 7.4)
Adverse effect: An unintended and potentially dangerous pharmacological effect that occurs when a medication is administered correctly. (Chapter 1.11)
Affective mood disorders: Mental health illness such as major depression. (Chapter 8.3)
Affinity: The strength of binding between drug and receptor. (Chapter 1.2)
Afterload: The tension that the ventricles must develop to pump blood effectively against the resistance in the vascular system. (Chapter 6.2)
Agonist: A drug that binds to a “receptor” and produces an effect. (Chapter 1.7)
Akathisia: Distressing motor restlessness. (Chapter 8.9)
Aldosterone: A mineralocorticoid released by the adrenal cortex that controls fluid and electrolyte balance through the regulation of sodium and potassium. (Chapter 9.3)
Allergies: Allergies occur when the immune system reacts to a foreign substance and makes antibodies that identify a particular allergen as harmful, even though it is not. (Chapter 5.3)
American Nurses Association (ANA): The professional organization that represents the interests of the nation’s four million registered nurses. (Chapter 2.2)
Anaphylaxis: A severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you are allergic to, such as peanuts or bee stings. (Chapter 5.3)
Antacids: Used to neutralize stomach acid and reduce the symptoms of heartburn. (Chapter 7.3)
Antagonist: A molecule that prevents the action of other molecules, often by competing for a cellular receptor; opposite of agonist. (Chapter 1.7)
Antagonistic interactions: Concurrent administration of two drugs causes harmful effects such as a decrease of drug activity, decreased therapeutic levels due to increased metabolism and elimination, or increased potential for toxicity due to decreased metabolism and elimination. An example of an antagonistic interaction is taking antacids with antibiotics, causing decreased absorption of the antibiotic. (Chapter 3.3)
Anticholinergics: Inhibit acetylcholine (ACh), which allows the SNS to dominate. Also called parasympatholytics or muscarinic antagonists. Overall use is to relax smooth muscle. (Chapter 4.2)
Anticoagulant: Any substance that opposes coagulation. (Chapter 6.12)
Antidiarrheals: Relieve the symptoms of diarrhea, such as an increased frequency and urgency when passing stools, but do not eliminate the cause of it. (Chapter 7.4)
Antidiuretic hormone (ADH): ADH is released by the posterior pituitary in response to stimuli from osmoreceptors indicating high blood osmolarity. Its effect is to cause increased water reabsorption by the kidneys. As more water is reabsorbed by the kidneys, the greater the amount of water that is returned to the blood, thus causing a decrease in blood osmolarity. ADH is also known as vasopressin because, in very high concentrations, it causes constriction of blood vessels, which increases blood pressure by increasing peripheral resistance. (Chapter 9.2)
Antifungal: Medications that are used to treat fungal infections. For example, nystatin is used to treat Candida albicans, a fungal infection. (Chapter 3.2)
Antimotility medications: Medications that help to treat diarrhea by slowing peristalsis. (Chapter 7.4)
Antiviral: Medications used to treat viral infections. For example, Tamiflu is used to treat influenza. (Chapter 3.2)
Area postrema: A structure in the medulla oblongata in the brain stem that controls vomiting. Its location in the brain also allows it to play a vital role in the control of autonomic functions by the central nervous system. (Chapter 7.5)
Arrhythmia: A deviation from the normal pattern of impulse conduction and contraction of the heart, which if serious and untreated, can lead to decreased cardiac output and death. (Chapter 6.3)
Arteriosclerosis: A condition when compliance in an artery is reduced and pressure and resistance within the vessel increase. This is a leading cause of hypertension and coronary heart disease, as it causes the heart to work harder to generate a pressure great enough to overcome the resistance. (Chapter 6.3)
Artery: A blood vessel that carries blood away from the heart (except for pulmonary arteries that carry oxygenated blood from the lungs back to the heart). (Chapter 6.2)
Atherosclerosis: A buildup, called plaque, that can narrow arteries enough to impair blood flow. (Chapter 6.3)
Autonomic nervous system: Controls cardiac and smooth muscle, as well as glandular tissue; associated with involuntary responses. (Chapter 4.2)
B
Bactericidal: Antimicrobial drugs that kill their target bacteria. (Chapter 3.2)
Bacteriostatic: Antimicrobial drugs that cause bacteria to stop reproducing but may not ultimately kill the bacteria. (Chapter 3.2)
Basal insulin: Long-acting (insulin glargine or insulin detemir) or intermediate-acting (NPH) insulin. (Chapter 9.4)
Basal metabolic rate: The amount of energy used by the body at rest. (Chapter 9.2)
Beneficence: To “do good.” (Chapter 2.2)
Bioavailability: The presence of a drug in the bloodstream after it is administered. (Chapter 1.2)
Blood-brain barrier (BBB): A nearly impenetrable barricade that is built from a tightly woven mesh of capillaries cemented together to protect the brain from potentially dangerous substances such as poisons or viruses. (Chapter 1.4, Chapter 8.11)
Blood osmolarity: The concentration of solutes (such as sodium and glucose) in the blood. (Chapter 9.2)
Blood pressure: A type of hydrostatic pressure or the force exerted by blood on the walls of the blood vessels or the chambers of the heart. (Chapter 6.2)
Boxed Warnings: The strongest warnings issued by the Federal Drug Association (FDA) that signify a drug carries a significant risk of serious or life-threatening adverse effects. (Chapter 2.3)
Bradykinesia: Slowness in initiation and execution of voluntary movements. (Chapter 8.3)
Broad-spectrum antimicrobial: An antibiotic that targets a wide variety of bacterial pathogens, including both gram-positive and gram-negative species. (Chapter 3.2)
C
Capillaries: Smallest arteries where nutrients and wastes are exchanged at the cellular level. (Chapter 6.2)
Cardiac output (CO): To calculate this value, multiply stroke volume (SV), the amount of blood pumped by each ventricle, by heart rate (HR), in contractions per minute (or beats per minute, bpm). It can be represented mathematically by the following equation: CO = HR × SV. (Chapter 6.2)
Catecholamines: Include norepinephrine, epinephrine, and dopamine. Stimulate the adrenergic receptors. (Chapter 4.15)
Central nervous system (CNS): Anatomical division of the nervous system located within the cranial and vertebral cavities, namely the brain and spinal cord. (Chapter 4.2, Chapter 8.2)
Cerebrovascular accident (CVA): Lack of blood flow to the brain that can cause irreversible brain damage, often referred to as a “stroke.” (Chapter 6.3)
Chemical synapse: Connection between two neurons, or between a neuron and its target, where a neurotransmitter diffuses across a very short distance. (Chapter 8.2)
Chemoreceptor trigger zone (CTZ): Area in the brain that responds directly to toxins in the bloodstream and also receives stimuli from several other locations in the body that stimulate the vomiting center. (Chapter 7.5)
Cholinergic: Postganglionic neuron where acetylcholine (ACh) is released that stimulates nicotinic receptors and muscarinic receptors. Also relating to drugs that inhibit, enhance, or mimic the action of ACh. (Chapter 4.2)
Chronic pain: Pain that lasts six months or more and can be caused by a disease or condition, injury, medical treatment, inflammation, or an unknown reason. (Chapter 10.3)
Chronotropic: Drugs may change the heart rate and rhythm by affecting the electrical conduction system of the heart and the nerves that influence it, such as by changing the rhythm (increasing) produced by the sinoatrial node. Positive chronotropes increase heart rate; negative chronotropes decrease heart rate. (Chapter 4.2)
Clostridium difficile (C-diff): Causes pseudomembranous colitis, a superinfection that can be caused by broad-spectrum antibiotic therapy. (Chapter 3.2)
Coagulation: The formation of a blood clot. (Chapter 6.2)
Code of Ethics for Nurses: Developed by the American Nurses Association as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession. (Chapter 2.2)
Complementary and alternative medications (CAM): Therapies that are commonly used in conjunction with, or as an alternate to, traditional medical therapies such as vitamins, herbs, and other supplements. These substances are not regulated by the FDA, and most have not undergone rigorous scientific testing for safety for the public. (Chapter 1.8)
Compliance: The ability of any compartment to expand to accommodate increased content. The greater the compliance of an artery, the more effectively it is able to expand to accommodate surges in blood flow without increased resistance or blood pressure. Veins are more compliant than arteries and can expand to hold more blood. When vascular disease causes stiffening of arteries, compliance is reduced and resistance to blood flow is increased. (Chapter 6.2)
Contractility: The force of contraction of the heart. (Chapter 6.2)
Culture: A test performed on various body substances for the presence of bacteria or fungus. (Chapter 3.2)
Cultural competence: The process by which nurses demonstrate culturally congruent practice. (Chapter 2.2)
Cultural humility: A humble and respectful attitude toward individuals of other cultures that pushes one to challenge their own cultural biases, realize they cannot possibly know everything about other cultures, and approach learning about other cultures as a lifelong goal and process. (Chapter 2.4)
Culturally congruent practice: The application of evidence-based nursing that is in agreement with the preferred cultural values, beliefs, worldview, and practices of the health care consumer and other stakeholders. (Chapter 2.2)
Cyanotic: A bluish or purplish discoloration (as of skin) due to deficient oxygenation of the blood. (Chapter 5.3)
Cytochrome P-450 enzymes: Enzymes produced from the cytochrome P450 genes involved in the formation (synthesis) and breakdown (metabolism) of various molecules, chemicals, and medications within cells. (Chapter 7.3)
D
Defecation: The digestive process where undigested materials are removed from the body as feces. (Chapter 7.4)
Diabetes insipidus (DI): A disease characterized by underproduction of ADH that causes chronic dehydration. (Chapter 9.2)
Diarrhea: The passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). (Chapter 7.4)
Diastole: The period of relaxation that occurs as the chambers fill with blood. (Chapter 6.2)
Distribution: The second stage of pharmacokinetics where medication is dispersed throughout the body via the bloodstream. (Chapter 1.2, Chapter 1.4)
Do Not Crush list: A list of medications that should not be crushed, often due to a sustained-release formulation. (Chapter 2.2)
Dose dependent: A more significant response occurs in the body when the medication is administered in large doses to provide a large amount of medication to the site of infection for a short period of time. (Chapter 3.3)
Dose-response: The dose of medication required to achieve the desired response to the medication. (Chapter 1.9)
Dromotropic: Stimulation causes speed of conduction between SA and AV node. (Chapter 4.2)
Drug diversion: The transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. (Chapter 2.3)
Drug reaction with eosinophilia and systemic symptoms (DRESS): A condition reported in clients taking antiepileptic drugs. Some of these events have been fatal or life-threatening. DRESS typically presents with fever, rash, lymphadenopathy, and/or facial swelling. (Chapter 8.10)
Drugs: Medications or other substances that have a physiological effect when introduced to the body. (Chapter 1.2)
Duration: The length of time that a medication is producing its desired therapeutic effect. (Chapter 1.9)
Dystonia: Inappropriate and continuous muscle contraction. (Chapter 8.3)
E
Edema: The presence of excess tissue fluid around the cells. (Chapter 6.2)
Efficacy: The maximum effect of which the drug is capable. (Chapter 1.9)
Electrical synapse: Connection between two neurons, or any two electrically active cells, where ions flow directly through channels spanning their adjacent cell membranes. (Chapter 8.2)
Embolus: When a portion of a thrombus breaks free from the vessel wall and enters the circulation. An embolus that is carried through the bloodstream can be large enough to block a vessel critical to a major organ. When it becomes trapped, an embolus is called an embolism. In the heart, brain, or lungs, an embolism may accordingly cause a heart attack, a stroke, or a pulmonary embolism. (Chapter 6.3)
Emesis: The forceful oral expulsion of gastric contents. (Chapter 7.5)
Endocrine gland: Gland that secretes hormones that target other organs. (Chapter 9.2)
Error-prone abbreviations: Abbreviations, symbols, and dose designations that are frequently misinterpreted and involved in harmful medication errors. (Chapter 2.5)
Excretion: The final stage of pharmacokinetics where drug byproducts and metabolites are eliminated from the body. (Chapter 1.2, Chapter 1.6)
Exocrine gland: Gland that secretes digestive enzymes. (Chapter 9.4)
Extrapyramidal symptoms: Involuntary motor symptoms similar to those associated with Parkinson’s disease. Includes symptoms such as akathisia (distressing motor restlessness) and acute dystonia (painful muscle spasms). Often treated with anticholinergic medications such as benztropine and trihexyphenidyl. (Chapter 8.9)
F
Fibrillation: An uncoordinated beating of the heart, which if serious and untreated, can lead to decreased cardiac output and death. (Chapter 6.3)
Fibrinolysis: The gradual degradation of a clot. (Chapter 6.2)
Fight-or-flight response: The response when the SNS is stimulated, causing the main effects of increased heart rate, increased blood pressure, and bronchodilation. (Chapter 4.2)
First-pass effect: The inactivation of orally or enterally administered drugs in the liver and intestines. (Chapter 1.3)
Five rights of medication administration: Standards of practice that require the following information is confirmed prior to each administration of medication: right patient, right drug, right dose, right time, and right route. (Chapter 2.3)
G
Gait disturbance: An abnormal way of walking, such as shuffling feet. (Chapter 8.3)
Gas exchange: The process at the alveoli level where blood is oxygenated and carbon dioxide, the waste product of cellular respiration, is removed from the body. (Chapter 5.2)
Gastroenteritis: Infection of the intestines. (Chapter 7.5)
Gastroesophageal reflux disease (GERD): Caused by excessive hydrochloric acid that tends to back up, or reflux, into the lower esophagus. (Chapter 7.3)
General adaptation syndrome (GAS): The pattern in which the body responds in different ways to stress: the alarm reaction (otherwise known as the fight-or-flight response), the stage of resistance, and the stage of exhaustion. (Chapter 9.3)
Glycogenolysis: The breakdown of glycogen into glucose, causing elevated blood glucose. (Chapter 4.2)
Glycolysis: Stimulated by insulin, the metabolism of glucose for generation of ATP. (Chapter 9.4)
Goiter: A visible enlargement of the thyroid gland when there is hyperstimulation of TSH due to deficient levels of T3 and T4 hormones in the bloodstream or an autoimmune reaction in which antibodies overstimulate the follicle cells of the thyroid gland, causing hyperthyroidism. (Chapter 9.5)
Gram-negative: Gram-negative bacteria are classified by the color they turn after a chemical called gram stain is applied to them. Escherichia Coli (also known as E. Coli) is an example of a gram-negative infection. (Chapter 3.2)
Gram-positive: Gram-positive bacteria are classified by the color they turn after a chemical called gram stain is applied to them. Infections caused by Streptococcus and Staphylococcus bacteria are examples of gram-positive infections. (Chapter 3.2)
Gram stain: A test used to quickly diagnose types of bacterial infection. Gram-positive and gram-negative bacteria stain differently because their cell walls are different. Identification of bacteria as gram-positive or gram-negative assists the health care provider in selecting an appropriate antibiotic to treat the infection. (Chapter 3.2)
H
Half-life: The rate at which 50% of a drug is eliminated from the bloodstream. (Chapter 1.5, Chapter 3.3)
Health literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information needed to make appropriate health decisions. (Chapter 2.4)
Hematemesis: Blood in the vomit. (Chapter 7.5)
Hemostasis: The process by which the body temporarily seals a ruptured blood vessel and prevents further loss of blood. (Chapter 6.2)
High-risk medications: Drugs that bear a heightened risk of causing significant client harm when they are used in error. (Chapter 2.5)
Homeostasis (in ANS): Balance between the SNS and PNS. At each target organ, dual innervation determines activity. For example, SNS stimulation causes the heart rate to increase, whereas PNS stimulation causes the heart rate to decrease. (Chapter 4.2)
Hormones: Chemical signals sent by the endocrine organs and transported via the bloodstream throughout the body where they bind to receptors on target cells and induce a characteristic response. (Chapter 9.2)
Humoral stimuli: Changes in blood levels of nonhormone chemicals that cause an endocrine gland to release or inhibit a hormone to maintain homeostasis. For example, high blood sugar causes the pancreas to release insulin. (Chapter 9.2)
Hypercalcemia: Elevated levels of calcium in the bloodstream. (Chapter 7.3)
Hyperglycemia: Elevated blood glucose levels. (Chapter 9.4)
Hyperlipidemia: Elevated cholesterol levels in the blood that increase a client’s risk for heart attack and stroke. (Chapter 4.2, Chapter 6.3)
Hyperparathyroidism: A disorder caused by an overproduction of PTH that results in excessive calcium resorption from bone, causing significantly decreased bone density and spontaneous fractures, decreased responsiveness of the nervous system, and calcium deposits in the body’s tissues and organs, impairing their functioning. (Chapter 9.5)
Hypertension: Chronically elevated blood pressure. (Chapter 6.10)
Hypertensive crisis: Severe hypertension (blood pressure greater than 180/120 mm Hg) with evidence of organ dysfunction. Symptoms may include occipital headache (which may radiate frontally), palpitations, neck stiffness or soreness, nausea or vomiting, sweating, dilated pupils, photophobia, shortness of breath, or confusion. Either tachycardia or bradycardia may be present and may be associated with constricting chest pain. Seizures may also occur. Intracranial bleeding, sometimes fatal, has been reported in association with the increase in blood pressure. (Chapter 8.7)
Hyperthyroidism: Abnormally elevated blood level of thyroid hormones T3 and T4, often caused by a pituitary tumor, thyroid tumor, or autoimmune reaction in which antibodies overstimulate the follicle cells of the thyroid gland. (Chapter 9.5)
Hypervolemia: Excessive fluid volume caused by retention of water and sodium, as seen in clients with heart failure, liver cirrhosis, and some forms of kidney disease. (Chapter 6.2)
Hypoglycemia: A blood glucose level below 70 mg/dL; severe hypoglycemia refers to a blood glucose level below 40. (Chapter 9.4)
Hypoparathyroidism: Abnormally low blood calcium levels caused by parathyroid hormone deficiency, which may develop following thyroid surgery. Low blood calcium can cause muscle twitching, cramping, spasms, or convulsions; severe deficits can paralyze muscles, including those involved in breathing, and can be fatal. (Chapter 9.5)
Hypothalamic-pituitary-adrenal (HPA) axis: The hypothalamus stimulates the release of ACTH from the pituitary, which then stimulates the adrenal cortex to produce the hormone cortisol and steroid hormones important for the regulation of the stress response, blood pressure and blood volume, nutrient uptake and storage, fluid and electrolyte balance, and inflammation. (Chapter 9.3)
Hypothalamus–pituitary complex: The “command center” of the endocrine system that secretes several hormones that directly produce responses in target tissues, as well as hormones that regulate the synthesis and secretion of hormones of other glands. In addition, the hypothalamus–pituitary complex coordinates the messages of the endocrine and nervous systems. (Chapter 9.2)
Hypothyroidism: Abnormally low blood levels of thyroid hormones T3 and T4 in the bloodstream. (Chapter 9.5)
Hypovolemia: Decreased blood volume that may be caused by bleeding, dehydration, vomiting, severe burns, or by diuretics used to treat hypertension. Treatment typically includes intravenous fluid replacement. (Chapter 6.2)
I
Immune-mediated disease process: Occurs when the body’s immune system attacks the central nervous system. (Chapter 10.3)
Inappropriate polypharmacy: Present when one or more medicines are prescribed that are not or no longer needed. (Chapter 2.5)
Indications: The use of a drug for treating a particular condition or disease. The FDA determines if there is enough evidence for a labeled indication of a drug. Providers may also prescribe medications for off-label indications if there is reasonable scientific evidence that the drug is effective, but these uses have not been approved by the FDA. (Chapter 3.5)
Inotropic: Stimulation causes increased force of contraction. (Chapter 4.2)
Insulin: A hormone that facilitates the uptake of glucose into skeletal and adipose body cells. (Chapter 9.4)
International normalized ratio (INR): A blood test used to monitor the effects of warfarin and to achieve therapeutic range, generally between 2.0 and 3.5 based on the indication. (Chapter 6.12)
Intrinsic factor: Necessary for the absorption of vitamin B12 in the small intestine. (Chapter 7.3)
Involuntary responses: Responses that the brain controls without the need for conscious thought. (Chapter 4.1)
Ischemia: Reduced blood flow to the tissue region “downstream” of the narrowed vessel. (Chapter 6.3)
L
Look-alike and sound-alike (LASA) drugs: Medications that require special safeguards to reduce the risk of errors and minimize harm. (Chapter 2.5)
Loop of Henle: A component of the nephron where loop diuretics act to eliminate sodium and water. (Chapter 6.2)
M
Maleficence: Causing harm to patients. (Chapter 2.2)
Mania: Periods of extreme highs in bipolar disorder. Manic episodes may include these symptoms: rapid speech, hyperactivity, reduced need for sleep, flight of ideas, grandiosity, poor judgment, aggression/hostility, risky sexual behavior, neglected basic self-care, or decreased impulse control. (Chapter 8.3)
Mechanism of action: How a medication works at a cellular level within the body. (Chapter 1.7, Chapter 3.2)
Metabolism: The third stage of pharmacokinetics that involves the breakdown of a drug so that it can be excreted by the body. (Chapter 1.2, Chapter 1.5)
Methicillin-resistant S. aureus (MRSA): An infection caused by Methicillin-resistant Staphylococcus aureus that is difficult to treat because it exhibits resistance to nearly all available antibiotics. (Chapter 3.2)
Mineralocorticoids: Hormones released by the adrenal cortex that regulate body minerals, especially sodium and potassium, that are essential for fluid and electrolyte balance. Aldosterone is the major mineralocorticoid. (Chapter 9.3)
Misuse: The use of illegal drugs and/or the use of prescription drugs in a manner other than as directed by a provider, such as using in greater amounts, more often, or longer than told to take a drug or using someone else’s prescription. (Chapter 10.4)
Motor neurons: Consist of the somatic nervous system that stimulates voluntary movement of muscles and the autonomic nervous system that controls involuntary responses. (Chapter 4.2)
Muscarinic agonists: Also called parasympathomimetics. Primarily cause smooth muscle contraction, resulting in decreased HR, bronchoconstriction, increased gastrointestinal/genitourinary tone, and pupil constriction. (Chapter 4.2)
Muscle spasticity: Condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. (Chapter 10.3)
Myocardial infarction (MI): Commonly referred to as a heart attack, resulting from a lack of blood flow (ischemia) and oxygen to a region of the heart, resulting in death of the cardiac muscle cells. (Chapter 6.3)
N
Narrow-spectrum antimicrobial: An antibiotic that targets only specific subsets of bacterial pathogens. (Chapter 3.2)
National Patient Safety Goals (NPSGs): Goals established by The Joint Commission to help accredited organizations address specific areas of concern related to patient safety. (Chapter 2.3)
Negative feedback loop: Characterized by the inhibition of further secretion of a hormone in response to adequate levels of that hormone. (Chapter 9.2)
Negative inotropic factors: Factors that decrease contractility. (Chapter 6.2)
Nerve: Cord-like bundle of axons located in the peripheral nervous system that transmits sensory input and response output to and from the central nervous system. (Chapter 8.8)
Neural stimuli: Released in response to stimuli from the nervous system. For example, the activation of the release of epinephrine and norepinephrine in the fight-or-flight response is stimulated by the sympathetic nervous system. (Chapter 9.2)
Neuroleptic malignant syndrome (NMS): Potentially life-threatening adverse effect that includes high fever, unstable blood pressure, and myoglobinemia. (Chapter 8.7)
Neuron(s): Neural tissue cell that is primarily responsible for generating and propagating electrical signals into, within, and out of the nervous system. (Chapter 4.2, Chapter 8.2)
Neurotransmitter: Chemical signal that is released from the synaptic end bulb of a neuron to cause a change in the target cell. (Chapter 8.2)
Nociceptors: Nerve endings that selectively respond to painful stimuli and send pain signals to the brain and spinal cord. (Chapter 10.2)
Nonpharmacologic therapy: Treatments that do not involve medications, including physical treatments (e.g., heat or cold therapy, exercise therapy, weight loss) and cognitive-behavioral treatments (e.g., distractions/diversions and cognitive behavioral therapy). (Chapter 10.4)
Nonselective beta-blockers: Medications that block both Beta-1 and Beta-2 receptors, thus affecting both the heart and lungs. (Chapter 4.2)
Nursing: The protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations, as defined by the American Nurses Association. (Chapter 2.2)
Nursing process: Standards of Practice that include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing client care. (Chapter 2.3)
Nursing Scope and Standards of Practice: A document created by the American Nurses Association that outlines professional nursing performance according to national standards. (Chapter 2.2)
O
Onset: When a medication first begins to work and exerts a therapeutic effect. (Chapter 1.9)
Ophthalmoplegia: Weakness in eye muscles. (Chapter 8.3)
Orthostatic hypotension: A significant change in blood pressure from lying to sitting to standing. (Chapter 8.7)
Osmoreceptors: Specialized cells within the hypothalamus that are sensitive to the concentration of sodium ions and other solutes in the bloodstream. (Chapter 9.2)
Osmotic agents: Cause water to be retained with the stool, increasing the number of bowel movements, and softening the stool so it is easier to pass. (Chapter 7.4)
P
Pallor: A deficiency of color especially of the face; paleness. (Chapter 5.4)
Paradoxical effect: An effect that is opposite to what is expected. (Chapter 5.6)
Parasympathetic nervous system (PNS): Includes nerves outside the brain and spinal cord. Associated with the “rest and digest” response. Stimulation of PNS causes decreased heart rate, decreased blood pressure via vasodilation, bronchial constriction, and stimulates intestinal motility, salivation, and relaxation of the bladder. (Chapter 4.2)
Parasympatholytics: Inhibit acetylcholine (ACh), which allows the SNS to dominate. Also called anticholinergics or muscarinic antagonists. (Chapter 4.2)
Parasympathomimetics: Also called muscarinic agonists. Primarily cause smooth muscle contraction, resulting in decreased HR, bronchoconstriction, increased GI/GU tone, and pupil constriction. (Chapter 4.2)
Parathyroid hormone (PTH): The hormone released by parathyroid glands and is involved in the regulation of blood calcium levels. (Chapter 9.5)
Parietal cells: Cells in the gastric glands that produce and secrete hydrochloric acid (HCl) and intrinsic factor. (Chapter 7.3)
Partial thromboplastin time (PTT): A blood test used to monitor how long it takes for a client’s blood to clot. PTT is used for clients receiving IV heparin therapy to achieve therapeutic range. Dosage is considered adequate when the activated partial thromboplastin time (aPTT) is 1.5 to 2 times the normal or when the whole blood clotting time is elevated approximately 2.5 to 3 times the control value. (Chapter 6.12)
Pathogen: An organism causing disease to its host. (Chapter 3.2)
Patient-controlled analgesia (PCA): To receive the opioid, the patient pushes a button on the PCA device, which releases a specific dose but also has a lockout mechanism to prevent an overdose. Included with hydromorphone or fentanyl. (Chapter 10.7)
Peak: When the maximum concentration of a drug is in the bloodstream. (Chapter 1.9, Chapter 1.10)
Pepsin: A digestive enzyme. (Chapter 7.3)
Peptic ulcer disease (PUD): Occurs when gastric or duodenal ulcers are caused by the breakdown of GI mucosa by pepsin in combination with the caustic effects of hydrochloric acid. (Chapter 7.3)
Peripheral nervous system (PNS): An anatomical division of the nervous system that is largely outside the cranial and vertebral cavities, namely all parts except the brain and spinal cord. (Chapter 4.2, Chapter 8.2)
Pharmacodynamics: The effects of drugs in the body and the mechanism of their action. (Chapter 1.2, Chapter 1.7)
Pharmacogenetics: The study of how a person’s genetic makeup affects their response to medicines. (Chapter 1.2)
Pharmacokinetics: The study of how the body absorbs, distributes, metabolizes, and eliminates drugs. (Chapter 1.2)
Pharmacology: The science dealing with actions of drugs on the body. (Chapter 1.1)
Pharmacy: The science of the preparation of drugs.
Polypharmacy: The concurrent use of multiple medications. (Chapter 2.5)
Positive inotropic factors: Factors that increase contractility. (Chapter 6.2)
Postganglionic neurons: Differ for the SNS and PNS branches. Postganglionic neurons of the autonomic system are classified as either cholinergic, meaning that acetylcholine (ACh) is released, or adrenergic, meaning that norepinephrine is released. (Chapter 4.2)
Postural instability: Abnormal fixation of posture (stoop when standing), problems with equilibrium, and righting reflex. (Chapter 8.3)
Potency: The drug dose required to produce a specific intensity of effect. (Chapter 1.11)
Prandial insulins: During or relating to the eating of food. (Chapter 9.4)
Preganglionic neurons: Release acetylcholine (ACh). (Chapter 4.2)
Preload: The amount of blood in the atria just prior to atrial contraction. (Chapter 6.2)
Prescription Drug Monitoring Programs (PDMP): A statewide electronic database that collects designated data on substances dispensed in a state to address prescription drug abuse, addiction, and diversion. (Chapter 2.3)
Probiotics: Used for the prevention and treatment of diarrhea by restoring normal bacteria flora in the gastrointestinal tract. (Chapter 7.4)
Professional assistance procedure: A voluntary nondisciplinary program to provide support for credentialed professionals in Wisconsin with a substance abuse disorder who are committed to their own recovery. (Chapter 2.3)
Prokinetic: Medications used to promote peristalsis to empty the gastrointestinal tract and reduce nausea. (Chapter 7.5)
Prostaglandins: Produced in nearly all cells and are part of the body’s way of dealing with injury and illness. Prostaglandins act as signals to control several different processes depending on the part of the body in which they are made. Prostaglandins are made at the sites of tissue damage or infection, where they cause inflammation, pain, and fever as part of the healing process. (Chapter 10.2)
Prothrombin time (PT): A blood test that measures how long it takes for a client’s blood to clot. PT is used to monitor the effects of warfarin in preventing clot formation. (Chapter 6.12)
Proton pump inhibitors (PPIs): Bind to the hydrogen-potassium ATPase enzyme system of the parietal cell and inhibit the release of hydrogen ions into the stomach. (Chapter 7.3)
Prototype: A common individual drug that represents a drug class or group of medications having similar chemical structures, mechanisms of action, and modes of action. (Chapter 3.5)
R
Rebound hyperacidity: A side effect of medication causing elevated levels of hydrochloric acid in the stomach after the medication is discontinued. (Chapter 7.3)
Registered Nurse (RN): An individual who is educationally prepared and licensed by a state to practice as a registered nurse. (Chapter 2.2)
Renin-angiotensin-aldosterone system (RAAS): Renin converts the plasma protein angiotensinogen into its active form—Angiotensin I. Angiotensin I circulates in the blood and is then converted into Angiotensin II in the lungs. This reaction is catalyzed by the angiotensin-converting enzyme (ACE). Angiotensin II is a powerful vasoconstrictor, greatly increasing blood pressure. It also stimulates the release of ADH and aldosterone, a hormone produced by the adrenal cortex. Aldosterone increases the reabsorption of sodium into the blood by the kidneys, causing reabsorption of water and increasing blood volume and raising blood pressure. (Chapter 6.2)
Resistance: A characteristic of bacteria when sensitivity analysis is performed demonstrating lack of effective treatment by a particular antibiotic. (Chapter 3.2)
Respiratory rate: The total number of breaths, or respiratory cycles, that occur each minute. A child under 1 year of age has a normal respiratory rate between 30 and 60 breaths per minute, but by the time a child is about 10 years old, the normal rate is closer to 18 to 30. By adolescence, the normal respiratory rate is similar to that of adults, 12 to 18 breaths per minute. (Chapter 5.2)
Rigidity: Increased muscle tone and increased resistance to movement. As severity increases, there may be cogwheel rigidity. (Chapter 8.3)
Root cause analysis: An analysis after an error occurs to help identify not only what and how an event occurred, but also why it happened. When investigators are able to determine why an event or failure occurred, they can create workable corrective measures that prevent future errors from occurring. (Chapter 2.3)
S
Safety culture: The culture of a health care agency that empowers staff to speak up about risks to clients and to report errors and near misses, all of which drive improvement in client care and reduce the incident of client harm. (Chapter 2.3)
Scheduled medications: The Controlled Substances Act (CSA) places all substances that are regulated under existing federal law into one of five schedules, ranging from Schedule I drugs with a high potential for abuse and the potential to create severe psychological and/or physical dependence, to Schedule V drugs with the least potential for abuse. (Chapter 2.3)
Selective beta-blocker: Medications that mostly inhibit B1-receptors. (Chapter 4.2)
Selectivity: The separation between the desired and undesired effects of a drug. (Chapter 1.11)
Sensitivity analysis: A test performed in addition to a culture to select an effective antibiotic to treat a microorganism. (Chapter 3.2)
Sensory neurons: Sense the environment and conduct signals to the brain that become a conscious perception of that stimulus. (Chapter 4.2)
Serotonin syndrome: May occur when taking serotonin medications. Includes mental status changes (e.g., agitation, hallucinations, coma), autonomic instability (e.g., tachycardia, labile blood pressure, hyperthermia), neuromuscular aberrations (e.g., hyperreflexia, incoordination) and/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Serotonin syndrome, in its most severe form, can resemble neuroleptic malignant syndrome, which includes hyperthermia, muscle rigidity, autonomic instability with possible rapid fluctuation of vital signs, and mental status changes. (Chapter 7.5, Chapter 8.7)
Side effect: Effect of a drug, other than the desired effect, sometimes in an organ other than the target organ. (Chapter 1.11)
Sinoatrial (SA) node: Normal cardiac rhythm is established by the sinoatrial (SA) node. The SA node has the highest inherent rate of depolarization and is known as the pacemaker of the heart. (Chapter 6.2)
Sinus rhythm: Normal electrical pattern followed by contraction of the heart. (Chapter 6.2)
“SLUDGE”: Mnemonic for the effects of anticholinergics: Salivation decreased, Lacrimation decreased, Urinary retention, Drowsiness/dizziness, GI upset, Eyes (blurred vision/dry eyes). (Chapter 4.2)
Social determinants of health (SDOH): Conditions in the places where people live, learn, work, and play that can affect a wide range of health risks and outcomes. (Chapter 2.2, Chapter 2.4)
Somatic nervous system: Causes contraction of skeletal muscles; associated with voluntary responses. (Chapter 4.2)
Sputum: Matter expectorated from the respiratory system and especially the lungs that is composed of mucus but may contain pus, blood, fibrin, or microorganisms (such as bacteria) in diseased states. (Chapter 5.4)
Standards of practice: Authoritative statements of duties by the American Nursing Association that all registered nurses, regardless of role, population, or specialty, are expected to perform competently. Standards of Practice include Assessment, Diagnosis, Outcome Identification, Planning, Implementation, and Evaluation components of providing client care. (Chapter 2.2)
Standards of professional performance: Describe a competent level of behavior in the professional role, including activities related to ethics, culturally congruent practice, communication, collaboration, leadership, education, evidence-based practice, and quality of practice as defined by the American Nursing Association. (Chapter 2.2)
State Board of Nursing: A group of officials who enforce the State Nurse Practice Act. (Chapter 2.3)
State Nurse Practice Act: Law enacted by state legislatures setting professional standards of nursing care to which nurses are held accountable by the State Board of Nursing. (Chapter 2.2)
Status epilepticus: A state of repeated or continuous seizures. (Chapter 8.3)
Steady state: The point at which the amount of drug entering the body is equal to the amount of drug being eliminated, resulting in a stable drug concentration. (Chapter 1.9)
Stimulants: Laxatives that cause the intestines to contract, inducing stool to move through the colon. (Chapter 7.4)
Stool softeners: Laxatives that facilitate movement of water and fats into stool to make it soft and improve regularity of bowel movements. (Chapter 7.4)
Stress-related mucosal damage: A common condition in hospitalized clients that can lead to peptic ulcer disease (PUD). (Chapter 7.3)
Stress ulcer prophylaxis: Medication to prevent the formation of stress ulcers. (Chapter 7.3)
Stroke volume (SV): The amount of blood that both ventricles pump during each contraction, normally in the range of 70–80 mL. (Chapter 6.2)
Substance use disorder: A pattern of behaviors that ranges from misuse to dependency or addiction, whether it is alcohol, legal drugs, or illegal drugs. Addiction is a complex disease with serious physical, emotional, financial, and legal consequences. (Chapter 2.3)
Superinfection: A secondary infection in a client having a preexisting infection. C-diff and yeast infections as a result of antibiotic therapy are examples of superinfections. (Chapter 3.2)
Surface epithelium cells: Cells found within the lining of the stomach that secrete mucus as a protective coating. (Chapter 7.3)
Sympathetic nervous system (SNS): Associated with the “fight-or-flight response.” Stimulation causes the main effects of increased heart rate, increased blood pressure via the constriction of blood vessels, and bronchodilation. (Chapter 4.2)
Sympathomimetics: Mimic the effects of the body’s natural SNS stimulation of adrenergic receptors. Also called adrenergic agonists. (Chapter 4.2)
Synapse: The connection between the neuron and its target cell. (Chapter 4.2)
Synergistic interaction: Concurrent drug administration producing a synergistic interaction that is better than the efficacy of either drug alone. An example of synergistic drug combinations is trimethoprim and sulfamethoxazole (Bactrim). (Chapter 3.3)
Systole: The period of contraction that the heart undergoes while it pumps blood into circulation. (Chapter 6.2)
T
Tardive dyskinesia: Involuntary contraction of the oral and facial muscles (such as tongue thrusting) and wavelike movements of the extremities. (Chapter 8.9)
Thalamus: The region of the central nervous system that acts as a relay for sensory pathways. (Chapter 8.2)
THC: Tetrahydrocannabinols found in marijuana. (Chapter 7.5)
The Joint Commission: A national organization that accredits and certifies health care organizations in the United States. (Chapter 2.3)
Therapeutic index: A quantitative measurement of the relative safety of a drug that compares the amount of drug that produces a therapeutic effect versus the amount of drug that produces a toxic effect. Medication with a large therapeutic index is safer than a medication with a small therapeutic index. (Chapter 1.10)
Therapeutic window: The dosing window in which the safest and most effective treatment will occur. (Chapter 1.10)
Threshold: The membrane voltage at which an action potential is initiated. (Chapter 8.2)
Thrombus: An aggregation of platelets, erythrocytes, and WBCs trapped within a mass of fibrin strands that adhere to the vessel wall and decrease the flow of blood or totally block the flow of blood. (Chapter 6.2)
Time dependent: Time dependency occurs when greater therapeutic effects are seen with lower blood levels over a longer period of time. (Chapter 3.3)
Titration: The process of adjusting a medication dose to achieve a desired therapeutic effect for the client. (Chapter 1.10)
Transient ischemic attack (TIA): Occurs when blood flow is interrupted to the brain, even for just a few seconds, resulting in loss of consciousness or temporary loss of neurological function. (Chapter 6.3)
Tremor: Usually tremor at rest; when person sits, the arms shake, but tremor stops when person attempts to grab something. (Chapter 8.3)
Tropic hormones: Hormones that turn on or off the function of other endocrine glands, including ACTH, FSH, LH, and TSH. (Chapter 9.2)
Trough: A drug level drawn from the bloodstream when the drug is at its lowest concentration, typically right before the next scheduled dose is given. (Chapter 1.10)
Type 1 diabetes: An autoimmune disease that affects the beta cells of the pancreas so they do not produce insulin; thus, synthetic insulin must be administered by injection or infusion. (Chapter 9.4)
Type 2 diabetes: A condition where the body’s cells become resistant to the effects of insulin. Over time, the beta cells become exhausted and if blood glucose levels cannot be controlled through a healthy diet and exercise, then oral diabetic medication must be implemented and eventually insulin administration may be required. (Chapter 9.4)
V
Vancomycin-Resistant S. Aureus (VRSA): An infection caused by Vancomycin-resistant Staphylococcus aureus that is difficult to treat because it exhibits resistance to nearly all available antibiotics. (Chapter 3.2)
Veins: Blood vessels that conduct blood toward the heart (except for pulmonary veins that carry deoxygenated blood from the heart to the lungs). (Chapter 6.2)
Venous reserve: Volume of blood located in venous networks within the liver, bone marrow, and integument. (Chapter 6.2)
Vertigo: A sense of spinning dizziness. It is a symptom of a range of conditions. It can happen when there is a problem with the inner ear, brain, or sensory nerve pathway. (Chapter 10.3)
Vestibular system: An area located within the inner ear that gives a sense of balance and spatial orientation for the purpose of coordinating movement with balance. (Chapter 7.5)
Vomiting center (VC): An area in the brain that initiates vomiting by inhibiting peristalsis and producing retro-peristaltic contractions beginning in the small bowel and ascending into the stomach. It also produces simultaneous contractions in the abdominal muscles and diaphragm that generate high pressures to propel the stomach contents upwards. (Chapter 7.5)
