Elder Abuse Attorney

Call us or email us today if you suspect that your loved one has been injured in a medical facility or nursing home and speak directly to an attorney who has over 20 years of litigation experience and can get you the results that you deserve.

Nursing Home Warning Signs

Warning Signs When Visiting Your Family Member in a Nursing Home or Other Facility

  1. Listen to what the resident is telling you about the home. Even if he has dementia, he still might be able to report on certain circumstances accurately.
  2. Observe their behavior/body language around the staff. Are there smiles and respectful communication? Do staffers know your loved one’s needs and preferences?
  3. Ask your family member if you can check their skin for cuts and bruises, depending of course on the relationship that you have with him or her. Also, know that not all bruises are a sign of abuse. If you see bruises, ask the resident what happened and also ask the provider.
  4. Warning signs of abuse/neglect/bad care can include such things as repeated falls, unexplained weight loss, sudden changes in behavior such as withdrawal or agitation, and not toileting or grooming. Again those are indicators and not dispositive. But do not hesitate to ask questions.

The above are excerpted with modification from The Seattle Times article “Warning signs to look for when visiting senior homes.” Additional suggestions include:

  1. When you visit the facility, arrive at different times of the day. If your loved one is always in bed or asleep, it could be an indication of over-medication, improper medication, malnutrition, or depression or some other problem.
  2. The resident’s avoidance, anxiety, agitation or withdrawn behavior around one or more staff members may be a warning sign.
  3. If the resident is left in soiled clothing, or exhibits poor hygiene, increased confusion, or behavioral changes, then these are the types of conditions that should prompt further questioning of both the resident and the staff.

For an additional resource on resident’s rights, see Residents’ Rights fact sheet which summarizes laws and regulations applicable to those in nursing homes and other long-term care facilities.

Elder Abuse Background Information (with video)

Video Courtesy: ElderJusticeNow.org

Wilson & McIntyre are experienced trial attorneys who have a unique understanding and compassion for the elderly. We have experienced many of the issues and decisions that you face with our own aging parents and friends. As advocates for our elders and senior population, the nursing home negligence lawyers at Wilson & McIntyre provide a powerful voice for those who are too often vulnerable and voiceless. We are committed to the prevention of elder neglect and abuse in the Commonwealth of Virginia and will vigorously seek justice for you and your family. If we handle your case, you will pay no fee unless you recover damages from those who have neglected or abused your loved one.

The “Age Wave” and Increasing Neglect

At Wilson & McIntyre, we understand that elder abuse is a serious emerging issue which many American families will be forced to confront. There are currently an estimated 1.4 million residents in nursing homes and an additional one million who reside in assisted living facilities throughout the United States. 78 million Baby Boomers are in line to age along with their parents, while the number of individuals in institutions is set to increase each year. In Virginia, studies project that there will be one million more seniors in 2025 than there are today. As the need for services increases and available funding decreases, the challenge to deliver quality care becomes obvious.

Given this “Age Wave,” nobody wants to imagine a growing segment of our society victimized by abuse or neglect by their caregivers. But it is real. Studies indicate that there are as many as five million potential cases of elder abuse each year – whether it is physical, financial, emotional or sexual abuse –affecting all socio-economic levels and all races.

Physical abuse and neglect take several forms, sometimes open and sometimes subtle. Pressure sores, falls, choking, overused chemical and physical restraints, prescription errors, over-medicating, under-medicating, malnourishment, dehydration and elopement (which is an unauthorized or unnoticed departure from the facility) are all potential signs that the standard of care is not being met. Often the conditions go unreported. Unabated. That is unacceptable.

Together we can challenge what is wrong

If you suspect that a loved one is the victim of abuse or neglect in a nursing home, adult assisted living facility, hospice or other facility, act promptly. The elderly and disabled have rights protected by law. Wilson & McIntyre can assist you in enforcing those rights in civil litigation to recover compensation in the event of injury or wrongful death. You and your family members are often the first ones to sense that something is not right. Together we can challenge what is wrong, protect those most in need of protecting, and empower families and their loved ones to reclaim their rights and dignity. You can be heard, and you can make a difference. Change and greater accountability often happen one case at a time.

Additional Helpful Links:
For a referral to an Elder Law Attorney practicing in Washington D.C. and Northern Virginia, contact Jeffrey Downey, an attorney with whom Wilson & McIntyre often affiliate when handling elder care claims. www.jeffdowney.com

For useful forms to keep track of medicines, or what questions to ask your doctor, see the National Transitions to Care Coalition’s consumer tools:

My Medicine List Taking Care of MY Health Care

For a compilation of some of the Virginia agencies that provide assistance to the elderly consult:

Virginia Department of Aging Virginia Department of Social Services List of Virginia Area Aging Agencies The National Long-Term Care Ombudsman Resource Center

Tips for Choosing a Nursing Home

Twenty Tips For Choosing a Nursing Home or Assisted Living Facility

Some helpful tips that Medicare and other experts recommend when deciding on a long-term care facility include:

  1. Make a list of what you are looking for as far as location, special services, atmosphere, etc. Ask your doctor, friends, family, neighbors, clergy and others for recommendations. Check ratings and read the inspection reports online. Compare the quality. Click here for further information.
  2. Call during business hours to speak to someone who can answer your questions. This may include the administrator, admissions coordinator or social service director. Pay attention to how you are treated on the phone. Does this sound like a place where you would like to live?
  3. Find out about costs and whether there is a bed available. How will you pay for the facility? What forms of payment do they accept?
  4. Schedule an appointment with the admissions director for the first visit. Ask to meet such key staff as the administrator, the director of nursing, the dietitian, activity director and any specialists. Then go back at a different time of the day for unscheduled visits to get a truer, more informal sense of the place.
  5. Make a list of your questions. During your visits, be observant and use your sight, hearing and smell. Take notes.
  6. Ask for the home’s brochure, admission policies and residents’ “Bill of Rights.”
  7. Visit during a meal, on evenings or during weekends, to see how staffing levels vary and meals are handled. Check out the food and ask to see the kitchen. Have a meal.
  8. Ask to see several floors of the home, the activity rooms, the dining area and other gathering areas – preferably when people are using them. Beware of the “chandelier syndrome,” in which a home has a fancy, glossy lobby but poorly maintained resident areas.
  9. Observe how the staff and residents interact. Are the residents spoken to with respect as adults, not as children? Is the staff friendly and accommodating? When talking with staff members, ask yourself: Do they seem sincere?
  10. Stop and talk with residents and family members about their experiences. Ask to talk to the head of the residents council or the family council.
  11. See if residents are dressed appropriately for the time of day, well-groomed, alert and involved with others. Do the residents appear happy, comfortable and at home?
  12. Check out the weekly activities calendar and how lively the home is. Are all the residents sitting in their rooms alone, or are they lined up and sleeping by the nursing station?
  13. Is it very noisy or too quiet because there is no activity?
  14. Specifically, check to see if residents with Alzheimer’s get special care and what activities, if any, they’re involved in.
  15. Are residents being taken care of in a timely manner? Are call bells unanswered?
  16. Is staffing adequate, and does the staff seem to care about the needs of the residents?
  17. If the building is older, remember that doesn’t reflect the quality of care. What’s more important, besides it being a nurturing environment, is that it’s clean and safe.
  18. Is there hot water in the bathrooms? Is the temperature in the facility comfortable, or is it too hot or too cold?
  19. Is the facility clean, tidy, and odor-free?
  20. Are the rooms decorated with personal furnishings and belongings? Do the residents have adequate privacy?

While not intended to be a complete list, these types of questions are based on common sense and are grounded in the fundamental philosophy that our loved ones should get the care for which they are paying. Our elders do not “sign away” their rights to dignity and comfort when entering a long-term care facility. Be vigilant and proactive.

Excerpts compiled and taken from “Your guide to selecting the right nursing home,” The Palm Beach Post February 7, 2010 and “Aging Parents and the Big Decision,” The Patriot Ledger, January 2, 2010.

Elder Abuse Attorney Profile

John S. Wilson

Before opening the firm of Wilson & McIntyre, John Wilson was an equity partner in a large Virginia law firm’s commercial litigation and insurance defense department. For over twenty years he defended Fortune 500 companies and prominent insurance companies against liability claims in both state and federal courts. Mr. Wilson handled sophisticated commercial disputes as well as catastrophic loss cases for major insurance companies, which involved claims for wrongful death, professional malpractice, severe personal injury and multi-million dollar property damages. Mr. Wilson received big firm training, charged big firm rates, and got big firm results.

Now you can hire a “big firm” lawyer to represent you, but with the benefits of being in a small firm setting. In addition to handling real property and commercial litigation, Wilson & McIntyre also handles most types of personal injury claims. Please call for a free, confidential consultation concerning your personal injury claim, including elder abuse and nursing home neglect, trucking, severe automobile and industrial accidents, and products liability. Let us show you what the big insurance companies and sophisticated businesses already know: choosing the right lawyer makes a difference. With Mr. Wilson, you have that choice.

Client Recommendations

“You are one terrific Lawyer John Wilson. Thank you.” (C.I. 2014)


“What is obvious is that you [John Wilson] are a superior lawyer and I am grateful that you are on my side.” (E.C. 2014)


“Thanks again for all you have done for us!!!! I am so thankful that we picked you as our lawyer. You always put us at ease.” (P.P., 2013)

“Last evening when I arrived home from work I was pleasantly surprised to find your check [for my personal injury claim]. I would like to take this opportunity to thank you for your kind assistance and utmost professionalism in working with me to resolve this matter. It was an entirely new experience for me and I must say that thanks to you, it turned out favorably.” (H.G., September, 2012)


“I felt compelled to write this short note thanking your law firm for the prompt and efficient legal services you provided to me and my husband. It is not often one encounters any business whose honesty, professionalism & integrity radiates consistently. This I found to be the case in working with your law firm.

I would be remiss if I did not cite how surprised I was with the expediency in which my legal matter was handled. Feeling stressed, worried and mentally shaken by the legal claim against me, I was astounded at how quickly this firm worked to resolve this issue. Your law firm’s diligence to represent me fairly along with your timely communication to me which included weekends did not go unnoticed. Your law firm exceeded by expectations.

I thank you whole heartedly. In today’s environment wherein one is often skeptical and leery in finding a law firm that handles such claims swiftly and fairly is really what prompted me to write this communication. I can truly say with 100% certainty that the law firm of Wilson & McIntyre is one that I would endorse and continue using when needed. More importantly, it is a firm I would encourage anyone who needs superior legal services for a fair market value to retain.

Thank you again. On behalf of my entire family, we are most appreciative.” (A.D.C.)


“I know I have said it in the past but I cannot thank you enough for all of your help. You took a very frustrating and confusing situation and completely eased all of my worries. Thank you so much!” (K. R.)


“Wilson & McIntyre were highly recommended by a friend and they STILL far exceeded any of our expectations! Professional, knowledgeable and courteous, they are the kind of attorneys you want on your side. We would use them again and most highly recommend them!” (J.M. & S.M.).

“Dear John [Wilson]- Thanks so much for your help and hard work on our case. This was our first and hope[fully] last accident. We could not have done it without you. (L.P. 2013)


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Legal and Medical Glossary
Abuse: Abuse can be physical and mental and generally refers to illegal or improper contact. Physical abuse is generally considered the intentional use of physical force that causes harm or apprehension of harm. Emotional and verbal abuse can occur when a person says or does something humiliating or embarrassing to a resident.

Abuse (Virginia legal definition at 12 VAC 5—371—10): The willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish, or deprivation by an individual, including caretaker, of goods or services that are necessary to attain or maintain physical, mental, and psychosocial well-being. This includes verbal, sexual, physical or mental abuse.

Accredited: Refers to meeting certain private standards that may be in place for a particular profession.

Active Range of Motion (AROM): The ability of an individual to move one’s arms or legs through their range of motion without restriction. After an injury health care providers may test AROM to determine the nature of the injury.

Activities of Daily Living (ADLs): Refers generally to the activities that are done in the normal course of a day such as eating, walking, dressing, grooming and bathing. In a nursing home setting nurse aides typically assist residents with ADLs depending on their level of dependence. ADL care should be charted in the nurse aid flow chart.

Admitting Physician: The doctor that admits a person to a hospital or other healthcare facility.

Advanced Directives: Written instructions telling how a person wants his or her healthcare administered in the event that the person is unable to make or speak his/her medical wishes. Also known as a living will. To learn more about advanced directives, please click here or here.

Advocate: A person or group that supports or protects another person’s rights. There are various advocacy groups in the long-term care setting that help protect the rights of residents in nursing homes or assisted living facilities. Ombudsmen are one form of advocates that are common in our long term care system. They are first responders to a nursing home complaint.

Albumen: Refers to a form of protein found in the human body, the measurement of which can be used to gauge poor nutrition or malnutrition. Albumen levels can be tested in the blood or urine.

Albuterol: Medication prescribed for the treatment of broncho spasms (or breathing problems) in patients with obstructive airway disease, including asthma.

Alzheimer’s Disease: A mental disorder involving the deterioration of mental functions. Named after a German neurologist, this is a progressive mental disease characterized by confusion, memory failure, disorientation, speech disturbances, and sometimes inappropriate behavior. It is the most common form of dementia in the United States, accounting for some two-thirds of all cases. Although this disease occurs with equal frequency in men and women, the familial risk is four times that of the general population. Diagnostic criteria involve the failure of cognitive functions including memory, use of language, visual/special skills, personality or reasoning skills. Click here to obtain more information about Alzheimer’s disease.

Anemia: Decrease in the hemoglobin of blood to levels below normal. Signs or symptoms may include fatigue, weight loss, dizziness, headaches, confusion or insomnia. Anemia is common in the elderly. Sometimes anemia may be caused by a benign disease or it may be a sign of a chronic illness.

Aneurysm: Localized dilation of an artery that can result from blockage or atherosclerosis. In the elderly, they typically occur at branching points (i.e. terminal aorta) or areas of stress (i.e., popliteal artery). Dilation results from increased pressure within the vessel. Severe harm or death can result from ruptures. Aneurysms may not cause pain until a rupture. High blood pressure (hypertension) is a significant risk factor. Diagnosis can be made on the basis of chest X-rays.

Aphagia: Refers generally to the loss of ability to swallow. This can be caused by a variety of things including stroke. Individuals who have this condition may require thickened liquids to reduce the risk of aspiration pneumonia.

Aphasia: Neurologic condition involving a decreased ability to speak.

Atrial flutter: Rapid, irregular atrial activity between 250 and 300 beats per minutre with flutter waives. It can be an indicator of organic heart disease. Among the elderly, common causes are coronary artery disease (CAD) and chronic obstructive pulmonary disease (COPD).

Atrial fibrillation: A lack of organized atrial activity and irregular timing of the QRS complexes, typically chronic in nature. The condition may cause uncomfortable heart palpatations and chest discomfort because of irregular heart-beats or increase in the heart rate. Click here for more information.

Bacterimia (Bacteria in the blood): Bacteria in the blood can also lead to sepsis or septicemia.

Balloon Angioplasty: A method of dilating or opening an obstructed blood vessel by threading a small balloon tipped catheter into the vessel. The balloon is then inflated to compress lesions that may be blocking the blood vessel. This is commonly used in the treatment of arteriosclerotic heart disease. For more information, click here.

Barium Enema: A rectal infusion of barium sulfate. A radiopaque contrast medium which is retained in the lower intestinal tract during diagnostic studies for purposes of assessing obstruction, tumors or other abnormalities.

Barrier Creams: Ointments or creams that are applied to the skin to act as a barrier, to protect the skin from irritants or pathogens. Barrier creams become very important to use for patients that are incontinent, as moisture can increase the risk of skin breakdown and infection.

Basal Body Temperature: Temperature of the body taken in the morning either orally or rectally after sleep but before the patient does any significant activity.

Basal Cell Carcinoma: A malignant epithelial cell tumor that begins as a papule and enlarges peripherally. Metastasis is rare but local growth may destroy adjacent tissue. The primary known cause of this cancer is excessive exposure to sun or radiation. To learn more about basal cell carcinoma, please click here.

Basal Metabolism: The amount of energy needed to maintain essential body function such as circulation, respiration, and muscle activity. It is typically measured when the subject is awake, had complete rest and has not eaten for 14 to 18 hours. For more information, click here.

Baseline: A known value or quantity with which an unknown value or quantities is compared against.

Battered Woman Syndrome (BWS): Repeated episodes of physical assault on a woman by a man with whom she has a relationship with, sometimes resulting in serious physical or psychological injury. It is estimated that between one and two million women in the United States are beaten by their husbands every year. Men who grow up in homes in which their father abused their mother are more likely to beat their wives.

Bed Rest: The restriction of a patient to bed for therapeutic reasons for a prescribed period.

Bedsore: Pressure induced skin breakdown involving the death of living tissue. Bedsores or pressure sores can occur anytime there is unrelieved pressure to an area of the body that has a bony prominence. Bedsores are a common type of injury in a nursing home setting and can be an indication of neglect. For more information, please click here.

Behavior Disorder: Any group of antisocial behavior patterns occurring primarily in children and adolescents. However, such behavioral disorders are also common with elderly who are suffering from dementia or Alzheimer’s disease. Behavioral management should initially focus on non-pharmacological interventions to control behavior, as medical management of negative behavior can cause adverse side effects.

Behavioral Management: Refers generally to interventions that are used from a nursing perspective to control a patient’s negative behavior.

Beneficiary: This term has multiple meanings depending on the context in which it is used. A legal beneficiary can be an individual who is entitled to participate in a recovery because of a familial connection. In the context of insurance or Medicare coverage a beneficiary refers to the person who has the benefit. With respect to Medicare, this may refer to the period of time that a beneficiary may be admitted to a hospital or skilled nursing facility and be entitled to receive Medicare payments.

Benign: A non-cancerous growth and therefore not malignant (see also Benign Neoplasm).

Benzodiazepine: Referring to a class of psychotropic agents which include tranquilizers, anti-anxiety medications, and medications for insomnia. Adverse reactions to Benzodiazepines can include drowsiness, ataxia, and paradoxical increase in aggression and/or hostilities.

Binet Age: Derived from the French psychologist, this measures the mental age of an individual as determined by the Binet-Simon test.

Biologic Half Life: The time required for the body to eliminate half of an administered dose of any substance by regular physiologic processes. This is also known as the metabolic half life.

Biopsy: The removal of a small piece of living tissue from an organ or other part of the body from microscopic examination to confirm a diagnosis or prognosis.

Bipolar Disorder: A major mental disorder characterized by episodes of mania and depression or mixed moods. Characteristics of a manic phase involve excessive emotional displays such as excitement or elation. Causes of the disorder are multiple in complex often involving biologic, psychological, interpersonal, and cultural factors.

Blood Clot: A semi-solid mass, the final result of a clotting process in the blood within seconds after an injury platelets clump at the site to prevent blood flow.

Blood Creatinine Test: Tests that measures the amount of creatinine in the blood in order to diagnose impaired renal function. Elevated creatinine levels suggest a chronic disease process.

Blood Glucose Level: The amount of glucose found in the blood stream, usually about 170 to 150 mgs/dl after an overnight fast. Significant fluctuations in blood glucose levels can be an indication of diabetes or pancreatic cancer.

Blood Sugar: A group of closely related substances such as glucose and fructose that are normal constituents of the blood and are essential for cellular metabolism.

Blood Urea Nitrogen (BUN): A measure of the amount of urea in the blood. Urea forms in the liver as an end product of protein metabolism and circulates in the blood. Urea is then excreted through the kidneys and urine. The BUN level determined by a blood test is directly related to the metabolic function of the liver and the excretion function of the kidney. Normal findings range from 10 to 20 for adults (in mg/dl). In the elderly, BUN levels may be slightly higher than the normal range.

Board Certification: A process by which a physician or other specialist is certified by a given specialty or Board. For example, certification is awarded by a 23-member board of the American Board of Medical Specialties upon the completion of accredited training and examinations. Experts who testify at trial are frequently Board certified in their specialties.

Bone Density: Generally refers to the thickness or strength of a particular bone. There are several methods of determining bone density which may not be apparent from a plain film Xray.

Bone Marrow: Semi-liquid tissue filling the space in cancelous bone. Bone marrow produces hemoglobin for the blood.

Bowel Incontinence: Generally referring to the inability to control one’s bowels or fecal elimination.

Bowel Management or Training: Refers generally to a nursing intervention to establish regular elimination of feces by reflex conditioning. Generally, a patient’s bowel habits are assessed and the necessity of developing a program to induce evacuation at the same time each day or every other day is implemented. Exercises to strengthen abdominal muscles can be employed. A patient is generally instructed to recognize and respond properly to signals indicating a full bowel.

Brain Death: An irreversible form of unconsciousness characterized by a complete loss of brain function, although the heart may continue to beat.

Bradycardia: A condition referring to an abnormally slow heart beat. Typically less than 60 beats per minute. For more information, click here.

Breast Cancer: Cancer of the breast usually affecting woman. About half of all breast cancer develops in women over 65 years old.

Bridging: A nursing technique of positioning a patient so that bony prominences are free of pressure on the mattress by using pads, bolsters or foam rubber.

Bromptoms Cocktail: An analgesic solution containing alcohol, morphine or heroin. The cocktail is administered in the control of pain for the terminally ill patient.

Bronchitis: An acute viral infection of the lower respiratory tract. It occurs primarily in infants.

Bundle Branch: A segment of the network of fibers transmitting electrical impulses within the ventricles of the heart.

Burden of Proof: Refers generally to the burden (or obligation) that one party has, usually the Plaintiff, to prove their case with evidence that outweighs the evidence presented by the opposing party. The burden of proof in a civil case is preponderance of evidence, which is also known as the greater weight of the evidence. If the Plaintiff has presented proof that is more persuasive than Defendant’s proof, even slightly more persuasive (mathematically 51 % vs 49%) he has met his burden. In a criminal trial the burden is typically beyond a reasonable degree, which is a much harder burden to meet. Legal definitions may vary between states.

Calcium (an alkaline metal element): Calcium is the fifth most abundant element in the human body and is mainly present in bone. The body requires calcium ions for the transmission of nerve impulses, muscle contractions, blood coagulation, and cardiac functions. Only about one-third of calcium ingested by humans is actually absorbed by the body, primarily in the small bowel.

Callous Ulcer: An ulcer with a hard indurated base and thick inelas margins. Such an ulcer generally lacks blood supply and is frequently associated with edema of the legs.

Calorie: The amount of heat required to raise the temperature of one gram of water one degree celsius at a pressure of one atmosphere.

Cancer: A neoplasm characterized by uncontrolled growth of anaplasti cells that tend to invade surrounding tissue and metastasize (spread) to other body sites. Cancer is generally distinguished by the nature site or clinical course of the lesion. Cancer is attributable to both genetic and environmental factors. More than 80% of cancer cases are attributable to cigarette smoking. An excessive rate of malignant tumors in organ transplantation recipients after amino suppressive therapy suggest that the immune system plays a vital role in controlling the proliferation of cancer cells. Cancer is second only to heart disease as the cause death in the United States, and is also a leading cause of death for children between 3 and 14 years old. In the United States common sites for the development of malignant cancer tumors include the skin, lung, prostate, breast and colon. Surgery remains the major form of treatment but radiation is widely used as a preoperative or primary therapy, along with chemotherapy.

Cancer Checkup: A cancer-related checkup is recommended every three years for people aged 20 to 40, and for every year for people aged 40 and older. Examination should include health counseling depending on the person’s age, examination of cancer of thyroid or cavity, skin lympnodes, intestines, and ovaries. The ACS recommend that both the prostate specific adogine test (PSA), and the digital rectal examination be offered annually to men beginning at age 50.

Burn: Any injury caused to the tissue of the body by objects or flames, electricity, chemicals or radiation. Treatment of burns include pain relief, careful asepsis, prevention of infection, regulation of body temperature, maintenance of the balance and body fluids and electrolytes, and good nutrition. Severe burns can cause shock which should be treated before the wound. Burns are sometimes classified as first, second, third and fourth degree burns.

Bursitis: Inflammation of the bursa, the connective tissue structure surrounding a joint. Bursitis can be precipitated by arthritis, infection, an injury or excessive exercise. With each symptom is severe pain of the affected joint particularly on movement.

Byte: The amount of memory required to include one character of information, i.e. letter, number of symbol in a computer system. See also Bit.

C-Diff: A contagious ailment that can cause frequent diarrhea. Cannabis: A psychoactive herb derived from the flowering tops of hemp plants. It has been used in the treatment of glaucoma as well as an anti-nausea medication in cancer patients on chemotherapy. Cannabis in high doses may impair the ability to perform motor tasks and will also hinder more complex action such as driving or flying. Cannabis may also enhance the non-dormant senses of touch, taste and smell. This drug also increases the heart rate and systolic blood pressure. Research indicates that cannabis may be therapeutic as anti-convalescence and in helping reduce intraocular pressure associated with glaucoma.

Capacity: Generally referring to the ability to hold, retain or absorb information. It can also refer to the volume or potential volume of a liquid, solid or gas.

Capillary: One of the many microscopic blood vessels in the human body joining arterials and venals. Blood and tissue fluids exchange various substances across capillary walls.

Capillary Refilling: The process whereby blood returns to a portion of the capillary system after its blood supply has been interrupted briefly. Capillary refilling can be a simple test used to determine blood flow to the skin. It is tested by pressing firmly on a fingernail and estimating the time required for blood to return after pressure is released. In a normal person with good cardiac output and digital profusion, capillary refilling should take less than three seconds. A time of five seconds or more is considered abnormal.

Capitation: A payment method for healthcare services. The Physician Hospital or other healthcare provider is paid a contracted rate for each member of a group. The agreed contractual rates are usually adjusted for age, gender, illness or regional differences.

Captain of the Ship Doctrine: An historical medical legal principle that the physician is ultimately responsible for all patient care activities under his supervision and may be sued for the negligence or malpractice of staff working under him.

Carbohydrate: Various groups of organic compounds specifically saccharine starch, cellulose and glycogen that constitute the main source of energy for body function, particularly brain function. Current dietary goals and recommendations for the United States suggest that carbohydrates provide 55%-60% of total calorie intake. Symptoms of carbohydrate deficiency can include, fatigue, depression, breakdown of essential body proteins and electrolyte imbalances.

Carbon: A non-metallic element that is essential to various chemical mechanisms of the body including metabolic processes. The element also acts a component of carbohydrates, amino acids, triglycerides and many other compounds.

Carcinoma: A malignant epithelial neoplasm that tends to invade surrounding tissue and metastasize in the other areas of the body, also known as cancer. For more information, click here.

Cardiac: Relating to the heart or heart ailments.

Cardiac Arrest: Sudden stoppage of the heart, also known as a heart attack or myocardial infarction. It is usually precipitated by ventricular fibrillation or ventricular asystole. When cardiac arrest occurs, delivery of oxygen and removal of carbon dioxide stop and tissue cell metabolism becomes anaerobic. Immediate initiation of cardio pulmonary resuscitation is required to prevent heart, lung, kidney and brain damage and death. For more information, click here.

Cardiac Arrhythmia: An abnormal cardiac rate or rhythm. The condition is caused by a failure of the sinus node to maintain its pacemaker function or by a defect in the electrical conduction system. Examples of arrhythmia include breadycardia, extra systole, heart block, and tachycardia.

Cardiac Catheterization: The diagnostic procedure in which a catheter is introduced through an incision into a large vein in the arm or leg and threaded through the circulatory system of the heart. Many conditions can be accurately identified with catheterization including congenital heart disease, stenosis and valvular incompetence. Among the risks of the procedure are infection, blood clots and cardiac arrhythmia.

Cardiac Decompensation: A condition of congestive heart failure in which the heart is unable to adequately maintain cellular profusion in all parts of the body without assistance. Causes may include heart attack, increased workload, infection, toxin, or defective heart valve.

Cardiac Murmur: An abnormal sound heard during auscultation of the heart caused by altered blood flow into a chamber or through a valve.

Cardio Pulmonary Resuscitation (CPR): A basic emergency procedure for life support consisting of artificial respiration and manual external cardiac massage. It is used in cases of heart attack to reestablish blood flow to the body. During heart compressions, blood flow is forced into systemic and pulmonary circulation and venus blood refills the heart when the compression is released.

Caregiver: One who contributes to the benefits of medical, social, economic or environmental resources to a dependent or partially dependent individual.

Care Plan: In the nursing home setting, care plans are used to plan for the care needs of the patient. The care plan follows a comprehensive nursing assessment that determines the patient’s medical limitations and condition, and the necessary assistance he or she may require to thrive in their long-term care environment. Care plans are also used in assisted living facilities and may be referred to as service plans.

Carnitine: A substance found in skeletal and cardiac muscles and certain other tissues that functions as a carrier of fatty acids across membranes of the mitochondria. This is used therapeutically in treating angina.

Carotid Bruit: A murmur heard over the carotid artery in the neck suggesting arterial narrowing, usually secondary to atherosclerosis. A stroke can result if the narrowing is severe and the condition is untreated.

Carpal Tunnel Syndrome: A commonly painful disorder of the wrist and hand caused by compression on the median nerve between the inelastic carpal ligament and other structures within the carpal tunnel. It is often seen in cumulative wrist trauma, but can also result from tumor or rheumatoid arthritis. The median nerve innervates the palm and the radial side of the hand. Treatment may involve surgery or the use of a lightweight risk splint.

Carteret: An abnormal progressive condition of the lens of the eye characterized by loss of transparency and vision. Most carterets are caused by degenerative changes and occur after fifty years of age.

Case Manager: A person who arranges necessary healthcare services for a patient or group of patients. The case manager could be any type of healthcare provider but is typically a nurse, doctor or other professional directly connected with the patient’s care.

Catastrophic Limit: In legal terms this may refer to the highest amount of money that a person would be required to pay out of his or her own pocket for a certain period of time based on their applicable health coverage.

Catheter: A hollow flexible tube that is inserted into a vessel or cavity of the body to withdraw or insert fluids, and sometimes used to visualize a vessel or cavity.

Causation: In law, this term describes the requirement to connect an act of negligence with an injury or adverse outcome suffered by the Plaintiff. In any malpractice lawsuit alleging injury, one must prove that it was the negligence of the healthcare provider that caused the injury at issue.

Cellulite: A diffuse acute infection of the skin and subcutaneous tissue usually involving redness, pain and swelling. It is occasionally associated with fever, malaise, chills or headaches.

Central Nervous System: One of two main divisions of the nervous system consisting of the brain and spinal cord. The system processes information to and from the peripheral nervous system and is the body’s main method of controlling various functions and sensations such as sleep, sexual activity, muscular movement, hunger, thirst, memory and emotions.

Cerebellum: Part of the brain located in the posterior cranial fossa behind the brain stem. Its primary function is to coordinate voluntary muscular activity.

Cerebral Aneurysm: Abnormal localized dilation of a cerebral artery. It is most commonly the result of congenital weakness of an artery wall but can also be caused by infection, trauma or neoplasms.

Cerebral Cortex: A layer of the neurons and synapses (grey matter) on the surface of the cerebral hemispheres. It integrates higher mental functions, general movement, perception, and behavioral reactions.

Cerebral Hemorrhage: A hemorrhage from a blood vessel in the brain. Cerebral hemorrhages are classified by location (subarachnoid, extradural, subdural), the kind of vessel involved (arterial, venous, capillary) and origin (traumatic, degenerative). Bleeding may lead to displacement or destruction of brain tissue.

Cerebrum: The largest and upper most section of the brain divided by a longitudinal fissure and to the left and right hemispheres. The cerebrum performs sensory functions, motor functions, and less easily defined integration functions associated with various mental activities.

Certified Nurse Aide: Typically, an employee of a long-term care facility who is not a licensed nurse, but who has received some limited training as it relates to providing nursing care.

Cervical: Referring to the neck.

Cervical Cancer: Third most common gynecologic malignancy after endometrial cancer and ovarian cancer. It can occur in woman of all agenes, but peak incidence occurs in patients in their 40s and 50s. Human papillomavirus (HPV) is thought to play a role in the development of this cancer.

Cervical Sprain/Strain: Refers generally to an injury to the neck, usually associated with trauma or flexion-extension injuries, as when the neck is thrown backwards in a rear end collision. Also know as whiplash or soft tissue injury.

Charge Nurse: A nurse assigned to manage the operation of a patient wing or hall for a particular shift. Responsibilities may include staffing, admissions, discharge, and coordination of care.

Cholesterol: A waxy lipid soluble compound found in animal tissues. It is an integral component of every cell in the body as it facilitates absorption and transport of fatty acids. Increased levels of low density lippo protein cholesterol may be associated with heart disease whereas high levels of high density lippo protein cholesterol appear to lower a person’s risk for heart disease.

Chronic: Relating to a long period of time. Chronic disease is one that persists over a long period of time as compared to the course of an acute disease which arises quickly. Symptoms of chronic diseases are sometimes less severe than those of acute diseases and may be progressive in nature. Examples of chronic disease include diabetes mellitus, emphysema and arthritis.

Circumstantial Evidence: In legal terms this is evidence not based on actual observation or knowledge.

Coccyx: The bone jointed to the sacrum by a disk of fibrocartilage at the base of the vertebral column. In humans coccyx becomes fused with the sacrum by the sixth decade of life. Because the coccyx area is subject to pressure, it is a frequent location for skin breakdown for patients who have reduced mobility.

Coffee-Ground Vomitus: Dark brown vomitus the color and consistency of coffee grounds, typically composed of gastric juices and old blood which can be indicative of an upper GI bleed.

Cognitive Function: An intellectual process by which one becomes aware of, perceives, or comprehends ideas. Upon admission to any long-term care facility cognitive function is generally assessed to determine a patient’s needs.

Cognitive Therapy: Any of the various methods of treating mental and emotional disorders that help a person change attitudes, perceptions and patterns of thinking from rationale to realistic thoughts about self and environment. Therapeutic approaches include behavior therapy, gestal therapy, and transactional analysis.

Colitis: An inflammation of the large intestine. It can be associated with diarrhea, bleeding, and ulceration of the mucosa of the intestine. Weight loss and pain can be significant.

Collagen: A fibrous insoluble protein consisting of bundles of tiny reticular fibers that come to form the white glistening inelastic of the tendons, the ligaments and the fascia. It is present in connective tissues including skin, bone, ligaments, and cartilage. Advanced age can bring about a loss of collagen to the skin which can increase one’s risk for skin breakdown.

Colorectal Cancer: A malignant neoplastic disease of the large intestine characterized by change in bowel habits and the passage of blood.

Colostomy: Surgical creation of an artificial anus on the abdomen wall by incising the colon and drawing it out to the surface. A temporary colostomy may be done to divert feces after surgery. Antibiotics, usually neomycin, is prescribed to reduce the bacterial count in the bowel and bowel cleansing methods are used. Failure to keep a colostomy bag and its components clean can lead to infection.

Communicable Disease: Any disease transmitted from one person or animal to another.

Community Health Nursing: A field of nursing that is a blend of primary healthcare and nursing practice with public health nursing. The community health nurse conducts a continuing and comprehensive practice that is preventive, curative and rehabilitative in focus.

Community Practice Standard: Although the legal definition may vary from state to state, this refers generally to the standard of conduct one would expect from a reasonably prudent health care provider under the same or similar standards. Where a health care provider fails to comply with a community practice standard, this constitutes a breach in the standard of care that may give rise to legal liability.

Compartment Syndrome: A common limb-threatening complication associated with trauma. The swelling of an injured muscle within a confining structure (cast or wound dressing) increases tissue pressure and blocks normal perfusion, resulting in tissue death. Extreme pain in the affected extremity can be a symptom of this condition. Treatment involves removal of the confining structure.

Complaint: In law a complaint refers to the legal document that begins a lawsuit. It generally contains a statement of the facts and legal allegations forming the claim against a Defendant. Different states have different rules as to how detailed the allegations in a complaint must be.

Comprehensive Assessment: Any individual admitted to a nursing home that received federal funding must have a comprehensive assessment performed within fourteen days of the resident’s admission. Comprehensive assessment should consider both the patient’s physical and mental condition and assess what services the patient will need at the facility. The comprehensive assessment will in turn be used to determine the patient’s overall Plan of Care that will be implemented by the nursing staff.

CT Scan: A radiographic technique that produces an image of a detailed cross section of tissue that may not be visible on plain film X-ray.

Concurrent Infection: A condition during which a person has two or more simultaneous infections.

Constipation: Difficulty in passing stool or incomplete or infrequent passage of stools. There are many causes of constipation both organic and functional. Typical causes include intestinal obstruction, diverticulitis, dehydration and tumors. Functional impairment of the colon may occur in elderly or bedridden patients who fail to respond to the urge to defecate.

Constitution: The general body health of an individual expressed by the person’s physical and mental abilities to function adequately in his environment.

Contributory Negligence: Negligence on behalf of the party bringing the lawsuit (Plaintiff) which contributes to the ultimate harm or injury. Contributory negligence rules vary from state to state, but in pure contributory negligence states any negligence on behalf of the Plaintiff that causally contributes to the harm, can create a total bar to recovery. In comparative negligence states the percentage of fault attributed to the Plaintiff may limit his recovery by the percentage of negligence assigned by the Jury. Virginia, Maryland and the District of Columbia apply contributory negligence principles.

Cost Containment: Generally referred to as the management and facilitation and cost-effective use of resources.

Counterclaim: In law this refers to a claim filed by the Defendant in response to the claim filed first by the Plaintiff.

Coumadin: A trademark for the anti-coagulant Warfarin Sodium. Coumadin may be given after a stroke to thin blood and allow adequate blood circulation. Adverse side effects can include hemorrhage or uncontrolled bleeding.

Creatine: An important nitrogenous compound produced by metabolic processes in the body. Combined with phosphorus it forms high energy phosphate. Creatine phosphate may increase in the blood levels when muscle damage has occurred.

Creatinine: A substance formed from the metabolism of creatine commonly found in blood, urine and muscle tissue. It is measured in blood and urine tests as an indicator or kidney function. Normal adult levels of creatine are .5 to 1.1 mg/dl for females and .6 to 1.2 fg/dl for males. These numbers decrease in the elderly population because of smaller muscle mass.

Cyanosis: A bluish discoloration of the skin and mucous membrane caused by lack of oxygen in the blood or structural defect in the hemoglobin molecule.

Cystitis: An inflammatory condition of the urinary bladder and urethra, characterized by pain, urgency, frequency of urination and hematuria (blood and urine).

Damages: In law this refers to money recovered in the courts for a civil injury or loss caused by either negligence or an intentional tort.

Damage Caps: In law this refers to caps or limits on recovery, typically seen in medical malpractice caps. Virginia, Maryland and West Virginia have caps on damages in malpractice cases. Virginia’s medical malpractice cap covers both economic and non-economic damages, and is significantly higher than Maryland’s cap, which covers only non-economic damages (like pain and suffering).

Darvocet: Trademark name for a drug containing an analgesic (amphetamine and opiate analgesic).

Data Analysis: The part of a study that includes classifying, coding and tabulating information needed to perform a qualitative or quantitative analysis.

Death With Dignity: The philosophy that a terminally ill patient should be allowed to die naturally and comfortably rather than experience a comatose vegetative life controlled by mechanical support systems.

Debride: The removal of dirt, foreign objects, damaged tissue or cellular debris from a wound or injury to prevent infection and promote healing. Large pressure sores are frequently debrided to facilitate healing and reduce the risk of infection. Debridement may be done surgically, mechanically, or chemically.

Decalcification: The loss of calcium salts from the teeth and bones caused by various conditions including malnutrition, mal-absorption or other factors including immobility. Mal-absorption can be caused by a lack of Vitamin D necessary for the absorption of calcium from the intestine. Individuals who have bones that are decalcified may be at higher risk for fracture injuries.

Decedent: A deceased person.

Declarative Memory: The mental registration, retention and recall of passed experiences, sensations, ideas, knowledge and thoughts.

Decompensation: The failure of a system as in cardiac decompensation and heart failure.

Deductible: The monetary amount that person covered under a health insurance plan or insurance policy must pay personally, in addition to whatever the insurance company may pay.

Deep Vein Thrombosis: Presence of a blood clot in a deep vein. Prolonged sitting and immobility can cause such a clot, which can be life threatening. Deep vein clots usually occur in the legs, regardless of the cause. The hallmark symptom is rapid leg swelling. Physical exam may reveal pitting edema and mild increase in skin temperature.

Dehydration: A medical condition resulting where a person has either lost or not retained sufficient fluids to maintain body function. Significant dehydration can be a sign of potential neglect in the long-term care setting. Dehydration is accompanied by the disturbance in the balance of essential electrolytes, particularly sodium, potassium and chloride. It may also follow prolonged fever, diarrhea, vomiting, acidosis or any condition where there is rapid depletion of body fluids. Signs of dehydration may include poor skin turgor, flush or dry skin, coated tongue, dry mucus membranes, irritability and confusion. For more information, click here.

Decubitus Ulcer: Generally referring to skin breakdown typically caused by pressure. This term is synonymous with pressure ulcer or bedsore.

Defendant: In a civil lawsuit, the party defending the lawsuit against whom Plaintiff seeks to recover damages.

Deficiency: Nursing homes that receive federal monies are generally inspected by federal agencies. These agencies, usually operating through local state government’s Department of Health, will issue deficiencies where the facility has failed to meet proper regulatory standards of care. The regulations governing deficiencies can be found at 42 C.F.R. 483.10 et seq. For more information, click here.

Dementia: A general term referring to the deterioration or decline of mental faculties, sometimes accompanied with aggressive or inappropriate behavior. There are many different types of dementia. One common form of dementia is Alzheimer’s disease. Dementia resulting from a stroke or acute brain damage is referred to as multi-infarct dementia. For more information, click here.

Deep Vein Thrombosis: A disorder involving a thrombosis or blood clot in one of the deep veins of the body most commonly the iliac or femoral vein. It can be potentially life-threatening.

Default Judgment: In law this refers to a judgment entered against the Defendant as a result of a Defendant’s failure to either appear in court or answer a Plaintiff’s claim within the proper time period.

Deficit: Any deficiency or difference from what is normal such as an oxygen deficit or memory deficit.

Deformity: Distortion, disfigurement, flaw or misshape that affects the body in general or in a specific way. It can be the result of disease, injury or birth defect.

Degenerative Disease: Any disease in which the deterioration of structures or functions of tissue occurs. Kinds of typical types of degenerative diseases can include arthrosclerosis and osteoarthritis.

Deinstitutionalization: A philosophy relating to the change in location of treatment from an institution to a community setting.

Delirium: Referring to a state of frenzied excitement or wild enthusiasm. It can also refer to an acute organic mental disorder characterized by confusion, disorientation or incoherence.

Delirium Tremens (DT): An acute and sometimes fatal reaction caused by the stopping of excessive alcohol intake, which has occurred over a long period of time. Initial symptoms can include loss of appetite, insomnia and general restlessness which can be followed by agitation, disorientation and confusion. Sometimes vivid hallucinations and acute fear or anxiety can result.

Dependency: The physical and emotional requirements of an infant or other individual who may depend on others for love, support and protection. Many nursing home patients who have significant physical or mental ailments may be completely dependent on their caregivers to meet their daily needs.

Deposition: In the law this refers to a process by which an individual’s testimony is given orally and transcribed by a court reporter. A deposition can be used in trial and for impeachment and under some circumstances can be used as trial testimony.

Depression: An abnormal emotional state characterized by exaggerated feelings of sadness, melancholy, worthlessness and/or hopelessness. This is one of the most common psychiatric disorders in the elderly population. Depression can be caused by genetic, environmental or other factors including disease. The prevalence of clinically significant symptoms of depression ranges from 8% o 15% for elders in community settings and about 30% for the institutionalized elderly. Not surprisingly, the elderly in nursing homes are vulnerable to depression especially during the initial admission when they are undergoing a significant change from their prior environment. A nursing home should do a complete assessment of the resident’s mental status which should include consideration of potential depression and related issues.

Dermis: The layer of the skin just below the epidermis consisting of papillary and reticular layers and further containing blood and lymphatic vessels, nerves and nerve endings.

Diabetes: A clinical condition characterized by the imbalance of blood sugars. Diabetes can be caused by a deficiency of anti-diuretic hormone (ADH) as in diabetes insipidus or it may be the polyuria resulting from the hypoglycemia that occurs in diabetes mellitus. Diabetes mellitus is primarily a result of a deficiency or lack of insulin secretion by the pancreas and/or resistance to insulin. The disease is often familial but can be acquired, as in Cushings syndrome. Early identification and treatment of diabetes is essential to the health of our elderly population. The goal of treatment is to maintain insulin glucose homeostasis. Type 1 diabetes generally refers to the need to treat the condition with insulin in combination with diet and exercise. For more information, click here.

Diabetic Acidosis: A type of acidosis that may occur in diabetes mellitus as a result of excessive production of ketone bodies during oxidation of fatty acids.

Diabetic Neuropathy: A non-inflammatory disease process associated with diabetes mellitus and characterized by sensory and motor disturbances in the peripheral nervous system.

Diagnostic and Statistical Manual of Mental Disorders: A commonly used and widely accepted reference book used to diagnose various mental disorders.

Dialysis: A medical procedure for the removal of certain elements from the blood or lymph by virtue of their differences in rates of diffusion through a permeable membrane. Dialysis is typically used to remove poisons, drugs or to correct electrolyte or acid-based imbalances and remove urrhyea, uric acid and creatinine in cases of chronic or stage renal disease.

Dialysis Dementia: A neurologic disorder that occurs in some patients undergoing dialysis. The precise cause is unknown.

Diarrhea: The frequent passage of loose, watery stools. The stool may also contain mucus, pus, blood or excessive amounts of fat. Diarrhea is usually a symptom of an underlying disorder or disease process. Untreated, severe dehydration may lead to rapid dehydration and electrolyte imbalance.

Diastole: The period between contractions of the atria or the ventricles during which blood enters the relaxed chamber from the circulatory system and lungs.

Diastolic Blood Pressure: Measures the blood pressure at the instant of maximum cardiac relaxation.

Diastolic Murmur: A noise caused by turbulence of blood flow during a ventricular relaxation. With few exceptions, diastolic murmurs are caused by organic heart disease.

Diazepam: A benzodiazepine sedative and minor tranquilizer usually given for the treatment of anxiety, nervous tension or muscle spasms. Adverse reactions can be withdrawal symptoms, respiratory depression, drowsiness and fatigue.

Dietary Fiber: A generic term for non-digestible carbohydrate substances found in plant cell walls and surrounding cellular material. Dietary fiber can have a beneficial effect on GI function and colon transit time. The main dietary fiber components are cellulose lignin petin and plant gums. Foods high in dietary fibers include fruits, green leafy vegetables, spinach, celery, cabbage, legumes, whole grain cereals, and breads.

Differential Diagnosis: The distinguishing between two or more possible diseases with similar symptoms by systematically comparing their different characteristics. Before a doctor reaches a final diagnosis he may undertake a differential diagnosis and list the various potential diagnoses that he will rule out.

Diffuse: In medical terms this may refer to a condition which is widely spread throughout a membrane or fluid.

Digestion: The conversion of food into absorbable substances in the GI tract. Digestion is accomplished through the mechanical and chemical breakdown into smaller components with the help of glands located both inside and outside of the gut. The elderly can suffer from various conditions which can hinder or prevent appropriate digestion.

Diphenoxylate Hydrochloride: An anti-diarrhea medication that contains atrophine sulfate which is generally prescribed in the treatment of non-infectious diarrhea and intestinal cramping. Adverse side effects can include abdominal discomfort, nausea, skin rash, urinary retention or intestinal obstruction.

Diplomat: Generally referring to an individual who has earned a diploma or certificate. Professionally a physician who has been Board certified in his specialty.

Direct Costs: In managed care this refers to the cost of labor, supplies and equipment to provide direct patient care services.

Discharge Planning: Refers generally to the procedure used by a healthcare provider in determining when it would be appropriate to discharge or release a patient from ongoing care. A social worker or case manager will typically get involved in discharge planning. The discharge planning process should involve an assessment as to the patient’s needs and what facility or environment would be best suited to meet those patient needs.

Discovery: In the legal setting this refers to pretrial procedures that allow one party to obtain vital documents, testimony or other evidence that may be held by the adverse party. American courts favor an open discovery which reduces the chance of surprise at trial and also allows the parties to evaluate their respective cases prior to trial.

Disectomy: Generally referring to the incision of an interverdebral disk.

Diuresis: Increased formation and secretion of urine. It occurs in conditions such as diabetes mellitus, diabetes insipidus, and acute renal failure. Water is considered to be the least expensive diuretic, as consuming large amounts of water will increase urine output.

Diverticulitis: Inflammation of one or more of the diverticula. Diverticula are sac-line mucosal projections through the muscular layer of the GI tract which can cause symptoms by slowing or stopping the flow of feces, or by becoming infected, rupturing or bleeding. Penetration of fecal matter to the thin walled diverticula can cause inflammation and abscess formation in the surrounding tissue, with repeated inflammation, the lumen of the colon narrows and becomes obstructed. Aging typically leads to bowel problems and enemas are sometimes used to rule out carcinoma of the colon. Conservative treatment may include bed rest, IV fluids, antibiotics and abstaining from eating and drinking for a limited period of time.

Documentation: In the medical field this refers to the general recording of pertinent patient data in the clinical record. Standards of care generally require the documentation of patient’s assessment, care plan and treatments.

Dorsal: Relating to the back or posterior of a body or organ.

Dorsalis Pedis Pulse: The pulse of the dorsalis pedis artery palpable on the top of the foot. The lack of a pulse in the foot can be an indication of reduced blood flow which can increase a patient’s risk for skin breakdown in his legs or feet.

Drainage: The removal of fluids from a body cavity, wound or other source of discharge by one or more methods.

Drug Addiction: A condition characterized by an overwhelming desire to continue taking a drug to which one has become habitually used to consuming because it produces a particular effect, usually an alteration in mental status. Common addictive drugs are barbiturates, alcohol, morphine and other opioids, especially heroine an oxycontin drug interaction. The modification of the effect of a drug when administered with another drug the effect may be an increase or decrease in the action of either substance or there may be an adverse effect not normally associated with either drug.

Drug Holiday: A period of withdrawal to reverse ineffectiveness of a drug resulting from receptor desensitization or adverse effects that result from chronic treatment. A drug holiday may be a good idea for an elderly person who has been on psychotropic or anti-psychotic medications for long periods of time.

Dry Skin: Epidermis that lacks moisture or sebum often characterized by a pattern of fine lines, scaling and itching.

Duodenum: The shortest and widest portion of the small intestine.

Durable Power of Attorney: A document that designates an agent or proxy to make healthcare decisions for a patient who is no longer able to make them. This document typically directs the person to function as the attorney-in-fact and make decisions regarding all treatment including the final decision about the cessation of life support treatment. A durable power of attorney is a written document that must be executed before a patient loses the mental capacity to understand what he/or she is signing.

Duress: In law this refers to an action compelling another person to do what he or she would not have ordinarily or voluntarily done.

Duty: In law this refers to an obligation to conform to a particular standard or requirement, the failure of which may give rise to liability. In malpractice cases both community practice standards or regulatory standards may give rise to legal duties, the breach of which may give rise to legal liability.

Dysentery: An inflammation of the intestines especially of the colon that may be caused by chemical irritants, bacteria, protozoa or parasites. It can be characterized by frequent and bloody stool, and/or abdominal pain.

Dyskinesia: An impairment of the ability to execute voluntary movements. Tardive dyskinesia is caused by the adverse effect of prolonged use of psychotropic medications in elderly patients or those with brain injuries.

Dysphasia: Difficulty in swallowing commonly associated with obstructive or motor disorders of the esophagus. Additionally, patients with strokes may have difficulty swallowing because of their inability to control muscles of the esophagus. Diagnosis of the underlying condition can be made by barium studies or clinical observation.

Dysplasia: Any abnormal development of tissue or organs that causes an alteration in cell growth.

Dyspenea: A distressful sensation of uncomfortable breathing that may be caused by certain heart conditions, strenuous exercise or anxiety. Also called breathlessness.

Dystonia: Any impairment of muscle tone.

Ecchymosis: Bluish discoloration of an area of the skin or membrane caused by an extravasation of the blood into the subcutaneous tissue as a result of trauma to the underlying blood tissue or fragility of the vessel walls. Also known as a bruise, contusion.

ECG: Abbreviation for electrocardiogram.

Echo Cardiogram: A graphic outline of the movements of the heart structures produced by ultrasonography.

Echo Encephalograph: The use of ultrasound to study the intracranial structures of the brain. It is useful for showing ventricular dilation or major shifts of midline structures caused by an expanding lesion.

Echogram: A recording of ultrasound echo patterns of a body structure.

Ecology: The study of interaction between organisms and their environment.

Ectomorph: A person whose physique is characterized by slenderness, fragility and a predominance of structures derived from the ectoderm.

Ectopic: Situated in an unusual place away from its normal position. For example, an ectopic pregnancy occurs outside the uterus.

Edema: An abnormal accumulation of fluid in the interstitial spaces of tissue such as in the pericardial sack or joint capsules. Edema can be caused by increased capillary fluid pressure, venous obstruction, pressure from casts, tight bandages, congestive heart failure, renal failure, hepatic cirrhosis, inflammatory reactions and other conditions. Edema can also result from loss of serum protein in burns or other significant wounds. Treatment of edema focuses on correcting the underlying cause. Potassium diuretics may be administered to promote excretion of sodium and water.

Efferent Nerve: A nerve that transmits impulses away or outward from a nerve center such as the brain or spinal cord, usually causing a muscle contraction or a release of glandular secretions.

Efficacy: The ability of a drug or treatment to effectively produce a specific, intended result.

Ejection Fraction (EF): The fraction of the total ventricular filling volume that is ejected during each ventricular convulsion. The normal EF of the left ventricle is 65. This is one measure used to assess heart function in the elderly population.

Elder Abuse: In the legal sense this refers to a reportable offense of physical, psychological or financial abuse of an elder. Many times an abused person may deny that abusive acts occur and feels helpless to respond to the abuse. See definition of abuse above.

Electroencephalogram (EEG): A graphic chart which is used to trace the electrical potential produced by brain cells as detected by electrodes.

Electrolyte: An element or compound that when dissolved in water or another solvent disassociates into ions and is able to conduct an electric current. Electrolytes are present in blood plasma and interstitial fluid. Proper balance of electrolytes is important to normal metabolic function. Diarrhea can cause a loss of many electrolytes leading to hypovolemia and shock.

Electromyogram (EMG): A test of the intrinsic electric activity in a skeletal muscle, which can aid in the diagnosis of neuromuscular problems. Readings are obtained by surface electrodes that measure electrical activity of the muscle.

Elopement: Describes the process in which a resident of a nursing home or other long-term care facility is able to successfully leave the premises without knowledge of the staff. Long term care facilities are required to evaluate residents for their potential risk of elopements and come up with a care plan to prevent such a problem. Many facilities use wander bracelets or other alarms to notify them when a resident has left a secure area. Every year elopements result in serious injuries, especially in situations where the elderly elope into a dangerous environment.

Emaciated: Characterized by extreme loss of subcutaneous fat that results in an abnormally lean body, i.e. as a condition associated with starvation.

Emancipated Minor: A person who may not be a legal adult under state law but because he or she is married, in the military or no longer dependent on parents, may not require parental permission for medical or surgical care.

Embolectomy: A surgical incision into an artery for the removal of an embolus or blood clot. Can be performed as an emergency treatment for an arterial embolism.

Embolus: A foreign object, quantity of air or gas, bit of tissue or piece of thrombus that circulates in the blood stream until it becomes lodged in a vessel.

Emergency Medical Technician (EMT): A person trained in and responsible for the administration of specialized emergency care usually associated with the transportation of victims of an acute illness or injury to a hospital.

Emergency Medicine: A branch of medicine concerned with the diagnosis and treatment of conditions generally associated with trauma or sudden illness, and presenting to an emergency room of a hospital or an acute care facility.

Emergency Nursing: Nursing care provided to prevent imminent severe damage or death or to avert serious injury. Activities typically involve basic nursing life support, cardiopulmonary resuscitation and control of hemorrhage.

Emesis: Vomit

Emetic: Pertaining to a substance that causes vomiting. An anti-emedic prevents nausea. Emetrol is a standard trademark drug used as an anti-nausea medication.

Emotional Abuse: The debasement of a person’s feelings or emotional state that causes himself to perceive that he is worthless or useless.

Emotional Deprivation: A lack of adequate warmth, affection and interest especially of a parent or significant nurturer. It is a relatively common problem among institutionalized persons or children from broken homes.

Emphysema: An abnormal condition of the pulmonary system characterized by over inflation and destructive changes in alveolar walls of the lungs. It results in a loss of lung elasticity and decreased gas exchange. Acute emphysema may be caused by a rupture of the alveoli during severe respiratory efforts. Emphysema may also occur after asthma or tuberculosis, conditions in which the lungs are overstretched until the elastic fibers of the alveolar walls are destroyed. In old age the alveolar membranes atrophy and may collapse producing large, air filled spaces and a decrease total surface area of the pulmonary membranes effectively reducing lung capacity.

Emphymea: An accumulation of pus in a body cavity especially in the pleural space, as a result of bacterial infection.

Encephalitis: Inflammation of the brain that can result from a variety of causes, including exposure to poison or other infections. Severe inflammation with destruction of nerve tissue can result in a seizure disorder or other permanent neurologic problems, or even death.

Encephalopathy: An abnormal condition of the structure or function of brain tissues especially chronic, destructive or degenerative conditions.

Endo: Prefix meaning inward or within.

Endocarditis: Inflammation of the endocardium and heart valve. This condition is characterized by lesions caused by a variety of diseases. All types of endocarditis can be lethal if not treated by various anti-bacterial or surgical means.

Endotrachaeal Tube: A large catheter tube inserted through the mouth or nose and into the trachea to the point above the bifurcation of the trachea. It is used for delivering oxygen under pressure when ventilation must be totally controlled.

End Stage Disease: A stage of the disease that is essentially terminal because of irreversible damage.

Enteral Tube Feeding: The introduction of nutrients directly into the GI tract by a feeding tube. Routes include both non-surgical and surgical placement.

Enteric Infection: A disease of the intestine caused by an infection among commonly involved enteric infections are Escherichia coli, vibrio cholera and several species of salmonella. These infections are typically characterized by diarrhea, nausea, abdominal pain and vomiting.

Enteritis: Inflammation of the mucosal lining of the small intestine, resulting from a variety of causes, such as bacterial, viral, functional or inflammatory.

Environmental Carcinogen: Any substance that can cause cancer or other disease processes. Such agents can be divided into chemical agents, physical agents, hormones, viruses and other pathogens. Some environmental carcinogens include arsenic, asbestos, uranium, vinyl chloride, radiation, xrays, and coal tar derivatives. Carcinogenic effects of chemicals can be delayed as long as thirty years.

Epidemiology: The study of the cause of diseases in the general population.

Epidermis: The superficial layers of the skin made up of the outer dead, conified part and a deeper living cellular part. The deepest layer of the skin is called the stratum basalae, which anchors the more superficial layers to the underlying tissue and provides new cells to replace those lost by abrasion from the outer layers.

Epilepsy: A group of neurologic disorders characterized by recurrent seizures, sensory disturbances, abnormal behavior and loss of consciousness. Common to all types of epilepsies are the uncontrolled electrical discharge from nerve cells of the cerebral cortex.

Epithelial Cancer: A carcinoma that develops from the epithelium or related tissue in the skin.

Equilibrium: The state of balance or rest from the equal action of opposing forces i.e., calcium and phosphorous in the body.

ERISA: An abbreviation for the Employment Retirement Income Security Act. For more information, click here.

Erythremia: An abnormal increase in the number of red blood cells.

Erythrocyte: Mature red blood cells that contain hemoglobin. This is one of the major cellular elements of the circulating blood and transports oxygen as its principal function. Blood loss, anemia, or chronic oxygen deprivation may cause erythrocyte production to increase. Erythrocytes originate in bone marrow of the long bones.

Esophageal Cancer: A rare malignant disease of the esophagus that peaks at about sixty years of age. It occurs three times more frequently in men than in women. Risk factors for the disease include heavy consumption of alcohol and tobacco.

Esophagus: The muscle membrane extending from the pharynx to the stomach.

Essential fatty acids (EFA): Poly unsaturated acid such as linoleic, alpha-linoleic, and anchidonic acids, essential in the diet for proper growth, maintenance and functioning of the body. EFAs play an important role in metabolism and the breaking up of cholesterol deposits on arterial walls. Best sources are natural vegetable oils such as soy and corn, wheat germ, edible seeds, fish oils and cod liver oil.

Etiology: The study of all factors involved in the causation of a disease including the susceptibility of the patient, the nature of the disease agent and the way in which the patient’s body is invaded by the agent.

Evoked Potential (EP): An electrical response in the brain stem or cerebral cortex that is elicited by a specific stimulus. Evoked Potential studies are used for patients with suspected sensory deficits who are unable to provide an accurate history of their symptoms. They are also used to evaluate areas of the cortex that receive incoming stimulus from the eyes, ears and extremities.

Excretion: The process of eliminating, shedding or getting rid of substances by body organs or tissues as part of a natural metabolic activity.

Expert Witness: A person who has specialized skill or knowledge about a subject which forms the basis for court testimony. Specialized knowledge can be acquired by education, experience, or observation. The admissibility of expert testimony varies from state to state.

Extended Care Facility: An institution devoted to providing medical, nursing or custodial care for an individual who over a prolonged period of time, usually in the course of a chronic disease or after rehabilitation for an acute injury or illness. Extended care facilities include intermediate care facilities and skilled nursing facilities (SNFs).

Extra Pyramidal Side Effects: Side effects that make voluntary movements or changes in muscle tone seen in tardive dyskinesia and Parkinson’s disease. These side effects can result from the use of drugs that block dopamine receptor sites. Psychotropic and antipsychotic drugs can cause such side effects when used for extended periods of time. For more information, click here.

Exudate: Fluid cells or other substances that have been expelled or discharged from cells or blood vessels through small pores or breaks in cell membranes. Perspiration, pus and serum are sometimes referred to as exudates in medical records.

Faculty: Physiologic function or natural ability of a living or organism, such as the digestive faculty or the ability to perceive and distinguish sensory stimuli.

Failure to Thrive (FTT): The abnormal retardation of growth and development of an infant resulting from conditions that interfere with normal metabolism, appetite, and activity. Causative factors include chromosomal abnormalities, as in Turner’s syndrome and the various trisomies; major organ system defects that lead to deficiency or malfunction; systemic disease or acute illness; physical deprivation, primarily malnutrition; and various psychosocial factors, as in severe cases of maternal deprivation syndrome. This term can also be used to describe a significant decline of an elderly person.

Fall Prevention: A nursing intervention from the Nursing Interventions Classification (NIC) defined as the institution special precautions with patient at risk for injury from falling. Aggressive fall prevention should part of any plan of care for an elderly person in a long term care setting, who is at risk for falling. The standard of care for long term care facilities requires that all patients get evaluated for fall risks and that evaluation forms the basis for a fall prevention plan.

False Positive: A test result that wrongly indicates the presence of a disease or other condition the test is designed to reveal.

Family Medicine: The branch of medicine that is concerned with the diagnosis and treatment of health problems in people of either sex and any age. Practitioners of family medicine are often called family practice physicians, family physicians, or, formerly, general practitioners. They often act as the primary health care providers, referring complex disorder to a specialist.

Fascia: The fibrous connective membrane of the body that may be separated from other specifically organized structures, such as the tendons, the aponeuroses, and the ligaments, and that covers, supports, and separates muscles.

Fatigue: A state of exhaustion or a loss of strength or endurance, such as may follow strenuous physical activity.

Febrile: Combining form meaning fever.

Fecal Impaction: An accumulation of hardened or inspissated feces in the rectum or sigmoid colon that the individual is unable to move. Diarrhea may be a sign of fecal impaction, since only liquid material is able to pass the obstruction. Occasionally fecal impaction may cause urinary incontinence through pressure on the bladder. Treatment includes oil and cleansing enemas and manual breaking up and removal of the stool by a gloved finger. Persons who are dehydrated, nutritionally depleted, on long periods of bed rest, receiving constipating medications (such as iron or opiates), or undergoing barium radiographic studies are at risk of developing fecal impaction. Prevention includes adequate ingestion of bulk food, fluids, exercise, regular bowel habits, privacy for defecation, and occasional stool softeners or laxatives.

Feces: Waste or excrement from the digestive tract that is formed in the intestine and expelled through the rectum.

Federal Tort Claims Act: A statute passed in 1946 that allows the U.S. federal government to be sued for the wrongful action or negligence of its employees. The act, for most purposes, eliminates the doctrine of governmental immunity, which formerly prohibited the bringing of a suit against the federal government.

Femoral Vein: A large vein in the thigh originating in the popliteal vein and accompanying the femoral artery in the proximal two thirds of the thigh.

Femur: The thigh bone, which extends from the pelvis to the knee. It is largely cylindric and is the longest and strongest bone in the body.

Fetal Distress: A compromised condition of the fetus, usually discovered during labor, characterized by a markedly abnormal rate or rhythm of myocardial contraction. Some patterns, such as late decelerations of the fetal heart rate seen on records of electronic fetal monitoring are indicative of fetal distress.

Fever: An elevation of body temperature above normal circadian range as a result of an increase in the body’s core temperature. Fever is a temperature above 37.2o C (98.9o F) in the morning or above 37.7o C (99.9o F) in the evening.

Fibromyalgia: A form of non-articular rheumatism characterized by musculoskeletal pain, spasms, stiffness, fatigue and severe sleep disturbance. Common sites of pain or stiffness include the lower back, neck, shoulder region, arms, hands, knees, hips, thighs, legs, and feet. These sites are known as trigger points. Physical therapy, nonsteroidal anti-inflammatory drugs, and muscle relaxants provide temporary relief. Also called fibrositis. For more information, click here.

Fibula: One of the two bones of the lower leg, lateral to and smaller in diameter than the tibia. Also called the calf bone.

Flatulence: The presence of an excessive amount of air or gas in the stomach.

Flexion: A movement allowed by certain joints of the skeleton that decreases the angle between two adjoining bones, such as bending the elbow, which decreases the angel between the humerus and the ulna. Compare extension.

Float Nurse: A nurse who is available for assignment to duty on an ad hoc basis, usually to assist in times of unusually heavy workloads or to assume the duties of absent nursing personnel. A float nurse is recruited from a group of nurses called a float pool. Also called contingent nurse.

Fluid Volume Deficiency: A fluid volume deficit is the state in which an individual experiences decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium.

Folic Acid: A yellow crystalline water-soluble vitamin essential for cell growth and reproduction. Deficiency results in poor growth, graying of hair, glossitis, stomatitis, GI lesions, and diarrhea, and it may lead to megaloblastic anemia.

Food and Drug Administration (FDA): A U.S. federal agency responsible for the enforcement of federal regulations on the manufacture and distribution of food, drugs, and cosmetics intended to prevent the sale of impure or dangerous substances.

Food Contaminants: Substances that make food unfit for human consumption. Examples include bacteria, toxic chemicals, carcinogens, teratogens, and radioactive materials.

Food Poisoning: Any of a large group of toxic processes that result from the ingestion of a food contaminated by toxic substances or by bacteria that contain toxins. Kinds of food poisoning include salmonella food poisoning, ciguatera poisoning, Minamata disease, mushroom poisoning, and shellfish poisoning.

Formulary: A listing of drugs intended to include a large enough range of medications and sufficient information about them to enable health practitioners to prescribe treatment that is medically appropriate. Hospitals maintain formularies that list all drugs commonly stocked in their pharmacy. Third-party organizations such as insurance companies usually maintain formularies that list drugs for which the company will cover under plan benefits.

Fracture: A broken bone, usually associated with a traumatic event. A fracture is classified by the bone involved, the part of that bone, and the nature of the break.

Fraud: The act of intentionally misleading or deceiving another person by any means so as to cause him or her legal injury, usually the loss of something valuable or the surrender of a legal right.

Free Radical: An organic compound with at least one unpaired electron.

Free-radical Theory of Aging: A concept of aging based on the premise that the main causative factor is an imbalance between the production and elimination of free chemical radicals in the body tissues.

Frontal Lobe: The largest of five lobes constituting each of two cerebral hemispheres. It is responsible for voluntary control over most skeletal muscles. The frontal lobe significantly influences personality and is associated with the higher mental activities, such as planning, judgment, and conceptualization.

Fusion: The joining into a single entity, as in optic fusion. The act of uniting two or more bones of a joint.

Gait Assessment Rating Scale (GARS): An inventory of 16 abnormal aspects of gait observed by an examiner as a patient walks at a self-selected pace.

Gait Disorder: An abnormality in the manner of style or walking.

Gallbladder (GB): It stores and concentrates bile, which it receives from the liver via the hepatic duct. In an adult it holds about 32 mL of bile. During digestion of fats the gallbladder contracts, ejecting bile through the common bile duct into the duodenum.

Gamma Radiation: Course of nuclear transition. Gamma radiation can injure and destroy body cells and tissue, especially cell nuclei. However, controlled application of gamma radiation is important in the diagnosis and treatment of various conditions, including skin cancer and malignancies deep within the body.

Ganglion: A knot or knot-like mass of nervous tissue.

Gangrene: Necrosis or death of tissue, usually the result of ischemia (loss of blood supply), bacterial invasion, and subsequent putrification. Dry gangrene is a late complication of diabetes mellitus that is already complicated by arteriosclerosis, in which the affected extremity become cold, dry, and shriveled and eventually turns black. Most gangrene may follow a crushing injury or an obstruction of blood flow by an embolism, tight bandages, or a tourniquet. This form of gangrene has an offensive odor, spreads rapidly, and may result in death in a few days. In all types of gangrene surgical debridement is necessary to remove the necrotic tissue before healing can progress. Cleanliness and maintenance of good circulation are nursing considerations essential in preventing this condition.

Gastric: Pertaining to the stomach.

Gastroenteritis: Inflammation of the stomach and intestines accompanying numerous GI disorders. Symptoms include fever, anorexia, nausea, vomiting, fever, abdominal discomfort, and diarrhea. For more information, click here.

Generalized Anxiety Disorder (GAD): An anxiety reaction characterized by persistent apprehension. The symptoms range from mild, chronic tenseness, with feelings of timidity, fatigue, apprehension, and indecisiveness, to more intense states of restlessness and irritability that may lead to aggressive acts.

Gene Therapy: A procedure that involves injection of “healthy genes” into the bloodstream of a patient to cure or treat a hereditary disease or similar illness.

Geriatrician: A physician who has specialized postgraduate education and experience in the medical care of older persons.

Geriatric Nurse Practitioner: A registered nurse with additional education obtained through a master’s degree program in nursing or a non-degree-granting certificate program that prepares the nurse to deliver primary health care to elder adults.

Geriatrics: The area of medicine dealing with the physiologic characteristics of aging and diagnosis and treatment of diseases affecting the elderly.

Gerontology: The study of all aspects of the aging process, including the clinical, psychological, economic, and sociologic issues encountered by older persons and their consequences for both the individual and society.

Giant Cell Carcinoma: A malignant epithelial neoplasm characteristically containing many large anaplastic cells.

Glasgow Coma Scale: A quick, practical standardized system for assessing the degree of conscious impairment in the critically ill and for predicting the duration and ultimate outcome of coma, primarily in patients with head injuries. The system involves three determinants, eye opening, verbal response, and motor response, all of which are evaluated independently according to a ranking order that reflects the level of consciousness and degree of dysfunction.

Glucagon: A polypeptide hormone, produced by alpha cells in the Islets of Langerhans, that stimulates the conversion of glycogen to glucose in the liver.

Gluco or Glyco: Combining form meaning ‘sweetness or glucose’.

Glucose: A simple sugar found in certain foods, especially fruits, and a major source of energy present in the blood and animal body fluids. Excess glucose in circulation is normally polymerized within the liver and muscles as glycogen, which is hydrolyzed to glucose and liberated as needed.

Gluteal Fold: A fold of the buttock at the the horizontal lower margin of the buttock at its junction with the thigh.

Gout: A disease associated with an inborn error of uric acid metabolism that increases production or interferes with excretion of uric acid. Excess uric acid is converted to sodium urate crystals that precipitate from the blood and become deposited in joints and other tissues. Men are more often affected than women. The great toe is a common site for the accumulation of urate crystals. The condition can cause exceedingly painful swelling of a joint, accompanied by chills and fever.

Gram-Negative: Having the pink color of the counter stain used in Gram’s method of staining microorganisms. This property is a primary method of characterizing organisms in microbiology. Brucella abortus, Escherichia coli, Haemophilus influenza, Klebsiella pneumonia, Proteus vulgaris, Salmonella typhi are typically referred to as gram negative organisms.

Gram-Positive: Retaining the violet color of the stain used in Gram’s method of staining microorganisms. This property is a primary method of characterizing organisms in microbiology. Some of the most common kinds of gram-positive pathogenic bacteria are Bacillus anthracis, Clostridium, Staphylococcus, Streptococci.

Habeus Corpus: A right retained by all psychiatric patients that provides for the release of individuals who claim they are being deprived of their liberty and detained illegally.

Haemophilus: A genus gram-negative pathogenic bacteria, frequently found in the respiratory tract of humans.

Halfway House: A specialized treatment facility, usually for psychiatric patients who no longer require complete hospitalization, but who need some care and time to adjust to living independently. Halfway houses are also used for substance abuse recovery.

Haloperidol: Tranquilizer. It is prescribed in the treatment of psychotic disorders.

Health Care Financing Administration (HCFA): The branch of the U.S. Department of Health and Human Services responsible for administering the Medicare and Medicaid programs. HCFA sets the coverage policy, payment, and other guidelines and directs the activities of government contractors (e.g., carriers and fiscal intermediaries).

Health Maintenance Organization (HMA): A type of group health care practice that provides basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee that is set without regard to the amount or kind of services received. In addition to diagnostic and treatment services, including hospitalization and surgery, an HMO often offers supplemental services such as dental, mental, and eye care, and prescription drugs. Federal financing support for the establishment of HMOs was provided under Title XIII of the 1973 U.S. Public Health Services Act.

Health Resources and Services Administration (HRS): A U.S. federal agency with responsibilities for the distribution of health information. This includes audiovisual materials relating to a wide range of health subjects such as recruitment of minorities into the health professions, and the role of women in dentistry.

Heart-Lung Machine: An apparatus consisting of a pump and an oxygenator that takes over the function of the heart and lungs, especially during open heart surgery.

Heimlich Maneuver: An emergency procedure for dislodging a bolus of food or other obstruction from the trachea to prevent asphyxiation.

Hematemesis: Vomiting of bright red blood, indicating rapid upper GI bleeding, commonly associated with esophageal varices of a peptic ulcer.

Hematoma: Swelling containing blood, also known as a bruise.
Hematuria: Abnormal presence of blood in the urine. It is symptomatic of various renal diseases and disorders of the genitourinary system.

Hemiparesis: Muscular weakness of one half of the body.

Hemodialysis: A procedure in which impurities or wastes are removed from the blood.

Hemoglobin: A complex protein-iron compound in the blood that carries oxygen to the cells from the lungs and carbon dioxide away from the cells of the lungs.

Hemorrhage: A loss of a large amount of blood in a short period, either externally or internally. Hemorrhage may be arterial, venous, or capillary.

Hemorrhagic Shock: Shock associated with the sudden and rapid loss of significant amounts of blood.

Hemorrhoid: Varicosity in the lower rectum of anus caused by congestion in the veins of the hemorrhoidal plexus.

Heparin: A naturally occurring mucopolysaccharide that acts in the body as an antithrombin factor to prevent intravascular clotting. The substance is produced by basophiles and mast cells, which are found in large numbers in the connective tissue surrounding capillaries, particularly in the lungs and liver. In the form of sodium salt, heparin is used therapeutically as an anticoagulant.

Hepatic Dyspepsia: A digestive difficulty caused by a liver disorder.

Hepatitis: An inflammatory condition of the liver, characterized by jaundice, hepatomegaly, anorexia, abdominal and gastric discomfort, abnormal liver function, clay-colored stools, and clay-colored urine.

Hepatotoxicity: The tendency of an agent, usually a drug or alcohol, to have a destructive effect on the liver.

Hernia: Protrusion or projection of an organ through an abnormal opening in the muscle wall of the cavity that surrounds it. A hernia may be congenital, may result from the failure of certain structures to close after birth, or may be acquired later in life as a result of obesity, muscular weakness, surgery, or illness.

Hernial Sac: A pouch of peritoneum into which organs or other tissues pass to form a hernia.

Herniated Disk: A rupture of the fibrocartilage surrounding an intervertebral disk, releasing the nucleus pulposus that cushions the vertebrae above and below. The resultant pressure on spinal nerve roots may cause considerable pain and damage the nerves, resulting in restriction of movement. The condition most frequently occurs in the lumbar region. Also called herniated intervertebral disk, herniated nucleus pulposus, ruptured intervertebral disk, slipped disk. Herniated disks may occur due to trauma, like an automobile accident. For more information, click here.

High-density Lipoprotein (HDL): A plasma protein made mainly in the liver and containing about 50% lipoprotein (apoprotein) along with cholesterol, triglycerides and phospholipid and is involved in transporting cholesterol and other lipids to the liver to be disposed. Higher levels of high-density lipoprotein are associated with decreased cardiac risk profiles.

Hippocratic Oath: An oath, attributed to Hippocrates, that serves as an ethical guide for the medical profession.

Hip Replacement: Substitution of an artificial ball and socket joint for the hip joint. Hip replacement may be performed to relieve a chronically painful and stiff hip in advanced osteoarthritis, an improperly healed fracture, or because of destruction of the joint due to traumadegeneration of the joint. Antibiotic therapy is begun before surgery, and the patient is taught to walk with crutches or a walker.

Histology: The science dealing with the microscopic identification of cells and tissue.

Holter Monitor: Trademark for a device for making prolonged electrocardiograph recordings on a portable tape recorder while the patient conducts normal daily activities. Also called an ambulatory electrocardiograph.

Home Health Nurse: A registered nurse who visits patients in the home. The nurse works primarily in the area of secondary or tertiary care, providing hands-on care and educating the patient and family on care and prevention of future episodes.

Homeostasis: A relative constancy in the internal environment of the body, naturally maintained by adaptive responses that promote health survival.

Hospice: Typically referring to end of life care or services provided at the home for terminally ill patients.

Human Ecology: The study of the interrelationships between people and their environments.

Hunger Contractions: Strong contractions of the stomach usually associated with a desire for food.

Hydrocephalus: A pathologic condition characterized by an abnormal accumulation of cerebrospinal fluid, usually under increased pressure, within the cranial vault and subsequent dilation of the ventricles.

Hypercalcemia: Greater than normal amounts of calcium in the blood, most often resulting from excessive bone release of calcium. Clinically patients with hypercalcemia experience confusion, anorexia, abdominal pain, muscle pain and weakness. Extremely high levels of blood calcium may result in coma, shock, kidney failure and death.

Hypertension: Elevated blood pressure persistently exceeding 140/90 mm Hg. The incidence of hypertension is higher in men than in women and is twice as great in African-Americans as in Caucasians. Inadequate blood supply to the coronary arteries may cause angina or myocardial infarction.

Hypocalcaemia: A deficiency of calcium in the serum that may be caused by hypoparathyroidism, vitamin D deficiency, kidney failure, acute pancreatitis, or inadequate amounts of plasma magnesium and protein. It involves a corrected serum calcium concentration less than 8.8 mg/dL or an ionized calcium concentration less than 4.8 mg/dL. In the elderly serum calcium rates can decrease for many reasons including decreased intake of dairy products, lower albumin levels and decreased vitamin D intake.

Hypoglycemia: A abnormally low blood glucose (sugar) level that leads to symptoms of sympathetic nervous system stimulation or central nervous system dysfunction. Causes include alcohol, end-stage liver or renal disease and insulin. Treatment may involve oral intake of sugar products, like fruit juice.

I and O: Abbreviation for intake and output. Intake and output is frequently tracked for the elderly, especially those in long term care facilities who may be a risk for dehydration.

Ibuprofen: A nonsteroidal anti-inflammatory agent.

Idopathic Disease: A disease that develops without an apparent or known cause.

Ileum: The lower-third distal portion of the small intestine, extending from the jejunum to the cecum.

Ileus: An obstruction of the intestines. For more information, click here.

Immune: Being protected against infective or allergic diseases by a system of antibody molecules and related resistance factors.

Immunocompromised: Pertaining to an immune response that has been weakened by a disease of an immunosuppressive agent.

Inactive Colon: Hypotonicity of the bowel that result in decreased contractions and propulsive movements and a delay in the normal 12-hour transit time of luminal contents from the cecum to the anus.

Incidence: The number of times an event occurs.

Incident Report: A document usually confidential, describing any accident or deviation from policies or orders involving a patient, employee, visitor, or study on the premises of a health care facility.

Incompetency: Legal status of a person declared to be unable to provide for his or her own needs and protection proved in a court hearing.

Incomplete Fracture: A bone break in which the crack in the osseous tissue does not completely traverse the width of the affected bone but may angle off in one or more directions.

Incontinence: The inability to control urination or defecation. Urinary incontinence may be caused by anatomic, physiologic, or pathologic factors. Treatment depends on the diagnosed cause. Fecal incontinence may result from relaxation of the anal sphincter or disorders of the central nervous system or spinal cord and may be treated by a program of bowel training.

Independence: The state of quality of being independent; autonomy; free of the influence, guidance, or control of a person or a group.

Independent Living Center: Rehabilitation facility in which disabled persons can receive special education and training in the performance of all or most activities of daily living with a particular handicap.

Indication: Reason to prescribe a medication or perform a treatment.

Induration: Hardening of a tissue, particularly the skin, caused by edema, inflammation, or infiltration by a neoplasm.

Infection: The invasion of the body by pathogenic microorganisms that reproduce and multiply, causing disease by local cellular injury, secretion of a toxin, or antigen-antibody reaction in the host.

Infection Control: Hospital or other health facility to minimize the risk of spreading of nosocomial or community-acquired infections to patients or members of the staff.

Informed Consent: Permission obtained from a patient to perform a specific test or procedure. Informed consent is required before performing most invasive procedures and before admitting a patient to a research study. The document used must be written in a language understood by the patient and at least one witness. For more information, click here.

Ingestion: Oral taking of substances into the body. The term is generally applied to both nutrients and medications.

Innervation: The distribution or supply of nerve fibers or nerve impulses to a body part.

Insidious: Describing a development that is gradual, subtle, or imperceptible.

Insulin: A naturally occurring polypeptide hormone secreted by the beta cells of the Islets of Langerhans in the pancreas in response to increased levels of glucose in the blood as well as the parasympathetic nervous system. The hormone acts to regulate the metabolism of glucose and the processes necessary for the intermediary metabolism of fats, carbohydrates, and proteins. Insulin lowers blood glucose level and promotes transport and entry of glucose into the muscle cells and other tissue. Inadequate secretion of insulin causes elevated blood glucose and lipid levels, and ketonemia, as well as the characteristic signs of diabetes mellitus, including increased desire to eat, excessive thirst, increased urination, and eventually lethargy and weight loss. Uncorrected severe deficiency of insulin is incompatible with life. Normal findings of insulin assay in adults are levels of 5 to 24 p.mU/ml. For more information, click here.

Insulin Shock: A condition of hypoglycemic shock caused by an overdose of insulin, decreased intake of food, or excessive exercise.

Intermediate Care: A unit where patients are kept who do not require intensive care but who are not yet ready to be kept in a regular medical-surgical unit.

Internal Bleeding: Any hemorrhage from an internal organ or tissue, such as intraperitoneal bleeding into the peritoneal cavity or intestinal bleeding into the bowel.

Interrogatories: A series of written questions submitted to a witness or other person having information of interest to the court. The answers are transcribed and are sworn to under oath. Interrogatories are used during the pretrial period as a means of discovery.

Intervertebral Disk: One of the fibrous, broad, and flattened disks found between adjacent spinal vertebrae, except the axis and the atlas. The disks vary in size, shape, thickness, and number, depending on the location in the back and on the particular vertebrae they separate.

Intestinal Flora: The natural bacterial content of the inside of the digestive tract.

Intestinal Obstruction: Any obstruction that results in failure of the contents of the intestine to progress through the lumen of the bowel.

Intubation: Passage of a tube into a body aperture, specifically the insertion of a breathing tube through the mouth or nose into the trachea to ensure a patent airway for the delivery of anesthetic gases and oxygen or both.

Invasion of Privacy: The violation of another person’s right to be left alone and free of unwarranted publicity and intrusion.

Ipecac: An emetic. It is prescribed to cause emesis in certain types of recent poisonings and drug overdoses.

Iron (FE): A common metallic element essential for the synthesis of hemoglobin.

Ischemia: A decreased supply of oxygenated blood to a body part. The condition is often marked by pain and organ dysfunction, as in ischemic heart disease.

JAMA: Abbreviation for Journal of the American Medical Association. For more information, click here.

JCAHO: Joint Commission on Accreditation of Healthcare Organizations.

Jejunum: The length of intestine between the duodenum and the ileum.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO): A private nongovernmental agency that establishes guidelines for the operation of hospitals and other health care facilities, conducts accreditation programs and surveys, and encourages the attainment of high standards of institutional medical care in the United States.

Ketoacidosis: Acidosis accompanied by an accumulation of ketones in the body, resulting from extensive breakdown of fats because of faulty carbohydrate metabolism. It occurs primarily as a complication of diabetes mellitus and is characterized by a fruity odor of acetone on the breath, mental confusion, dyspnea, nausea, vomiting, dehydration, weight loss, and, if untreated, coma. Emergency treatment includes the administration of insulin and IV fluids and the evaluation and correction of electrolyte imbalance.

Kidney: One of a pair of a bean-shaped, purplish brown urinary organs in the dorsal part of the abdomen; one is located on each side of the vertebral column between the twelfth thoracic and third lumbar vertebrae. The kidneys filter the blood and eliminate wastes in the urine through a complex filtration network and resorption system comprising more than 2 million nephrons.

Kinetics: The study of the forces that produce, arrest, or modify the motions of the body.

Klebsiella: A genus of diplococcal bacteria that appear as small plump rods with rounded ends. Several respiratory diseases, including bronchitis, sinusitis, and some forms of pneumonia, are called by Klebsiella. For more information, click here.

Labile: Unstable, characterized by a tendency to change or be altered or modified.

Laboratory Diagnosis: A diagnosis arrived at after study of secretions, excretions, or tissue through chemical, microscopic, or bacteriologic means or by biopsy.

Lactic Acid: A three-carbon organic acid produced by anaerobic respiration. Lactic acid in muscle and blood is a product of glucose and glycogen metabolism.

Lactic Acidosis: A disorder characterized by an accumulation of lactic acid in the blood, resulting in a lowered pH in muscle and serum.

Laminectomy: Surgical removal of the bony arches of one or more vertebrae. It is performed to relieve compression of the spinal cord as caused by a bone displaced in an injury, as the result of degeneration of a disk, or to reach and remove a displaced intervertebral disk. For more information, click here.

Latent: Dormant; existing as a potential.

Lateral: Pertaining to a side.

Lavage : The process of washing out an organ, usually the bladder, bowel, paranasal sinuses or stomach, for therapeutic purposes.

Laxative: Pertaining to a substance that causes evacuation of the bowel by a mild action.

Lead Poisoning: A toxic condition caused by the ingestion or inhalation of lead or lead compounds. Poisoning also occurs from the ingestion of water from lead pipes and lead salts in certain foods and wines, the use of pewter or earthenware glazed with a lead glaze, and the use of leaded gasoline.

Left Ventricle (LV): The thick-walled chamber of the heart that pumps blood through the aorta and the systemic arteries, the capillaries, and back through the veins to the right atrium.

Lethargy: The state or quality of dullness, prolonged sleepiness, sluggishness, or serious drowsiness.

Leukocyte: A white blood cell, one of the formed elements of the circulating blood system. Leukocytes function as phagocytes of bacteria, fungi, and viruses, detoxifiers of toxic proteins that may result from allergic reactions and cellular injury, and immune system cells.

Leukocytosis: An abnormal increase in the number of circulating white blood cells.

Liabiliity: Something one is obligated to do or an obligation required to be fulfilled by law, usually financial in nature.

Licensed Practical Nurse (LPN): A person educated in basic nursing techniques and direct patient care who practices under the supervision of a registered nurse. The course of education usually lasts 1 year.

Ligament: One of many predominantly white shiny flexible bands of fibrous tissue binding joints together and connecting the articular bones and cartilages to facilitate movement.

Lipid: Any of a structurally diverse group of organic compounds that are insoluble in water but soluble in alcohol, chloroform, ether and other solvents. Some lipids are stored in the body and serve as an energy reserve, but are elevated in various diseases such as atherosclerosis.

Liquid Diet: A diet consisting of foods that can be served in liquid or strained form but that may include custard, ice cream, pudding, tapioca, and soft-cooked eggs. It is prescribed in acute infections, in acute inflammatory conditions of the GI tract, and for patients unable to consume other soft or semifluid foods, usually after surgery.

Lithium Carbonate: An antimanic agent. It is prescribed in the treatment of manic episodes of manic-depressive disorder.

Liver: The largest gland of the body and one of its most complex organs. More than 500 functions of the liver have been identified. Some of the major functions are the production of the bile by hepatic cells; the secretion of glucose, proteins, vitamins, fats, and most of the other compounds used by the body; the processing of hemoglobin for vital use of its iron content; and the conversion of poisonous ammonia to urea.

Living Will: An advance declaration by a patient that, if determined to be hopelessly and terminally ill, the person does not want to be connected to life support equipment.

Local Infection: An infection involving bacteria that invade the body at a specific point and remain there, multiplying, until eliminated.

Long-term care (LTC): The provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders. The care may be provided in environments ranging from institutions to private homes. Long-term care services usually include symptomatic treatment, maintenance, and rehabilitation for patients of all age groups.

Lorazepam: A benzodiazepine tranquilizer. It is prescribed in the treatment of anxiety, nervous tension, and insomnia.

Loss of Consortium: A claim for damages sought to compensate for the loss of conjugal relations, including society, affection, and assistance, and impairment or loss of sexual relations. Such a claim is typically brought by the spouse of an injured party.

Low-density Lipoprotein (LDL): A plasma protein provided from very low-density lipoproteins or by the liver, containing relatively more cholesterol and triglycerides than protein.

Lumbar Nerves: These are five pairs of spinal nerves rising in the lumbar (lower back) region of the vertebral column.

Macular Degeneration: A progressive deterioration of the maculae of the retina that can cause blindness.

Magnetic Resonance Imaging (MRI): Medical imaging based on the resonance of atomic nuclei in a strong magnetic field. Among its advantages are its superior soft-tissue contrast resolution and ability to image in multiple planes. About 15% of patients require some form of a sedative to overcome claustrophobia during the procedure.

Major Medical Insurance: Insurance coverage designed to offset the costs of prolonged or catastrophic illness and injury.

Malabsorption: Impaired absorption of nutrients from the GI tract. It occurs in celiac disease, sprue, dysentery, diarrhea, inflammatory bowel disease, and other disorders.

Malfeasance: Performance of an unlawful or wrongful act.

Malignant: Tending to become worse and to cause death. Describing a cancer: anaplastic, invasive, and metastatic. Also virulent.

Malingering: Willful and deliberate feigning of the symptoms of a disease or injury to gain some consciously desired result.

Malnutrition: Any disorder of nutrition. It may result from an unbalanced, insufficient, or excessive diet or from impaired absorption, assimilation, or inadequate ingestion of foods.

Malpractice: In law, this refers to professional negligence that is the proximate cause of an injury or harm to a patient, resulting from a lack of professional knowledge, experience, or skill that can be expected from others similarly situated in the profession. If a medical practitioner holds himself out as an expert or specialist in a particular field, he or she will be held to the standards of the specialists in that field.

Managed Care: A health care system in which there is administrative and central control over primary health care services in a medical group practice setting. The intention is to eliminate redundant facilities and services and to reduce costs. Health education and preventive medicine are emphasized. HMOs (Health maintenance organizations) are a form of managed care.

Mastectomy: The surgical removal of one or both breasts, most commonly performed to remove a malignant tumor.

Material Fact: In law this refers to a fact that establishes or refutes an element essential to the complaint, charge, or defense.

Medanomas: Highly malignant skin tumors that readily metastasize. The incidence of Melanomas increae with age. Mortality rates among elderly men are high, likely due to delyated diagnosis. Suspicious lesions should be evaluated by a dermatologist.

Median: Number representing the middle value of the scores in a sample.

Median Nerve: One of the terminal branches of the brachial plexus, which extends along the radial parts of the forearm and the hand and supplies various muscles and the skin of these parts.

Mediate: To settle a dispute, as in collective bargaining process.

Medicaid: A U.S. federally funded state operated program of medical assistance to people with low incomes, authorized by Title XIX of the Social Security Act. Under broad federal guidelines the individual states determine benefits, eligibility, rates of payment, and methods of administration.

Medical Diagnosis: The determination of the cause of a patient’s illness.

Medical Director: A physician who is usually employed by a hospital to serve in a medical and administrative capacity as head of the organized medical staff.

Medicare: A federally funded national health insurance program in the United States for people over 65 years of age. The program is administered in two parts. Part A provides basic protection against costs of medical, surgical, and psychiatric hospital care. Part B is a voluntary medical insurance program financed in part from federal funds and in part from premiums contributed by enrollees. Medicare enrollment is offered to people 65 years of age or older who are entitled to receive Social Security or railroad retirement benefits.

Medication Error: Any incorrect or wrongful administration of a medication, such as a mistake in dosage or route of administration, failure to prescribe or administer the correct drug or formulation for a particular disease of condition, use of outdated drugs, failure to observe the correct time for administration of the drug, or lack of awareness of adverse effects of certain drug combinations.

MEDLINE: U.S. National Library of Medicine computer data base that covers approximately 600,000 references to biomedical journal articles published currently and in the 2 preceding years. For more information, click here.

Metabolic Acidosis: Acidosis in which excess acid is added to the body fluids or bicarbonate is lost from them. Acidosis is indicated by a pH of blood below 7.4. Severe diarrhea, renal failure, and lactic acidosis also may result in metabolic acidosis. Hyperkalemia may accompany the condition.

Metabolism (change): The aggregate of all chemical processes that take place in living organisms, resulting in growth, generation of energy, elimination of wastes, and other body functions as they relate to the distribution of nutrients in the blood after digestion. Metabolism takes place in two steps: anabolism, the constructive phase, in which smaller molecules (such as amino acids) are converted to larger molecules *such as proteins); and catabolism, the destructive phase, in which larger molecules (such as glycogen) are converted to smaller molecules (such as glucose).

Morbid Obesity (fatness): An excess of body fat that threatens necessary body functions such as respiration.

Moribund: Near death or in the act of dying.

Mucositis: Any inflammation of a mucous membrane, such as the lining of the mouth and throat.

Mucus: The viscous, slippery secretions of mucous membranes and glands, containing mucin, white blood cells, water, inorganic salts, and exfoliated cells.

Muscle: A kind of tissue composed of fibers or cells that are able to contract, causing movement of body parts and organs. Muscle fibers are richly vascular, excitable, conductive, and elastic.

Muscle Guarding: A protective response in muscle that results from pain or fear of movement.

Myasthenia Gravis: An abnormal condition characterized by chronic fatigue and muscle weakness, especially in the face and throat, as a result of a defect in the conduction of nerve impulses at the neuromuscular junction.

Mycetoma: A severe fungal infection involving skin, subcutaneous tissue, fascia, and bone.

Myelitis: Inflammation of the spinal cord with associated motor or sensory dysfunction.

Myelogram: An x-ray film taken after the injection of a radiopaque medium into the subarachnoid space to demonstrate any distortions of the spinal cord, spinal nerve roots, and subarachnoid space.

Myocardium: A thick contractile middle layer of uniquely constructed and arranged muscle cells that forms the bulk of the heart wall.

Myopathy: An abnormal condition of skeletal muscle characterized by muscle weakness, wasting, and histologic changes within muscle tissue, as seen in any of the muscular dystrophies.

Narcotic: Narcotic analgesics, derived from opium or produced synthetically, that alter perception of pain.

Nasogastric: Pertaining to the nose and stomach.

Nasogastric Intubation: the placement of a nasogastric tube through the nose into the stomach to relieve gastric tension by removing gas, gastric secretions, or food; to instill medication, food, or fluids.

National Bureau of Standards (NBS): A federal agency in the Department of Commerce that sets accurate measurement standards for commerce, industry, and science in the United States.

National Institute on Aging (NIA): A branch of the (U.S.) National Institutes of Health established in 1974. The NIA supports biomedical, social and behavioral research and education related to aging.

Necrosis: Localized tissue death that occurs in groups of cells in response to disease or injury. Necrosis can result from physical or chemical insults that overwhelm normal cellular processes and cause cell death.

Necrotizing Enteritis: Acute inflammation of the small and large intestine by the bacterium Clostridium perfringens, characterized by severe abdominal pain, blood diarrhea, and vomiting.

Negligence : In law, the commission of an act that a reasonably prudent person would not done under the same or similar circumstances.

Negligence per se (in law): A finding of negligence rendered in judgment of a professional action or inaction in violation of a statute or so at odds with common sense that beyond any doubt no prudent person would be guilty of it. The violations of certain statues that were enacted to protect a specific class of people may give rise to a negligence per se claim.

Neoplasm: Any abnormal growth of new tissue, benign or malignant.

Nephrectomy: The removal of a kidney.

Nephrology: The study of the anatomy, physiology, and pathology of the kidney.

Nephropathy: Any disorder of the kidney.

Nerve Compression: A pathologic event that causes harmful pressure on one or more nerve trunks, resulting in nerve damage and muscle weakness or atrophy. Any nerve that passes over a rigid prominence is vulnerable, and the degree of damage depends on the magnitude and duration of the compressive force. For more information, click here.

Nerve Conduction Test: An electrodiagnostic test of the integrity of the peripheral nerves.

Nerve Root Impingement: The abnormal protrusion of body tissue into the space occupied by a spinal nerve root. Causes may include disk herniation, tissue prolapsed, and inflammation.

Neurologic Assessment: An evaluation of the patient’s neurologic status and symptoms.

Neurosurgery: Any surgery involving the brain, spinal cord, or peripheral nerves.

Nucleus Pulposus: The central part of each intervertebral disk, consisting of a pulpy elastic substance that loses some of its resiliency with age. The nucleus pulposus may be suddenly compressed and squeeze out through the annular fibrocartilage, causing a herniated disk and extreme pain.

Numbness (loss of feeling): A partial or total lack of sensation in a body part, resulting from any factor that interrupts the transmission of impulses from the sensory nerve fibers. Numbness is often accompanied by tingling.

Nurse: A person educated and licensed in the practice of nursing.

Nurse Practitioner: A registered nurse who has advanced education in nursing and clinical experience in a specialized area of nursing practice. NPs are certified by passing an examination administered by a professional organization such as the American Nuses’ Credentialing Center (ANCC).

Nurse’s Aide: A person who is employed to carry out basic nonspecialized tasks in the care of patients, such as bathing and feeding, making beds, and transporting patients, under the supervision and direction of a registered nurse.

Nurses’ Station: An area in a clinic, unit, or ward in a health care facility that serves as the administrative center for nursing care for a particular group of patients.

Nursing Care Plan: A plan based on a nursing assessment and a nursing diagnosis carried out by a nurse. The nursing care plan is begun when the patient is admitted to the health service, and, after the initial nursing assessment, a diagnosis is formulated and nursing orders are developed. The goal of the process is to ensure that nursing care is consistent with the patient’s needs and progress toward self-care. A written nursing care plan should be a part of every patient’s chart.

Nursing Director: A nurse whose function is the administrative and clinical leadership of the nursing service of a division of a health care facility.

Nutrient: A chemical substance that provides nourishment and affects the nutritive and metabolic processes of the body.

Nutritional Monitoring: A nursing intervention from the Nursing Interventions Classification (NIC) defined as collection and analysis of patient data to prevent or minimize malnourishment.

Obese (swollen): Pertaining to a corpulent or excessively heavy individual. Generally a person is regarded as medically obsese if he or she is 20% above desirable body weight for the person’s age, sex, height, and body build.

Objective Symptom (that which happens): A symptom accompanied by signs that tend to confirm the patient’s physical complaint and enable the examining physician, nurse, or other health care provider to deduce the cause.

Older Americans Act Amended of 1987: U.S. federal legislation authorizing support of Title III nutrition services for state and county programs on aging. The services include both congregate and home-delivered meals, with related nutrition education.

Ombudsman: A person who investigates and mediates patient problems and complaints with health care providers. Ombudsman are frequent visitors to nursing homes, as these advocates are frequently first responders to complaints of neglect. Also called a patient representative.

Oncology: The study of cancerous growths. For more information, click here.

Onychomycosis: A fungal infection of the skin, caused by dermatophytes, yeast or molds, depending on the patients geographic region. Nails become yellow and thickened, and may separate from the nail bed.

Opium: It is an opioid analgesic, a hypnotic, and an astringent. Opium contains several alkaloids, including codeine, morphine, and papaverine.

Optic Nerve: One of a pair of cranial nerves that transmit visual impulses.

Optic Neuropathy: A disease characterized by dysfunction or destruction of the optic nerve tissues.

Oral Hygiene: The condition or practice of maintaining the tissues and structures of the mouth. Dependent or unconscious patients are assisted in maintaining a healthy oral condition.

Orientation: The awareness of one’s physical environment with regard to time, place, and the identity of other people.

Orthopedics: Branch of health care that is concerned with the prevention and correction of disorders of the musculoskeletal system of the body. Also spelled orthopaedics.

Orthopedic Traction: A procedure in which a patient is maintained in a device attached by ropes and pulleys to weights that pull on an extremity or body part while counteraction is maintained.

Orthopedist: A physical who specializes in orthopedics. Also called orthopod.

Osmology: The science of the sense of smell.

Osteomyelitis: Local or generalized infection of bone and bone marrow. It is usually caused by bacteria introduced by trauma or surgery, by direct extension from a nearby infection, or via the bloodstream. Staphylococci are the most common causative agents.

Osteopenia: Condition of subnormally mineralized bone, usually the result of a rate of bone Iysis that exceeds the rate of bone matrix synthesis.

Osteoporosis: A disorder characterized by abnormal loss of bone density and deterioration of bone tissue, with an increased fracture risk. For about 10 years after menopause, bone loss accelerates by a factor of ten. It is six times more common in women than men.

Ostomy: A surgical procedure in which an opening is made to allow the passage of urine from the bladder or of intestinal contents from eh bowel to an incision or stoma surgically created in the wall of the abdomen.

Ostomy Care: The management and support of a patient with a surgical opening created in the bladder, ileum, or colon for the temporary or permanent passage of urine or feces.

Otolaryngology: A branch of medicine dealing with the diagnosis and treatment of diseases and disorders of the ears, nose, and throat.

Outpatient (OP): Patient, not hospitalized, who is being treated in an office, clinic, or other ambulatory care facility.

Oxygen Saturation: The fraction of the hemoglobin molecules in a blood sample that are saturated with oxygen at a given partial pressure of oxygen.

Pacing: Setting of the heart’s rhythm by the sinus node, by another site in the heart, or by an artificial electrical stimulator.

Package insert: A leaflet that, by order of the Food and Drug Administration (FDA), must be placed inside the package of every prescription drug.

Paget’s disease: A common nonmetabolic disease of bone of unknown cause, usually affecting middle-aged and elderly people, and characterized by excessive bone destruction and unorganized bone repair.

Pain and Suffering: In law, an element in a claim for damages that allows recovery for the mental and physical pain, suffering, distress, and trauma that an individual has endured as a result of an injury.

Pain assessment: An evaluation of the reported pain and the factors that alleviate or exacerbate it, as well as the response to treatment of pain. All long term care facilities should assess their resident’s level of pain and make recommendations for pain medications.

Palliative treatment: Therapy designed to relieve or reduce intensity of uncomfortable symptoms but not to produce a cure.

Pallor: An unnatural paleness or absence of color in the skin.

Palpation: To touch gently, as part of an examination.

Pancreas: An elongated grayish pink gland and secrets various substances, such as digestive enzymes, insulin, and glucagon.

Pancreatic Cancer: Malignant neoplastic disease of the pancreas, characterized by anorexia, flatulence, weakness, dramatic weight loss, epigastric or back pain. Diagnostic studies include barium radiographic studies of the stomach and duodenum, transhepatic cholangiography, or laboratory evaluation of liver function.

Pancreatic Diabetes: Diabete mellitus caused by a deficiency of insulin production by the islet of the pancreas.

Pancreatitis: An inflammatory condition of the pancreas that may be acute or chronic.

Acute pancreatitis: Is generally the result of damage to the biliary tract, as by alcohol, trauma, infectious disease, or certain drugs.

Paracentesis: A procedure in which fluid is withdrawn from a body cavity.

Paradigm: A pattern that may serve as a model or example.

Paralysis: The loss of muscle function, loss of sensation, or both. It may be caused by a variety of problems, such as trauma, disease, and poisoning.

Paralytic ileus: A decrease in or absence of intestinal peristalsis. It may occur after abdominal surgery or peritoneal injury or be associated with severe pyelonephritis, ureteral stone, fractured ribs, myocardial infarction.

Parenchymal Cell: Any cell that is a functional element of an organ such as a hepatocyte.

Paresis: Motor weakness or partial paralysis related in some cases to local neuritis.

Parietal Bone: One of a pair of bones forming the sides of the cranium.

Parkinsonian: A mild resting tremor with slow, regular oscillations of three to six per Tremor: second, exacerbated by fatigue, cold, or emotion.

Parkinsonism: A neurologic disorder characterized by tremor, muscle rigidity, hypokinesia, a slow shuffling gait, and difficulty in chewing, swallowing, and speaking, caused by various lesions in the extrapyramidal motor system. See also Parkinson’s disease.

Patella: A flat, large bone at the front of the knee joint, having a pointed apex that attaches to the ligamentum patellae.

Patent: Open and unblocked, such as a patent airway or a patent anus.

Pathogen: Any microorganism capable of producing disease.

Pathogenic: Capable of causing or producing a disease. Also called pathogenetic.

Pathologist: A physician specializing in the study of disease. A pathologist usually specializes in autopsy or in clinical or surgical pathology.

Peer Review: An appraisal by professional coworkers of equal status of the way an individual health professional conducts practice, education, or research. In some states the peer review process may form the basis for an objection from producing certain documents created by a peer review committee.

Pentose Drain: A thin rubber tube used as a surgical drain device.

Peptic Ulcer: A sharply circumscribed loss of the mucous membrane of the stomach, duodenum, or any other part of the GI system exposed to gastric juices containing acid and pepsin. Also called gastric ulcer.

Percutaneous: Performed through the skin, such as a biopsy, aspiration of fluid from a space below the skin using a needle, catheter, and syringe.

Perfusion: The passage of a fluid through specific organ or an area of the body.

Pericardiac: Pertaining to the area around the heart. Also pericardial.

Pericarditis: Inflammation of the pericardium associated with trauma, malignant neoplastic disease, infection, uremia, myocardial infarction, collagen disease, or unknown causes.

Pericardium: A fibroserous sac that surrounds the heart and roots of the great vessels. It consists of the serous pericardium and the fibrous pericardium.

Perineal Care: A cleansing procedure prescribed for cleansing the perineum after various obstetric and gynecologic procedures. Perineal care is given at prescribed intervals and after urination or defecation.

Peripheral: Pertaiing to the outside, surface, or surrounding area of an organ, other structure, or field of vision.

Peripheral Nervous: The motor and sensory nerves and ganglia outside the brain and spinal system: cord.

Peripheral Neuropathy: Any functional or organic disorder of the peripheral nervous system.

Peripheral Vascular Disease (PVD): Any abnormal condition that affects the blood vessels and lymphatic vessels, except those that supply the heart. Different kinds and degrees of PVD are characterized by a variety of signs and symptoms, such as numbness, pain, pallor, elevated blood pressure, and impaired arterial pulsations. Causative factors include obesity, cigarette smoking, stress, sedentary occupations, and numerous metabolic disorders. Treatment of severe cases may require amputation of gangrenous body parts. Some kinds of peripheral vascular disease are atherosclerosis and arteriosclerosis.

Peripheral Arterial Disease: A common age related disorder which parallels atherosclerosis. Risk factors include smoking, diabetes mellitus, hyperlipidemia, hypertension, family history and advanced age. Many patients with this condition, including the elderly, have no initial symptoms. Almost 70% of a vessel’s flow must be obstructed before the diseases can be clinically recognized.

Peristalsis: The coordinated, rhythmic serial contraction of smooth muscle that forces food through the digestive tract, bile through the bile duct, and urine through the ureters.

Peritoneum: An extensive serous membrane that lines the entire abdominal wall of the body and is reflected over the contained vicera.

Peritonitis: An inflammation of the peritoneum. It is produced by bacteria or irritating substances introduced into the abdominal cavity by a penetrating wound or perforation of an organ in the GI tract or the reproductive tract. Peritonitis is caused most commonly by rupture of the appendix but also occurs after perforations of intestinal diverticula, peptic ulcers, gangrenous gallbladders, gangrenous obstructions of the small bowel, or incarcerated hernias, as well as ruptures of the spleen, liver, ovarian cyst, or fallopian tube, especially in ectopic pregnancy. Characteristic signs and symptoms include abdominal distension, rigidity and pain, rebound tenderness, decreased or absent bowel sounds, nausea, vomiting, and tachycardia.

Phagocyte: A cell that is able to surround, engulf, and digest microorganisms and cellular debris.

Phalanx: Any of the 14 tapering bones composing the fingers of each hand and toes of each foot. The fingers each have three phalanges (proximal, middle, and distal); the thumb has two.

Pharmacist: A person prepared to formulate, dispense, and provide clinical information on drugs or medications to health professionals and patients, through completion of a university program in pharmacy.

Pharmacokinetics: The study of the action of drugs within the body, including the mechanisms of absorption, distribution, metabolism, and excretion; onset of action; duration of effect, biotransformation, and effects and routes of excretion of the metabolites of the drug.

Phenobarbital: A barbiturate anticonvulsant and sedative-hypnotic.

Phlebotomist: A person with special training in the practice of drawing blood.

Phobia: An obsessive, irrational, and intense fear of a specific object, such as an animal or dirt, of an activity, such as meeting strangers or leaving the familiar setting of the home.

Photoaging: In the elderly, this refers to changes in the skins appearance that are the result of chronic exposure to UV radiation from sunlight. Elderly persons who are not exposed to the sun through lifestyle or occupation choices often look younger than their chronologic age.

Physical Abuse: One or more episodes of aggressive behavior, usually resulting in physical injury with possible damage to internal organs, sense organs, the central nervous system, or the musculoskeletal system of another person.

Physical Restraint: A nursing intervention from the Nursing Interventions Classification (NIC) defined as application, monitoring, and removal of mechanical restraining devices or manual restraints which are use to limit physical mobility of patient.

Physical Therapist: A person who is licensed in the examination, evaluation, and treatment of physical impairments through the use of special exercise, applications of heat or cold, and other physical modalities.

Physical Therapy Assistant: A person who, under the supervision of a physical therapist, assists in carrying out patient treatment programs.

Physician’s Desk Reference (PDR): A compendium compiled annually, containing information about drugs, primarily prescription drugs and products used in diagnostic procedures in the United States, supplied by their manufacturers.

Pitting Edema: An edema characterized by a condition in which a finger pressed into the skin over an accumulation of fluid will result in a temporary depression in the skin, normal skin and subcutaneous tissue quickly rebound when the pressure is released.

Placebo: An inactive substance, such as saline solution, distilled water, or sugar, or a less than effective dose of a harmless substance, such as a water-soluble vitamin, prescribed as if it were an effective dose of a needed medication.

Plaintiff: A person who files a lawsuit initiating a legal action. The plaintiff complains or sues for remedial relief and names a complainant in various civil actions.

Plasma: The watery straw-colored fluid part of the lymph and the blood in which the leukocytes, erythrocytes, and platelets are suspended. Plasma is made up of water, electrolytes, proteins, glucose, fats, bilirubin, and gases is essential for carrying the cellular elements of the blood through the circulation, transporting nutrients, maintaining the acid-base balance of the body, and transporting wastes from the tissues.

Plastic Surgery: The alteration, replacement, or restoration of visible parts of the body, performed to correct a structural or cosmetic defect.

Pleural Effusion: An abnormal accumulation of fluid in the intrapleural spaces of the lungs. It is characterized by fever, chest pain, dyspnea, and nonproductive cough. An exudate may result from pulmonary infarction, trauma, tumor, or infection, such as tuberculosis.

Plexus: A network of intersecting nerves and blood vessels or of lymphatic vessels. The body contains many plexuses, such as the brachial plexus, the cardiac plexus, the cervical plexus, and the solar plexus.

Pneumonia: An acute inflammation of the lungs, often caused by inhaled pneumococci of the species Streptococcus pneumonia. The alveoli and bronchioles of the lungs become plugged with a fibrous exudates. Pneumonia may be caused by other bacteria, as well as by viruses, rickettsiae, and fungi.

Pneumothorax: The presence of air or gas in the pleural space, causing a lung to collapse. Pneumothorax may be the result of an open chest wound that permits the entrance of air, the rupture of an emphysematous vesicle on the surface of the lung, or a severe bout of coughing.

Podiatrist: A health professional who diagnoses and treats disorders of the feet.

Popliteal Artery: A continuation of the femoral artery, extending from the opening of the abductor magnus, passing through the popliteal fossa at the knee, dividing into eight branches, and supplying various muscles of the thigs, leg, and foot.

Popliteal Pulse: The pulsation of the popliteal artery, behind the knee, best palpated with the patient lying prone with the knee flexed.

Postraumatic: Pertaining to any emotional, mental, or physiological consequences after a major illness or injury.

Posture: The position of the body with respect to the surrounding space.

Potassium (K): Potassium salts are necessary to the life of all plants and animals. Potassium in the body constitutes the predominant intracellular action, helping to regulate neuromuscular excitability and muscle contraction. Potassium is important in glycogen formation, protein synthesis, and correction of imbalances of acid-base metabolism. Potassium is most commonly depleted in the body by an increased rate of excretion by the kidneys or the GI tract. Increased renal excretion may be caused by diuretic therapy, large doses of anionic drugs, or renal disorders. Increased GI excretion of potassium may occur with the loss of GI fluid through vomiting, diarrhea, surgical drainage, or chronic use of laxatives.

Power of Attorney: A document authorizing one person to take legal actions on behalf of another, to act as an agent for the grantor.

Precedent: Previously adjudged decision that serves as an authority in a similar case.

Presbycardia: An abnormal cardiac condition that especially affects elderly individuals and may be associated with heart failure in the presence of other complications, such as heart disease, fever, anemia, mild hyperthyroidism, and excess fluid administration.

Pressure: A force, or stress, applied to a surface by a fluid or an object, usually measured in units or mass per unit of area.

Pressure Ulcer: A sore or open wound in the skin over a bony prominence that occurs most frequently on the sacrum elbows, heels, outer ankles, inner knees, hips, shoulder blades, and occipital bone on high risk-patients, especially those who are obese, elderly, or suffering from chronic diseases, infections, injuries, or poor nutritional state.

Preventive Care: A pattern of nursing and medical care that focuses on disease prevention and health maintenance.

Primary Care: The first contact in a given episode of illness that leads to a decision regarding a course of action to resolve the health problem.

Primary Physician: The physician who usually takes care of a patient; the physician who first sees a patient for the care of a given health problem.

Primaxin: Trademark for a broad-spectrum parenteral antibiotic.

Prognosis: Prediction of the probable outcome of a disease based on the condition of the person and the usual course of the disease as observed in similar situations.

Projectile Vomiting: Expulsive vomiting that is extremely forceful.

Pronation: Assumption of a prone position, one in which the ventral surface of the body faces downward.

Prostate Cancer: Cancer of the prostate that affects about 2% of the primary population above age 50, and is one of the most common cancers in adult men. It is the second leading cause of cancer deaths in men after lung cancer. This cancer typically runs a protracted course, so most patients die with prostate cancer but not from it. Serum Prostate-specific antigen (PSA) screening is typically used to detect this form of cancer.

Protein: A large group of naturally occurring complex organic nitrogenous compounds. Each is composed of large combinations of amino acids (usually 50 or more) containing the elements carbon, hydrogen, nitrogen, oxygen, and occasionally sulfur, phosphorus, iron, iodine, or other essential constituents of living cells. Twenty-two amino acids have been identified as vital for proper growth. Adequate protein is considered essential for good nutrition and can be measured with an Albumin lab test.

Proteinemia: An excessive level of protein in the blood. Also called hyperproteinemia.

Prothrombin Time (PT): A one-stage test for detecting certain plasma coagulation defects caused by a deficiency of factors V, VII, or X. Thromboplastin and calcium are added to a sample of the patient’s plasma and simultaneously to a sample from a normal control.

Pseudomonas: A genus of gram-negative bacteria that includes several free-living species in soil and water and some opportunistic pathogens, such as Pseudomonas aeruginosa, isolated from wounds, burns, and infections of the urinary tract.

Psittacosis: An infectious illness caused by bacterium Chlamydia psittaci. It is characterized by respiratory pneumonia-like symptoms.

Psoriasis: A common chronic skin disorder characterized by circumscribed red patches covered by thick, dry silvery adherent scales that are the result of excessive development of epithelial cells.

Psychic Trauma: An emotional shock or injury or distressful situation that produces a lasting impression, especially on the subconscious mind.

Psychoanalysis: A branch of psychiatry founded by Sigmund Freud, devoted to the study of the psychology of human development and behavior. Using such techniques as free association, dream interpretation, and analysis of defense mechanisms, emotions and behavior are traced to the influence of repressed instinctual drives in the unconscious.

Psychology (psych): The study of behavior and of the functions and processes of the mind, especially as related to the social and physical environment.

Pruritis: An unpleasant sensation that instinctively causes one to scratch or rub. It is a common complaint among the elderly and is usually caused by dry skin (Xerosis).

Q: Symbol for blood volume. Symbol for quantity.

QRS: A series of waveforms that represent both normal and abnormal depolarization of ventricular muscle cells.

Quadriplegia: Paralysis of the arms, legs, and trunk of the body below the level of an associated injury to the spinal cord.

Quarantine: Isolation of people with communicable disease or those exposed to communicable disease during the contagious period in an attempt to prevent spread of the illness.

Rabies: An acute, usually fatal viral disease of the central nervous system of mammals.

Radial Artery: An artery in the forearm, starting at the bifurcation of the brachial artery and passing in 12 branches to the forearm, wrist, and hand.

Radial Nerve: The largest branch of the brachial plexus, arising on each side as a continuation of the posterior cord. It supplies the skin of the arm and forearm and their extensor muscles.

Radial Pulse: The pulse of the radial artery palpated at the wrist over the radius.

Radiation: The emission of energy, rays, or waves.

Radiation Burn: A burn resulting from exposure to radiant energy in the form of sunlight, x-rays, or nuclear emissions of explosion.

Radical: An atom or group of atoms that contains an unpaired electron.

Radicular: Pertaining to a root, such as a spinal nerve root or radical.

Radiculitis: An inflammation involving a spinal nerve root, resulting in pain and hyperesthesia.

Range of Motion: The extent of movement of a joint, measured in degrees of a circle.

Reaction: A response to a substance, treatment, or other stimulus, such as an antigen-antibody reaction, an allergic reaction, or an adverse pharmacological reaction.

Reasonably Prudent Person Doctrine: A concept that a person of ordinary sense will use ordinary care and skill in meeting the health care needs of a patient.

Recannulate: To make a new opening through an organ or tissue, such as opening a passage through an occluded blood vessel.

Receptive Aphasia: A form of sensory aphasia marked by impaired comprehension of language.

Reciprocity: A mutual agreement to exchange, dependence, or relationships.

Record: A written form of communication that permanently documents information relevant to the care of a patient.

Rectum: The lower part of the large intestine, about 12 cm long.

Recumbent: Lying down or leaning backward.

Reduce: (in surgery) The restoration of a part to its original position after displacement, as in the reduction of a fractured bone.

Reflex Sympathetic Dystrophy (RSD): A diffuse, persistent pain involving central reorganization of sensory processing. It is characterized by vasomotor disorders, limited joint mobility.

Registered Nurse: A nurse who has completed a course of study at a state approved school of nursing and passed the National Council Licensure Examination (NCLEX-RN). A registered nurse may use the initials RN after the signature.

Reimbursement: A method of payment, usually by a third-party payor, for medical treatment or hospital costs.

Reminiscence Therapy: A psychotherapeutic technique in which self-esteem and personal satisfaction are restored, particularly in older persons, by encouraging patients to review past experiences of a pleasant nature.

Renal Acidosis: an excessive increase in the H+ ions in body fluids because of impaired kidney function. The acidosis can result from excessive loss of bicarbonate or from the inability to excrete phosphoric and sulfuric acid.

Renal Diet: A diet prescribed in chronic renal failure and designed to control intake of protein, potassium, sodium, phosphorus, and fluids, depending on individual conditions.

Renal Failure: Inability of the kidneys to excrete wastes, concentrate urine, and conserve electrolytes.

Acute Renal Failure: Characterized by oliguria and by the rapid accumulation of nitrogenous wastes in the blood (azotemia).

Chronic Renal Failure: May result from many other diseases. The early signs include sluggishness, fatigue, and mental dullness. Later, anuria, convulsions, GI bleeding, malnutrition, and various neuropathies may occur. Urinalysis reveals greater than normal amounts of urea and creatinine.

Renal Insufficiency: Partial kidney function failure characterized by less than normal urine excretion.

Res Ipsa Loquitur: A legal concept that is important in some malpractice suits, describing a situation in which an injury occurred when the defendant was solely and exclusively in control and in a situation in which the injury would not have occurred had due care been exercised. Classic examples of res ipsa loquitur are a sponge left in the abdomen after abdominal surgery or the amputation of the wrong extremity.

Resonance: An echo or other sound produced by percussion of an organ or cavity of the body during a physical examination.

Respiration Rate: The rate of breathing. It is typically from 40 to 50 breaths per minute for newborns, 20 to 25 breaths per minute for older children, and 15 to 20 breaths per minute for teenagers and adults.

Respiratory Acidosis: An abnormal condition characterized by a low plasma pH resulting from reduced alveolar ventilation.

Respite Care: Provision of short-term care to provide relief for family caregiver.

Respondeat Superior: The concept that an employer may be held liable for torts committed by employees acting within the scope of their employment.

Restorative: Pertaining to the power or ability to restore or renew a person to a normal state of health or consciousness.

Restraint of Trade: An illegal act that interferes with free competition in a commercial or business transaction so as to restrict the production of a product or the provision of a service, affect the cost of a product or a service, or control the market in any way to the detriment of the consumers or purchasers of the service or product. The Clayton Act and the Sherman Antitrust Act are U.S. federal statutes that embody the basic concepts of the definition and the illegal nature of restraint of trade.

Retinal Detachment: A separation of the retina from the retinal pigment epithelium in the back of the eye.

Retinopathy: A group of noninflammatory eye disorders. Major contributing conditions include diabetes, hypertension, and atherosclerotic vascular disease.

Retrospective Study: A study in which a search is made for a relationship between one (usually current) phenomenon or condition and another that occurred in the past.

Rheumatology: The study of disorders characterized by inflammation, degeneration, or derangement of connective tissue and related structures of the body.

Ribosome: An organelle composed of RNA and protein that functions in the synthesis of protein.

Risk Factor: A factor that causes a person or a group of people to be particularly susceptible to an unwanted, unpleasant, or unhealthful event.

Rupture: A tear or break in the continuity or configuration of an organ or body. See also hernia.

Sarcoma: A malignant neoplasm of the soft tissues arising in fibrous, fatty, muscular, synovial, vascular, or neural tissue, usually first manifested as a painless swelling.

Scabies: A contagious disease caused by Sarcoptes scabiei, the human itch mite, characterized by intense itching of the skin and excoriation from scratching.

Scapula: One of the pair of large flat triangular bones that form the dorsal part of the shoulder girdle.

Sciatica: An inflammation of the sciatic nerve, usually marked by pain and tenderness along the course of the nerve through the thigh and leg. For more information, click here.

Scoliosis: skōlēō’sis [Gk, skoliosis, curvature] Lateral curvature of the spine, a common abnormality of childhood, especially in females.

Sebaceous Gland: One of the many small sacculated organs. The sebrum secreted by the glands oils the hair and the surrounding skin, helps prevent evaporation of sweat, and aids in the retention of body heat.

Seizure: A hyperexcitement of neurons in the brain leading to a sudden, violent involuntary series of contractions of a group of muscles.

Sensory Deficit: A defect in the function of one or more of the senses.

Sensory Nerve: A nerve consisting of afferent fibers that conduct sensory impulses from the periphery of the body to the brain or spinal cord via the dorsal spinal roots.

Septic: Pertaining to an infection with pyogenic microorganisms. For more information, click here.

Septicemia: Systemic infection in which pathogens are present in the circulating blood, having spread from an infection in any part of the body.

Septic Shock: A form of shock that occurs in septicemia when endotoxins or exotonins are released from certain bacteria in the bloodstream.

Septum: A partition or wall, such as the interatrial septum that separates the atria of the heart.

Sequela: Any abnormal condition that follows and is the result of a disease, treatment, or injury.

Settlement: In law, an agreement made between parties to resolve a claim or lawsuit. Terms of a settlement typically include the amount paid and a dismissal of the claim with prejudice (finality). Some settlements may include additional provisions like confidentiality. Certain settlements like those involving wrongful death or minors, may require Court approval.

Sexual Assault: The forcible perpetration of an act of sexual contact on the body of another person, male or female, without his or her consent.

Sexual Disorder: Any disorder involving sexual functioning, desire, or performance.

Short-acting Insulin: A clear preparation of regular (crystalline zinc) insulin with an immediate (15 to 30 minutes) onset of action that reaches a peak of action in 2 to 4 hours. The duration of action is 6 to 8 hours.

Shoulder Subluxation: The separation of the humeral head from the glenoid cavity, resulting in strain on the soft tissues surrounding the shoulder joint.

Sigmoid Colon: The part of the colon that extends from the one descending colon in the pelvis to the juncture of the rectum. Also called sigmoid flexure.

Sigmoidoscope: An instrument used to examine the lumen of the sigmoid colon.

Sinus Arrhythmia: An irregular rhythm in which the heart rate usually increase during inspiration and decreased during expiration.

Sinus Node Dysfunction: Any disturbance in the normal functioning of the sinus node, such as slow sinus rate or sinoatrial block, that leads to the development of arrhythmias.

Sitz Bath: A bath in which only the rectal and perineal areas are immersed in water or saline solution. The procedure is used after childbirth and after rectal or perineal surgery to decrease swelling, inflammation, and pain.

Skin: The tough, supple cutaneous membrane that covers the entire surface of the body.

Skin Pigment: Any skin coloring caused by melanin deposits in skin and hair.

Slipped disk: A rupture of the fibrocartilage surrounding an intervertebral disk, releasing the nucleus pulposus that cushions the vertebrae above and below. The resultant pressure on spinal nerve roots may cause considerable pain and damage to the nerves, resulting in restriction of movement and/or radiating pain. The condition most frequently occurs in the lumbar region. Also called herniated intervertebral disk, herniated nucleus pulposus, ruptured intervertebral disk, slipped disk. For more information, click here.

Small Intestine: The longest part of the digestive tract, extending for about 7 m from the pylorus of the stomach to the illiocecal junction. It is divided into duodenum, jejunum, and ileum. It functions in digestion and is the major organ of absorption of prepared food.

Social Isolation: The diagnosis involving feelings of loneliness, which the patient acknowledges as negative or threatening.

Sodium Bicarbonate: An antacid, electrolyte, and urinary alkalinizing agent. It is prescribed in the treatment of acidosis, gastric acidity, peptic ulcer, and indigestion.

Sodium Chloride: Common table salt (NaCI), used in various concentrations as a fluid and electrolyte replenisher, isotonic vehicle, irrigating solution, and enema.

Spinal Fusion: The fixation of an unstable segment of the spine. It is accomplished by skeletal traction or immobilization of the patient in a body cast but most frequently by a surgical procedure.

Spinal Nerves: The 31 pairs of nerves without special names that are connected to the spinal cord and numbered according to the level of the vertebral column at which they emerge. There are 8 cervical, 12 thoracic, 5 lumbar, and 5 sacral pairs, and 1 coccygeal pair.

Spinal Stenosis: Narrowing of the vertebral canal, nerve root canals, or intervertebral foramina of the lumbar spine caused by encroachment of the bone on the space; symptoms are caused by compression of the cauda equine and include pain, paresthesias, and neurogenic claudication.

Spleen: The precise function of the spleen has baffled physiologists for more than 100 years, but research indicates it performs various tasks, such as defense, hemopoiesis, blood storage, and destruction/recycling of red blood cells and platelets. The spleen also produces leukocytes, monocytes, lymphocytes, and plasma cells in response to an infectious agent.

Spondylolisthesis: The partial forward dislocation of one vertebra over the one below it, most commonly the fifth lumbar vertebra over the first sacral vertebra.

Spondylosis: A condition of the spine characterized by fixation of stiffness of a vertebral joint.

Squamous Cell Carcinoma: A slow growing malignant tumor of squamous epithelium, frequently found in the lungs and skin and occurring also in the anus, cervix, larynx, nose, and bladder.

Standing Orders: A written document containing rules, policies, procedures, regulations, and orders for the conduct of patient care in various stipulated clinical situations.

Staphylococcal Infection: An infection caused by any one of several pathogenic species of Staphylococcus, commonly characterized by the formation of abscesses of the skin or other organs. Staphylococcal pneumonia often follows influenza or other viral disease and may be associated with chronic or debilitating illness. For more information, click here.

Starch: A polysaccharide composed of long chains of glucose subunits. See also carbohydrate, glucose, glycogen.

Statute of Limitations: In law, a statute that sets a limit of time during which a suit may be brought or criminal charges may be made.

Stem Cell: A formative cell; a cell whose daughter cells may give rise to other cell types.

Sterile: Free of living microorganisms.

Sternum: The elongated flattened bone forming the middle part of a thorax.

Stomach: The food reservoir and first major site of digestion, located just under the diaphragm and divided into a body and a pylorus.

Streptococcus: A genus of nonmotile gram-positive cocci classified by serologic types. Many species cause disease in humans. Streptococcus faecalis, a penicillin-resisant group D enterococcus and normal inhabitant of the GI tract, may cause infection of the urinary tract or endocradium. S. pneumonia (formerly Diplococcus pneumonia) cause a majority of the cases of bacterial pneumonia in the United States.

Stretching of Contractures: [as drawing together] Any of several procedures for release of muscle and other structures that have been shortened because of paralysis, spasm, disuse, or fibrosis.

Stump: The part of a limb that remains after amputation.

Stupor: A state of unresponsiveness in which a person seems unaware of the surroundings.

Subacute: Less than acute. Pertaining to a disease or other abnormal condition present in a person who appears to be clinically well.

Subcutaneous Facia: A continuous layer of connective tissue over the entire body between the skin and the deep fascial investment of the specialized structures of the body, such as the muscles. It comprises an outer normally fatty layer and an inner thin elastic layer.

Subcutaneous Injection: The introduction of a hypodermic needle into the subcutaneous tissue beneath the skin, usually on the upper arm, thigh, or abdomen. A 24- or 24-gauge needle 2 cm long is used.

Subdural hemotoma: An accumulation of blood in the subdural space, usually caused by an injury. It can be acute or slower bleed over time. For more information, click here.

Subpoena: In law, a document from a court commanding that a person appear at a certain time and place to testify on a specific matter, or to produce documents or things. Subpoenas are governed by applicable court rules of criminal or civil procedures.

Sulfonamide: One of a large group of synthetic bacteriostatic drugs that are effective in treating infections caused by many gram-negative and gram-positive microorganisms. They are used in treating some urinary tract infections.

Summary Judgment: A judgment requested by any party to a civil action to end the action when it is believed that there is no genuine issue or material fact in dispute. If summary judgment is granted, there is usually no jury trial.

Sundowning: A condition in which persons with cognitive impairment, typically the elderly become confused or disoriented at the end of the day. With less light, they lose visual cues that help them to compensate for their sensory impairments. It may also be a result of decreased sensory stimulation, especially in the evening.

Supine: Position of the arms or body in which the palms of the hands face upward. Lying horizontally on the back.

Support Group: Defined as use of a group environment to provide emotional support and health-related information for members.

Surgical Fever: A fever that develops after surgery.

Surgical Pathology: The study of disease by the analysis of tissue specimens obtained during surgery.

T: Symbol for temperature; abbreviation for tumor.

Tacho: swift or rapid, as in tachycardia (fast heartbeat).

Tachycardia: A condition in which the heart contracts at a rate greater than 100/min. It may occur normally in response to fever, exercise, or nervous excitement.

Tactile: Pertaining to the sense of touch.

Tapeworm: A parasitic intestinal worm belonging to the class Cestoda and having a scolex and ribbon-shaped body composed to segments in a chain.

T cell: A small circulating lymphocyte produced in the bone marrow that matures in the thymus. T cells primarily mediate cellular immune responses such as graft rejection and delayed hypersensitivity. One kind of T cell, the helper cell, affects the production of antibodies by B cell.

Temperature: A relative measure of sensible heat or cold normally maintained at a constant level of 98.6o F (37 o C).

Temporal Arteritis: A progressive inflammatory disorder of cranial blood vessels, principally the temporal artery. It occurs most frequently in women over 70 years of age. Symptoms are intractable headache, difficulty in chewing, weakness, rheumatic pains, and loss of vision in the central retinal artery becomes occluded.

Temporomandibular Joint Pain dysfunction Syndrome (TMJ): An abnormal condition characterized by facial pain and mandibular dysfunction. Some common indications of this syndrome are clicking of the joint when the jaws move, limitation of jaw movement, subluxation, and temporomandibular dislocation. For moreinformation, click here.

Testamentary Capacity: A person’s competency to make a will, including that he or she be aware that a will is being made, of the nature and extent of property covered by the will, and of the identities of beneficiaries.

Thoracic: Meaning the chest.

Thoracic Nerves: The 12 pairs of spinal nerves emerging from the spinal cord at the level of the thorax, including 11 intercostal nerves and one subcostal nerve.

Thorax: The upper part of the trunk or cage of bone and cartilage containing the principal organs of respiration and circulation and covering part of the abdominal organs.

Thrombectomy: The removal of a thrombus from a blood vessel, performed as emergency surgery to restore circulation to the affected part. Anticoagulant therapy may being before surgery.

Thrombo: Combining form meaning ‘clot’.

Thrombocytosis: An abnormal increase in the number of platelets in the blood; it usually occurs after splenectomy, inflammatory disease, hemolytic anemia, hemorrhage, or iron deficiency.

Thrombolytic Therapy (TT): Administration of a thrombolytic agent such as tissue plasminogen activator, urokinase, or streptokinase to dissolve an arterial clot.

Thrush: Candidiasis of the tissues of the mouth. The condition is characterized by the appearance of creamy white patches of exudate on an inflamed tongue or buccal mucosa.

Tinnitus: A subjective noise sensation, often described as ringing, heard in one or both ears. It may be a sign of acoustic trauma.

Topical Anesthesia: Surface analgesia produced by application of a topical anesthetic in the form of a solution, gel, or ointment to the skin, mucous membrane, or cornea.

Toxicologist: A specialist in poisons, their effects, and antidotes.

Toxic Substance: Any poison.

Transient: Pertaining to a condition that is temporary, such as transient ischemic attack.

Transplant: To transfer an organ or tissue from one person to another or from one body part to another.

Trauma: Physical injury caused by violent or disruptive action or by the introduction into the body of a toxic substance.

Tremor: Rhythmic, purposeless, quivering movements resulting from the involuntary alternating contracting and relaxation of opposing groups of skeletal muscles occurring in some elderly individuals, certain families, and patients with various neurodegenerative disorders.

Triage: A process in which a group of patients is sorted according to their need for care.

Trochlear Nerve: Either of the smallest pair of cranial nerves, essential for eye movement and eye muscle sensibility.

Turgor: The expected resiliency of the skin caused by the outward pressure of the cells and interstitial fluid. Dehydration results in decreased skin turgor, manifested by lax skin that, when grasped and raised between two fingers, slowly returns to a position level with the adjacent tissue.

Ulcer: A circumscribed, craterlike lesion of the skin or mucous membrane resulting from necrosis that accompanies some inflammatory, infectious, or malignant processes. An ulcer may be shallow, involving only the epidermis, as in pemphigus, or deep, as in a rodent ulcer.

Ulna: The bone on the medial or little finger side of the forearm, lying parallel with the radius.

Ulnar Nerve: One of the terminal branches of the brachial plexus that arises on each side from the medial cord of the plexus. It receives fibers from both cervical and thoracic nerve roots and supplies the muscles and skin on the ulnar side of the forearm and the hand.

Ultrasound Imaging: The use of high-frequency sound (several MHz or more) to image internal structures by the differing reflection signals produced when a beam of sound waves is projected into the body and bounces back at interfaces between those structures.

Ultraviolet Radiation: A range of electromagnetic waves extending from the violet or short-wavelength end of the visible spectrum to the beginning of the x-ray spectrum.

Undisplaced (or nondisplaced) fracture: A bone break in which cracks in the bone may radiate in several directions but the bone fragments do not separate.

Urea Nitrogen Blood Test (BUN): A blood test that detects levels of urea nitrogen in the blood, which serve as an index of liver and kidney function and indicate diseases of these organs, as well as other conditions that affect their function.

Uremia: The presence of excessive amounts of urea and other nitrogenous waste products in the blood, as occurs in renal failure.

Urethra: A small tubular structure that drains urine from the bladder.

Urinalysis: A physical microscopic, or chemical examination of urine.

Urinary Incontinence: Inability to control urination. Several forms are recognized. Urinary incontinence can increase one’s risk for skin breakdown, specially where the patient has limited mobility.

Urinary Tract Infection (UTI): An infection of one or more structures in the urinary system. Most UTIs are caused by gram-negative bacteria, mostly common Escherichia coli or species of Klebsiella, Proteus, Pseudomonas, or Enterobacter. The condition is more common in women than in men.

Urologic: Pertaining to the scientific study of the urinary tract.

Urology: The branch of medicine concerned with the study of the anatomy, physiology, disorders, and care of the urinary tract in men and women and of the male genital tract.

Vagotomy: The cutting of certain branches of the vagus nerve, performed with gastric surgery, to reduce the amount of gastric acid secreted and lessen the chance of recurrence of a gastric ulcer.

Vagus Nerve: Either of the longest pair of cranial nerves mainly responsible for parasympathetic control over the heart and many other internal organs, including thoracic and abdominal viscera.

Varicose Vein: A tortuous, dilated vein with incompetent valves. Causes include congenitally defective valves, thrombophlebitis, pregnancy, and obesity.

Vascular: Pertaining to a blood vessel.

Vasculitis: Inflammation of the blood vessels.

Vasodilation: An increase in the diameter of a blood vessel.

Vasodilator: A nerve or agent that causes dilation of blood vessels by promoting the relaxation of vascular smooth muscle. Chemical vasodilators include hydralazine, nitroglycerin, nitroprusside, and trimethaphan. They have been useful in the treatment of acute heart failure in myocardial infarction, in cases associated with severe mitral regurgitation, and in failure resulting from myocardial disease.

Venous Insufficiency: An abnormal circulatory condition characterized by decreased return of venous blood from the legs to the trunk o the body. Edema is usually the first sign of the condition.

Ventricle: A small cavity, such as the right and the left ventricles of the heart or one of the cavities filled with cerebrospinal fluid in the brain.

Ventricular Dysfunction: An abnormality in the contraction of the ventricles or the motion of the walls.

Ventricular Hypertrophy: Abnormal enlargement of the heart ventricles. It is often caused by hypertension, a valvular disease, or heart failure.

Ventriculography: The radiographic examination of a ventricle of the heart after injection of a radiopaque contrast medium.

Vertebra: Any one of the 33 bones (26 in the adult) of the spinal column, comprising the 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (1 in adult), and 4 coccygeal vertebrae (1 in adult).

Vertigo: A sensation of instability, giddiness, loss of equilibrium, or rotation, caused by a disturbance in the semicircular canal of the inner ear or the vestibular nuclei of the brainstem.

Viral infection: Any of the diseases caused by one of approximately 200 viruses pathogenic to humans. If cells are damaged by the viral attack, disease exists. Viruses are introduced into the body through nonintact skin or mucous membranes or through a transfusion into the bloodstream or transplantation, by droplet infection through the respiratory tract, or by ingestion through the digestive tract into the GI system.

Visual field defect: One or more spots or defects in the vision that remains constant in position, unlike a floater.

Visual Pathway: A pathway over which a visual sensation is transmitted from the retina to the brain.

Vitamin: An organic compound essential in small quantities for normal physiologic and metabolic functioning of the body.

Volvulus: A twisting of the bowel on itself, causing intestinal obstruction. The condition is frequently the result of a prolapsed segment of mesentery and occurs most often in the ileum, the cecum, or the sigmoid parts of the bowel. If it is not corrected, the obstructed bowel becomes necrotic, peritonitis and rupture of the bowel occur, and death may result.

Wandering: The diagnosis is defined as meandering, aimless or repetitive locomotion that exposes the individual to harm. It is frequently incongruent with boundaries, limits, or obstacles. Related factors include cognitive impairment, specifically memory and recall deficits, disorientation, poor visuoconstructive ability, and language defects.

Wasting: A process of deterioration marked by weight loss and decreased physical vigor, appetite, and mental activity. See also wasting syndrome.

Whiplash Injury: An injury to the cervical vertebrae or their supporting ligaments and muscles marked by pain and stiffness. It usually results from sudden acceleration or deceleration, such as in a rear-end car collision that causes violent back-and-forth movement of the head and neck.

White Blood Cell: A white blood cell, one of the formed elements of the circulating blood system.

World Health Organization (WHO): An intergovernmental organization within the United Nations system whose purpose is to aid in the attainment of the highest possible level of health by all people. For more information, click here.

Wound: Any physical injury involving a break in the skin, usually caused by an act or accident rather than by a disease, such as a chest wound, gunshot wound, or puncture wound. To cause an injury, especially one that breaks the skin.

Wound Care: A nursing intervention from the Nursing Interventions Classification (NIC) defined as prevention of wound complications and promotion of wound healing.

Xanax: Trademark for a benzodiazepine antianxiety agent (alprazolam).

X-ray: Electromagnetic radiation with wavelengths between about 0.005 and 10 mm. X-rays are produced when electrons traveling at high speed strike certain materials, particularly heavy metals such as tungsten. For more information, click here.

X-ray Dermatitis: A skin inflammation caused by exposure to x-rays. Excessive exposure to x-rays can lead to skin cancer.

Yeast: Any unicellular, usually oval, nucleated fungus that reproduces by budding.

Yellow Fever: An acute arbovirus infection transmitted by mosquitoes.

Zinc: An essential nutrient in the body and is used in numerous pharmaceutics, such as zinc acetate, zinc oxide, zinc permanganate, and zinc stearate.

Zinc deficiency: A condition resulting from insufficient amounts of zinc in the diet. It is characterized by abnormal fatigue, decreased alertness, a decrease in taste and odor sensitivity and poor appetite.

Zinc Oxide: A topical protectant used for a wide range of minor skin irritations.

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