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ENGLISH TERMS GENERAL TERMS activities of daily living (ADLs): self-care activities including bathing, grooming, dressing, eating, toileting, and bowel and bladder care adaptive device: a type of assistive technology that is used to change the environment or help the person to modify the environment (e.g., a ramp that can be used in place of steps for someone in a wheelchair) adaptation: a change or alteration designed to assist in adapting to a new situation or environment adherence: the process of faithfully following guidelines or directions adrenocorticotropic hormone (ACTH): a hormone produced by the anterior lobe of the pituitary gland that stimulates the secretion of cortisol and other hormones by the adrenal cortex ankylosis: fixation or immobility of a joint antidiuretic hormone (ADH): a hormone secreted by the posterior lobe of the pituitary gland that constricts blood vessels, elevates blood pressure, and reduces the excretion of urine anxiety: an emotional state characterized by feelings of apprehension, discomfort, restlessness, or worry arthritis: inflammation of a joint arthroplasty: replacement of a joint assessment: the systematic collection of data to determine the patient’s health status and any actual or potential health problems assistive device: a type of assistive technology that helps people with disabilities perform a given task (e.g., a lap board with pictures that is used to assist a person who cannot talk to communicate) assistive technology: any item, piece of equipment, or product system—whether acquired commercially, off the shelf, modified, or customized—that is used to improve the functional capabilities of individuals with dis- abilities; this term encompasses both assistive devices and adaptive devices auscultation: listening to sounds produced within different body structures created by the movement of air or fluid bereavement: feelings, thoughts, and responses that occur after a loss body mass index (BMI): a calculation done to estimate the amount of body fat of a person catecholamines: any of the group of amines (such as epinephrine, norepinephrine, or dopamine) that serve as neurotransmitters chronic conditions: medical or health problems with associated symptoms or disabilities that require long-term management (3 months or longer) collaborative problems: specific pathophysiologic manifestations that nurses monitor to detect onset or changes in status community: an interacting population of individuals living together within a larger society coping: the cognitive and behavioral strategies used to man- age the stressors that tax a person’s resources critical thinking: a process of insightful thinking that utilizes multiple dimensions of one’s cognition to develop conclusions, solutions, and alternatives that are appropriate for the given situation culture: the knowledge, belief, art, morals, laws, customs, and any other capabilities and habits acquired by humans as members of society culturally competent nursing care: effective, individualized care that demonstrates respect for the dignity, personal rights, preferences, beliefs, and practices of the person receiving care, while acknowledging the biases of the caregiver and preventing these biases from interfering with the care provided cultural nursing assessment: a systematic appraisal or examination of individuals, families, groups, and communities in terms of their cultural beliefs, values, and practices deontological or formalist theory: an ethical theory maintaining that ethical standards or principles exist independently of the ends or consequences depression: state in which a person feels sad, distressed, and hopeless, with little to no energy for normal activities disability: restriction or lack of ability to perform an activity in a normal manner; the consequences of impairment in terms of an individual’s functional performance and activity. Disabilities represent disturbances at the level of the person (e.g., bathing, dressing, communication, walking, grooming) dysplasia: bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same tissue type ethics: the formal, systematic study of moral beliefs evaluation: determination of the patient’s responses to the nursing interventions and the extent to which the outcomes have been achieved faith: belief and trust in God or a higher power family: a group whose members are related by reciprocal caring, mutual responsibilities, and loyalties feedback: the return of information about the results of input given to a person or a system glucocorticoids: the group of steroid hormones, such as cortisol, that are produced by the adrenal cortex; they are involved in carbohydrate, protein, and fat metabolism and have anti-inflammatory properties gluconeogenesis: the formation of glucose by the liver from non-carbohydrate sources, such as amino acids and the glycerol portion of fats grief: a universal response to any loss guided imagery: the mindful use of a word, phrase, or visual image to achieve relaxation or direct attention away from uncomfortable sensations or situations habilitation: making able; learning new skills and abilities to meet maximum potential health education: a variety of learning experiences designed to promote behaviors that facilitate health health history: a series of questions that provides an overview of the patient’s current health status health promotion: the art and science of assisting people to change their lifestyle toward a higher state of wellness holistic health: promotion of the total health of mind, body, and spirit homeostasis: a steady state within the body; the stability of the internal environment hyperplasia: an increase in the number of new cells of a tissue hypoxia: inadequate supply of oxygen to the cell impairment: loss or abnormality of psychological, physiologic, or anatomic structure or function at the organ level (e.g., dysphagia, hemiparesis); an abnormality of body structure, appearance, and organ or system function resulting from any cause implementation: actualization or carrying out of the plan of care through nursing interventions inflammation: a localized, protective reaction of tissue to injury, irritation, or infection, manifested by pain, redness, heat, swelling, and sometimes loss of function inspection: visual assessment of different aspects of the patient instrumental activities of daily living (IADLs): complex aspects of independence including meal preparation, grocery shopping, household management, finances, and transportation learning: the act of gaining knowledge and skill learning readiness: the optimum time for learning to occur; usually corresponds to the learner’s perceived need and desire to obtain specific knowledge mental disorder: a state in which a person has deficits in functioning, has a distorted sense of self or the world, is unable to sustain relationships, or cannot handle stress or conflict effectively mental health: a state in which a person can meet basic needs, assume responsibilities, sustain relationships, resolve conflicts, and grow throughout life metaplasia: a cell transformation in which there is conversion of one type of mature cell into another type of cell minority: group of people whose physical or cultural characteristics differ from the majority of people in a society moral dilemma: situation in which a clear conflict exists between two or more moral principles or competing moral claims moral distress: conflict that arises within oneself when a person is aware of the correct course of action but institutional constraints stand in the way of pursuing the correct action moral problem: competing moral claim or principle; one claim or principle is clearly dominant moral uncertainty: conflict that arises within a person when he or she cannot accurately define what the moral situation is or what moral principles apply but has a strong feeling that something is not right morality: the adherence to informal personal values negative feedback: feedback that decreases the output of a system nursing diagnoses: actual or potential health problems that can be managed by independent nursing interventions nursing process: a deliberate problem-solving approach for meeting people’s health care and nursing needs; common components are assessment, diagnosis, planning, implementation, and evaluation nutrition: the science that deals with food and nourishment in humans osteoarthritis: degenerative joint disease osteophyte: a bony outgrowth or protuberance; bone spur palpation: examination of different organs of the body using the sense of touch pannus: proliferation of newly formed synovial tissue infiltrated with inflammatory cells percussion: the use of sound to examine different organs of the body physical fitness: the condition of being physically healthy as a result of proper exercise and nutrition planning: development of goals and outcomes, as well as a plan of care designed to assist the patient in resolving the diagnosed problems and achieving the identified goals and desired outcomes positive feedback: feedback that increases the output of a system posttraumatic stress disorder (PTSD): the development of severe anxiety-type symptoms after the experience of a traumatic life event pressure ulcer: breakdown of the skin due to prolonged pressure and insufficient blood supply, usually at bony prominences rehabilitation: making able again; relearning skills or abilities or adjusting existing functions reinforcement: the process of strengthening a given response or behavior to increase the likelihood that the behavior will continue rheumatic diseases: numerous disorders affecting skeletal muscles, bones, cartilage, ligaments, tendons, and joints rheumatoid arthritis: autoimmune disease of unknown origin secondary conditions or disorders: any physical, mental, or social disorders resulting directly or indirectly from an initial disabling condition; a condition to which a person with a disability is more susceptible because of having a primary disabling condition self-responsibility: personal accountability for one’s actions or behavior spirituality: connectedness with self, others, a life force, or God that allows people to find meaning in life steady state: a stable condition that does not change over time, or when change in one direction is balanced by change in an opposite direction stress: a disruptive condition that occurs in response to adverse influences from the internal or external environments stress management: behaviors and techniques used to strengthen a person’s resources against stress subchondral bone: bony plate that supports the articular cartilage subculture: relatively large groups of people who share characteristics that identify them as a distinct entity substance abuse: a maladaptive pattern of drug use that causes physical and emotional harm with the potential for disruption of daily life teaching: the imparting of knowledge teleological theory or consequentialism: the theoretical basis of ethics, which focuses on the ends or consequences of actions, such as utilitarianism therapeutic regimen: a routine that promotes health and healing tophi: accumulation of crystalline deposits in articular surfaces, bones, soft tissue, and cartilage transcultural nursing: nursing care to clients and families across cultural variations utilitarianism: a teleological theory of ethics based on the concept of “the greatest good for the greatest number” wellness: a condition of good physical and emotional health sustained by a healthy lifestyle HEALTH CARE OF THE ADULT PATIENT advance directive: a formal, legally endorsed document that provides instructions for care (“living will”) ageism: a bias that discriminates, stigmatizes, and disadvantages older people based solely on their chronologic age alopecia: loss of hair from any cause comorbidity: having more than one illness at the same time (e.g., diabetes mellitus and congestive heart failure) delirium: an acute, confused state that begins with disorientation that if not immediately evaluated and treated, can progress to changes in level of consciousness, irreversible brain damage, and sometimes death dementia: broad term for a syndrome characterized by a general decline in higher brain functioning, such as reasoning, with a pattern of eventual decline in ability to perform even basic activities of daily living, such as toileting and eating depression: the most common affective (mood) disorder of old age; results from changes in reuptake of the neurochemical serotonin in response to chronic illness and emotional stresses related to the physical and social changes associated with the aging process dermatosis: any abnormal skin condition durable power of attorney: a formal, legally endorsed document that identifies a proxy decision maker who can make decisions if the signer becomes incapacitated elder abuse: the physical, emotional, or financial harm to an elderly person by one or more of the individual’s children, caregivers, or others; includes neglect erythema: redness of the skin caused by congestion of the capillaries hirsutism: the condition of having excessive hair growth hyperpigmentation: increase in the melanin of the skin, resulting in an increase in pigmentation hypopigmentation: decrease in the melanin of the skin, resulting in a loss of pigmentation keratin: an insoluble, fibrous protein that forms the outer layer of skin Langerhans cells: dendritic clear cells in the epidermis that carry surface receptors for immunoglobulin and complement and that are active participants in delayed hypersensitivity of the skin melanin: the substance responsible for coloration of the skin melanocytes: cells of the skin that produce melanin Merkel cells: cells of the epidermis that play a role in transmission of sensory messages orientation: a person’s ability to recognize who and where he or she is in a time continuum; used to evaluate one’s basic cognitive status polypharmacy: the administration of multiple medications at the same time; common in older persons with several chronic illnesses presbycusis: the decreased ability to hear high-pitched tones that naturally begins in midlife as a result of irreversible inner ear changes presbyopia: the decrease in visual accommodation that occurs with advancing age petechiae: pinpoint red spots that appear on the skin as a result of blood leakage into the skin rete ridges: undulations and furrows that appear at the dermis–epidermis junction and are responsible for cementing together the two layers sebaceous glands: glands that exist within the epidermis and secrete sebum to keep the skin soft and pliable sebum: fatty secretion of the sebaceous glands sundowning: increased confusion at night telangiectases: red marks on the skin caused by distention of the superficial blood vessels vitiligo: a localized or widespread condition characterized by destruction of the melanocytes in circumscribed areas of the skin, resulting in white patches Wood’s light: a blue light used for diagnosing skin conditions PAIN MANAGEMENT addiction: a behavioral pattern of substance use characterized by a compulsion to take the substance (drug or alcohol) primarily to experience its psychic effects agonist: a substance that when combined with the receptor produces the drug effect or desired effect. Endorphins and morphine are agonists on the opioid receptors algogenic: causing pain antagonist: a substance that blocks or reverses the effects of the agonist by occupying the receptor site without producing the drug effect balanced analgesia: using more than one form of analgesia concurrently to obtain more pain relief with fewer side effects breakthrough pain: a sudden and temporary increase in pain occurring in a patient being managed with opioid analgesia dependence: occurs when a patient who has been taking opioids experiences a withdrawal syndrome when the opioids are discontinued; often occurs with opioid tolerance and does not indicate an addiction endorphins and enkephalins: morphine like substances produced by the body. Primarily found in the central nervous system, they have the potential to reduce pain nociception: activation of sensory transduction in nerves by thermal, mechanical, or chemical energy impinging on specialized nerve endings; the nerves involved convey information about tissue damage to the central nervous system nociceptor: a receptor preferentially sensitive to a noxious stimulus non-nociceptor: nerve fiber that usually does not transmit pain opioid: a morphine like compound that produces bodily effects including pain relief, sedation, constipation, and respiratory depression pain: an unpleasant sensory and emotional experience resulting from actual or potential tissue damage pain threshold: the point at which a stimulus is perceived as painful pain tolerance: the maximum intensity or duration of pain that a person is able to endure patient-controlled analgesia (PCA): self-administration of analgesic agents by a patient instructed about the procedure placebo effect: analgesia that results from the expectation that a substance will work, not from the actual substance itself prostaglandins: chemical substances that increase the sensitivity of pain receptors by enhancing the pain-provoking effect of bradykinin referred pain: pain perceived as coming from an area different from that in which the pathology is occurring sensitization: a heightened response seen after exposure to a noxious stimulus. Response to the same stimulus is to feel more pain tolerance: occurs when a person who has been taking opioids becomes less sensitive to their analgesic properties (and usually side effects); characterized by the need for increasing doses to maintain the same level of pain relief FLUID AND ELECTROLYTE IMBALANCE acidosis: an acid–base imbalance characterized by an increase in H+ concentration (decreased blood pH). A low arterial pH due to reduced bicarbonate concentration is called metabolic acidosis; a low arterial pH due to increased PCO2 is respiratory acidosis active transport: physiologic pump that moves fluid from an area of lower concentration to one of higher concentration; active transport requires adenosine triphosphate for energy alkalosis: an acid–base imbalance characterized by a reduction in H+ concentration (increased blood pH). A high arterial pH with increased bicarbonate concentration is called metabolic alkalosis; a high arterial pH due to reduced PCO2 is respiratory alkalosis diffusion: the process by which solutes move from an area of higher concentration to one of lower concentration; does not require expenditure of energy homeostasis: maintenance of a constant internal equilibrium in a biologic system that involves positive and negative feedback mechanisms hydrostatic pressure: the pressure created by the weight of fluid against the wall that contains it. In the body, hydrostatic pressure in blood vessels results from the weight of fluid itself and the force resulting from cardiac contraction hypertonic solution: a solution with an osmolality higher than that of serum hypotonic solution: a solution with an osmolality lower than that of serum isotonic solution: a solution with the same osmolality as serum and other body fluids. Osmolality falls within normal range for serum (280 to 300 mOsm/kg) osmolality: the number of osmoles (the standard unit of osmotic pressure) per kilogram of solution. Expressed as mOsm/kg, osmolality is used more often than the term osmolality to evaluate serum and urine osmolality: the number of osmoles (the standard unit of osmotic pressure) per liter of solution. It is expressed as milliosmoles per liter (mOsm/L); describes the concentration of solutes or dissolved particles osmosis: the process by which fluid moves across a semipermeable membrane from an area of low solute concentration to an area of high solute concentration; the process continues until the solute concentrations are equal on both sides of the membrane tonicity: fluid tension within the extracellular fluid or intracellular fluid that describes the relationship between the solutes and water, primarily determined by fluid osmolality SHOCK AND MULTIPLE ORGAN DYSFUNCTION anaphylactic shock: circulatory shock state resulting from a severe allergic reaction producing an overwhelming systemic vasodilation and relative hypovolemia biochemical mediators: messenger substances that may be released by a cell to create an action at that site or be carried by the bloodstream to a distant site before being activated; also called cytokines cardiogenic shock: shock state resulting from impairment or failure of the myocardium circulatory shock: shock state resulting from displacement of blood volume creating a relative hypovolemia and inadequate delivery of oxygen to the cells; also called distributive shock colloids: intravenous solutions that contain molecules that are too large to pass through capillary membranes crystalloids: intravenous electrolyte solutions that move freely between the intravascular compartment and interstitial spaces hypovolemic shock: shock state resulting from decreased intravascular volume due to fluid loss multiple organ dysfunction syndrome: presence of altered function of two or more organs in an acutely ill patient such that interventions are necessary to support continued organ function neurogenic shock: shock state resulting from loss of sympathetic tone causing relative hypovolemia septic shock: circulatory shock state resulting from overwhelming infection causing relative hypovolemia shock: physiologic state in which there is inadequate blood flow to tissues and cells of the body systemic inflammatory response syndrome: overwhelming inflammatory response in the absence of infection causing relative hypovolemia and decreased tissue perfusion ONCOLOGY AND END-OF-LIFE CARE anaplasia: cells that lack normal cellular characteristics and differ in shape and organization with respect to their cells of origin; usually, anaplastic cells are malignant apoptosis: programmed cell death assisted suicide: use of pharmacologic agents to hasten the death of a terminally ill patient; illegal in most states autonomy: self-determination; in the health care context, the right of the individual to make choices about the use and discontinuation of medical treatment benign: not cancerous; benign tumors may grow but are unable to spread to other areas bereavement: period during which mourning for a loss takes place biologic response modifier (BRM) therapy: use of agents or treatment methods that can alter the immunologic relationship between the tumor and the host to provide a therapeutic benefit biopsy: a diagnostic procedure to remove a small sample of tissue to be examined microscopically to detect malignant cells brachytherapy: delivery of radiation therapy through internal implants cancer: a disease process whereby cells proliferate abnormally, ignoring growthregulating signals in the environment surrounding the cells carcinogenesis: process of transforming normal cells into malignant cells chemotherapy: use of medications to kill tumor cells by interfering with cellular functions and reproduction control: containment of the growth of cancer cells cure: prolonged survival and disappearance of all evidence of disease so that the patient has the same life expectancy as anyone else in his or her age group cytokines: substances produced by cells of the immune system to enhance production and functioning of components of the immune system dysplasia: bizarre cell growth resulting in cells that differ in size, shape, or arrangement from other cells of the same type of tissue euthanasia: Greek for “good death”; has evolved to mean the intentional killing by act or omission of a dependent human being for his or her alleged benefit extravasation: leakage of medication from the veins into the subcutaneous tissues grading: identification of the type of tissue from which the tumor originated and the degree to which the tumor cells retain the functional and structural characteristics of the tissue of origin graft-versus-host disease (GVHD): an immune response initiated by T lymphocytes of donor tissue against the recipient’s tissues (skin, gastrointestinal tract, liver); an undesirable response graft-versus-tumor effect: the donor cell response against the malignancy; a desirable response grief: the personal feelings that accompany an anticipated or actual loss hospice: a coordinated program of interdisciplinary care and services provided primarily in the home to terminally ill patients and their families hyperplasia: increase in the number of cells of a tissue; most often associated with periods of rapid body growth interdisciplinary collaboration: communication and cooperation among members of diverse health care disciplines jointly to plan, implement, and evaluate care malignant: having cells or processes that are characteristic of cancer Medicare Hospice Benefit: a Medicare entitlement that provides for comprehensive, interdisciplinary palliative care and services for eligible beneficiaries who have a terminal illness and a life expectancy of less than 6 months metaplasia: conversion of one type of mature cell into another type of cell metastasis: spread of cancer cells from the primary tumor to distant sites mourning: individual, family, group, and cultural expressions of grief and associated behaviors myelosuppression: suppression of the blood cell–producing function of the bone marrow nadir: lowest point of white blood cell depression after therapy that has toxic effects on the bone marrow neoplasia: uncontrolled cell growth that follows no physiologic demand neutropenia: abnormally low absolute neutrophil count oncology: field or study of cancer palliation: relief of symptoms and promotion of comfort and quality of life palliative care: comprehensive care for patients whose disease is not responsive to cure; care also extends to patients’ families palliative sedation: use of pharmacologic agents, at the request of the terminally ill patient, to induce sedation when symptoms have not responded to other management measures; the purpose is not to hasten the patient’s death but to relieve intractable symptoms prognosis: the expected course of an illness and the chance for recovery radiation therapy: use of ionizing radiation to interrupt the growth of malignant cells spirituality: personal belief systems that focus on a search for meaning and purpose in life, intangible elements that impart meaning and vitality to life, and a connectedness to a higher or transcendent dimension staging: process of determining the extent of disease, including tumor size and spread or metastasis to distant sites stomatitis: inflammation of the oral tissues, often associated with some chemotherapeutic agents and radiation therapy to the head and neck region targeted therapies: cancer treatments that seek to minimize the negative effects on healthy tissues by disrupting specific cancer cell functions, such as malignant transformation, communication pathways, processes for growth and metastasis, and genetic coding terminal illness: progressive, irreversible illness that despite cure-focused medical treatment will result in the patient’s death thrombocytopenia: decrease in the number of circulating platelets; associated with the potential for bleeding tumor-specific antigen (TSA): protein on the membrane of cancer cells that distinguishes the malignant cell from a benign cell of the same tissue type vesicant: substance that can cause tissue necrosis and damage, particularly when extravasated xerostomia: dry oral cavity resulting from decreased function of salivary glands PRE-INTRA-OPERATIVE: ambulatory surgery: includes outpatient, same-day, or short-stay surgery that does not require an overnight hospital stay anesthesia: a state of narcosis, analgesia, relaxation, and loss of reflexes anesthesiologist: physician trained to deliver anesthesia and to monitor the patient’s condition during surgery anesthetic agent: the substance, such as a chemical or gas, used to induce anesthesia anesthetist: health care professional, such as a nurse anesthetist, who is trained to deliver anesthesia and to monitor the patient’s condition during surgery circulating nurse (or circulator): registered nurse who coordinates and documents patient care in the operating room dehiscence: partial or complete separation of wound edges epidural anesthesia: state of narcosis, analgesia, relaxation, and loss of reflexes achieved by injecting an anesthetic agent into the epidural space of the spinal cord evisceration: protrusion of organs through the surgical incision first-intention healing: method of healing in which wound edges are surgically approximated and integumentary continuity is restored without granulation general anesthesia: state of narcosis, analgesia, relaxation, and loss of reflexes produced by pharmacologic agents informed consent: the patient’s autonomous decision about whether to undergo a surgical procedure, based on the nature of the condition, the treatment options, and the risks and benefits involved intraoperative phase: period of time that begins with transfer of the patient to the operating room table and continues until the patient is admitted to the post-anesthesia care unit local anesthesia: injection of a solution containing the anesthetic agent into the tissues at the planned incision site malignant hyperthermia: a rare life-threatening condition triggered by exposure to most anesthetic agents inducing a drastic and uncontrolled increase in skeletal muscle oxidative metabolism that can overwhelm the body’s capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if untreated. Malignant hyperthermia is often inherited as an autosomal dominant disorder moderate sedation: previously referred to as conscious sedation, involves use of sedation to depress the level of consciousness without altering the patient’s ability to maintain a patent airway and to respond to physical stimuli and verbal commands monitored anesthesia care: moderate sedation administered by an anesthesiologist or anesthetist perioperative phase: period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care Phase I PACU: area designated for care of surgical patients immediately after surgery and for patients whose condition warrants close monitoring Phase II PACU: area designated for care of surgical patients who have been transferred from a phase I PACU because their condition no longer requires the close monitoring provided in a phase I PACU Phase III PACU: setting in which the patient is cared for in the immediate postoperative period and then prepared for discharge from the facility Post-anesthesia care unit (PACU): area where postoperative patients are monitored as they recover from anesthesia; formerly referred to as the recovery room or postanesthesia recovery room postoperative phase: period of time that begins with the admission of the patient to the post-anesthesia care unit and ends after follow-up evaluation in the clinical setting or home preadmission testing: diagnostic testing performed before admission to the hospital preoperative phase: period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table regional anesthesia: an anesthetic agent is injected around nerves so that the area supplied by these nerves is anesthetized restricted zone: area in the operating room where scrub attire and surgical masks are required; includes operating room and sterile core areas scrub role: registered nurse, licensed practical nurse, or surgical technologist who scrubs and dons sterile surgical attire, prepares instruments and supplies, and hands instruments to the surgeon during the procedure semi restricted zone: area in the operating room where scrub attire is required; may include areas where surgical instruments are processed spinal anesthesia: achieved when a local anesthetic agent is introduced into the subarachnoid space of the spinal cord surgical asepsis: absence of microorganisms in the surgical environment to reduce the risk for infection unrestricted zone: area in the operating room that interfaces with other departments; includes patient reception area and holding area second-intention healing: method of healing in which wound edges are not surgically approximated and integumentary continuity is restored by the process known as granulation third-intention healing: method of healing in which surgical approximation of wound edges is delayed and integumentary continuity is restored by apposing areas of granulation GENETICS: carrier: person who is heterozygous; possessing two different alleles of a gene pair chromosome: microscopic structures in the cell nucleus that contain genetic information and are constant in number in a species (e.g., humans have 46 chromosomes) deoxyribonucleic acid (DNA): the primary genetic material in humans consisting of nitrogenous bases, a sugar group, and phosphate combined into a double helix dominant: a genetic trait that is normally expressed when a person has a gene mutation on one of a pair of chromosomes and the “normal” form of the gene is on the other chromosome genetics: the scientific study of heredity; how specific traits or predispositions are transmitted from parents to offspring genome: the total genetic complement of an individual genotype genomics: the study of the human genome, including gene sequencing, mapping, and function genotype: the genes and the variations therein that a person inherits from his or her parents Human Genome Project: an international research effort aimed at identifying and characterizing the order of every base in the human genome mutation: a heritable alteration in the genetic material nondisjunction: the failure of a chromosome pair to separate appropriately during meiosis, resulting in abnormal chromosome numbers in reproductive cells (gametes) pedigree: a diagrammatic representation of a family history phenotype: a person’s entire physical, biochemical, and physiologic makeup, as determined by the person’s genotype and environmental factors predisposition testing: testing that is used to determine the likelihood that a healthy person with or without a family history of a condition will develop a disorder prenatal screening: testing that is used to identify whether a fetus is at risk for a birth defect such as Down syndrome or spina bifida (e.g., multiple marker maternal serum screening in pregnancy) presymptomatic testing: genetic testing that is used to determine whether persons with a family history of a disorder, but no current symptoms, have the gene mutation (e.g., testing for Huntington disease) recessive: a genetic trait that is expressed only when a person has two copies of a mutant autosomal gene or a single copy of a mutant X-linked gene in the absence of another X chromosome variable expression: variation in the degree to which a trait is manifested; clinical severity X-linked: located on the X chromosome RESPIRATORY SYSTEM: acute lung injury: an umbrella term for hypoxemic, respiratory failure; acute respiratory distress syndrome is a severe form of acute lung injury acute respiratory distress syndrome: nonspecific pulmonary response to a variety of pulmonary and non-pulmonary insults to the lung; characterized by interstitial infiltrates, alveolar hemorrhage, atelectasis, decreased compliance, and refractory hypoxemia air trapping: incomplete emptying of alveoli during expiration due to loss of lung tissue elasticity (emphysema), bronchospasm (asthma), or airway obstruction airway pressure release ventilation (APRV): mode of mechanical ventilation that allows unrestricted, spontaneous breaths throughout the ventilatory cycle; on inspiration patient receives preset level of continuous positive airway pressure, and pressure is periodically released to aid expiration alaryngeal communication: alternative modes of speaking that do not involve the normal larynx; used by patients whose larynx has been surgically removed alpha1-antitrypsin deficiency: genetic disorder resulting from deficiency of alpha1 antitrypsin, a protective agent for the lung; increases patient’s risk for developing panacinar emphysema even in the absence of smoking aphonia: impaired ability to use one’s voice due to disease or injury to the larynx apnea: cessation of breathing asbestosis: diffuse lung fibrosis resulting from exposure to asbestos fibers assist–control ventilation (A/C): mode of mechanical ventilation in which the patient’s breathing pattern may trigger the ventilator to deliver a preset tidal volume; in the absence of spontaneous breathing, the machine delivers a controlled breath at a preset minimum rate and tidal volume asthma: a disease with multiple precipitating mechanisms resulting in a common clinical outcome of reversible air- flow obstruction; no longer considered a category of COPD atelectasis: collapse or airless condition of the alveoli caused by hypoventilation, obstruction to the airways, or compression bronchiectasis: chronic dilation of a bronchus or bronchi; the dilated airways become saccular and are a medium for chronic infection; no longer considered a category of COPD bronchitis: a disease of the airways defined as the presence of cough and sputum production for at least a combined total of 3 months in each of 2 consecutive years; a category of COPD bronchophony: abnormal increase in clarity of transmitted voice sounds bronchoscopy: direct examination of larynx, trachea, and bronchi using an endoscope carcinogen: agent that can cause cancer; carcinogens can be chemicals, viruses, hormones, ionizing radiation, or solid materials central cyanosis: bluish discoloration of the skin or mucous membranes due to hemoglobin carrying reduced amounts of oxygen chest drainage system: use of a chest tube and closed drainage system to re-expand the lung and to remove excess air, fluid, and blood chest percussion: manually cupping over the chest wall to mobilize secretions by mechanically dislodging viscous or adherent secretions in the lungs chest physiotherapy (CPT): therapy used to remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles; types include postural drainage, chest percussion, and vibration chronic obstructive pulmonary disease: disease state characterized by airflow limitation that is not fully reversible; sometimes referred to as chronic airway obstruction or chronic obstructive lung disease cilia: short hairs that provide a constant whipping motion that serves to propel mucus and foreign substances away from the lung toward the larynx compliance: measure of the force required to expand or inflate the lungs consolidation: lung tissue that has become more solid in nature due to collapse of alveoli or infectious process (pneumonia) continuous positive airway pressure (CPAP): positive pressure applied throughout the respiratory cycle to a spontaneously breathing patient to promote alveolar and airway stability; may be administered with endotracheal or tracheostomy tube or by mask controlled ventilation: mode of mechanical ventilation in which the ventilator completely controls the patient’s ventilation according to preset tidal volumes and respiratory rate; because of problems with synchrony, it is rarely used except in paralyzed or anesthetized patients cor pulmonale: ”heart of the lungs”; enlargement of the right ventricle from hypertrophy or dilation or as a secondary response to disorders that affect the lungs crackles: soft, high-pitched, discontinuous popping sounds during inspiration caused by delayed reopening of the airways diffusion: exchange of gas molecules from areas of high concentration to areas of low concentration dysphagia: difficulties in swallowing dyspnea: labored breathing or shortness of breath egophony: abnormal change in tone of voice that is heard when auscultating lungs emphysema: a disease of the airways characterized by destruction of the walls of over-distended alveoli; a category of COPD empyema: accumulation of purulent material in the pleural space endotracheal intubation: insertion of a breathing tube through the nose or mouth into the trachea epistaxis: hemorrhage from the nose due to rupture of tiny, distended vessels in the mucous membrane of any area of the nose fine-needle aspiration: insertion of a needle through the chest wall to obtain cells of a mass or tumor; usually performed under fluoroscopy or chest computed tomography guidance fraction of inspired oxygen (FiO2): concentration of oxygen delivered (1.0 = 100% oxygen) fremitus: vibrations of speech felt as tremors of chest wall during palpation hemoptysis: the coughing up of blood from the lower respiratory tract hemothorax: partial or complete collapse of the lung due to blood accumulating in the pleural space; may occur after surgery or trauma herpes simplex: cold sore (cutaneous viral infection with painful vesicles and erosions on the tongue, palate, gingiva, buccal membranes, or lips) hypoxemia: decrease in arterial oxygen tension in the blood hypoxia: decrease in oxygen supply to the tissues and cells incentive spirometry: method of deep breathing that provides visual feedback to help the patient inhale deeply and slowly and achieve maximum lung inflation induration: an abnormally hard lesion or reaction, as in a positive tuberculin skin test intermittent mandatory ventilation (IMV): mode of mechanical ventilation that provides a combination of mechanically assisted breaths and spontaneous breaths laryngectomy: surgical removal of all or part of the larynx and surrounding structures laryngitis: inflammation of the larynx; may be caused by voice abuse, exposure to irritants, or infectious organisms mechanical ventilator: a positive- or negative-pressure breathing device that supports ventilation and oxygenation medicamentosa: rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants metered-dose inhaler: patient-activated medication canister that provides aerosolized medication that the patient inhales into the lungs nosocomial: pertaining to or originating from a hospitalization; not present at the time of hospital admission nuchal rigidity: stiffness of the neck or inability to bend the neck obstructive sleep apnea: temporary absence of breathing during sleep secondary to transient upper airway obstruction open lung biopsy: biopsy of lung tissue performed through a limited thoracotomy incision orthopnea: shortness of breath when reclining or in the supine position orthopnea: inability to breathe easily except in an upright position oxygen saturation: percentage of hemoglobin that is bound to oxygen pharyngitis: inflammation of the throat; usually viral or bacterial in origin physiologic dead space: portion of the tracheobronchial tree that does not participate in gas exchange pleural effusion: abnormal accumulation of fluid in the pleural space pleural friction rub: localized grating or creaking sound caused by the rubbing together of inflamed parietal and visceral pleurae pleural space: the area between the parietal and visceral pleurae; a potential space pneumothorax: partial or complete collapse of the lung due to positive pressure in the pleural space polycythemia: increase in the red blood cell concentration in the blood; in COPD, the body attempts to improve oxygen carrying capacity by producing increasing amounts of red blood cells positive end-expiratory pressure (PEEP): positive pressure maintained by the ventilator at the end of exhalation (instead of a nor- mal zero pressure) to increase functional residual capacity and open collapsed alveoli; improves oxygenation with lower fraction of inspired oxygen postural drainage: positioning the patient to allow drainage from all the lobes of the lungs and airways pressure support ventilation (PSV): mode of mechanical ventilation in which preset positive pressure is delivered with spontaneous breaths to decrease work of breathing proportional assist ventilation (PAV): mode of mechanical ventilation that provides partial ventilatory support in proportion to the patient’s inspiratory efforts; decreases the work of breathing pulmonary edema: increase in the amount of extravascular fluid in the lung pulmonary embolism: obstruction of the pulmonary vasculature with an embolus; embolus may be due to blood clot, air bubbles, or fat droplets purulent: consisting of, containing, or discharging pus pulmonary perfusion: blood flow through the pulmonary vasculature respiration: gas exchange between atmospheric air and the blood and between the blood and cells of the body respiratory weaning: process of gradual, systematic withdrawal or removal of ventilator, breathing tube, and oxygen restrictive lung disease: disease of the lung that causes a decrease in lung volumes rhinitis: inflammation of the mucous membranes of the nose; may be infectious, allergic, or inflammatory in origin rhinorrhea: drainage of a large amount of fluid from the nose rhinosinusitis: inflammation of the nares and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses; replaces the term “sinusitis” rhonchi: low-pitched wheezing or snoring sound associated with partial airway obstruction, heard on chest auscultation synchronized intermittent mandatory ventilation (SIMV): mode of mechanical ventilation in which the ventilator allows the patient to breathe spontaneously while providing a preset number of breaths to ensure adequate ventilation; ventilated breaths are synchronized with spontaneous breathing spirometry: pulmonary function tests that measure specific lung volumes (e.g., FEV1, FVC) and rates (FEF25–75%); may be measured before and after bronchodilator administration stridor: harsh high-pitched sound heard on inspiration, usually without need of stethoscope, secondary to upper airway obstruction tachypnea: abnormally rapid respirations tension pneumothorax: pneumothorax characterized by increasing positive pressure in the pleural space with each breath; this is an emergency situation and the positive pressure needs to be decompressed or released immediately thoracentesis: insertion of a needle into the pleural space to remove fluid that has accumulated and decrease pressure on the lung tis- sue; may also be used diagnostically to identify potential causes of a pleural effusion thoracotomy: surgical opening into the chest cavity tidal volume: volume of air inspired and expired with each breath during normal breathing tonsillitis: inflammation of the tonsils, usually due to an acute infection tracheostomy tube: indwelling tube inserted directly into the trachea to assist with ventilation tracheotomy: surgical opening into the trachea transbronchial: through the bronchial wall, as in a transbronchial lung biopsy ventilation: movement of air in and out of airways ventilation–perfusion ratio: the ratio between ventilation and per- fusion in the lung; matching of ventilation to perfusion optimizes gas exchange vibration: a type of massage administered by quickly tapping the chest with the fingertips or alternating the fingers in a rhythmic manner, or by using a mechanical device to assist in mobilizing lung secretions wheezes: continuous musical sounds associated with airway narrowing or partial obstruction xerostomia: dryness of the mouth from a variety of causes COPD - chronic obstructive pulmonary disease CRP - C‐reactive protein FEV1 - forced expiratory volume in 1 second LABA - long acting inhaled β2 agonist LABD - long acting bronchodilator MDI - metered dose inhaler NIV - non‐invasive ventilation PEFR - peak expiratory flow rate SABA - short acting β2 agonist SABD - short acting bronchodilator SAMA - short acting muscarinic antagonist Sao2 - arterial oxygen saturation CARDIOVASCULAR SYSTEM: ablation: purposeful destruction of heart muscle cells, usually in an attempt to control a dysrhythmia acute coronary syndrome: refers to rupture of an atheromatous plaque in a diseased coronary artery, which rapidly forms an obstructive thrombus. Signs and symptoms that indicate unstable angina or acute myocardial infarction afterload: the amount of resistance to ejection of blood from the ventricle angina pectoris: chest pain brought about by myocardial ischemia antiarrhythmic medication: a medication that suppresses or prevents a dysrhythmia apical impulse (also called point of maximum impulse): impulse normally palpated at the fifth intercostal space, left mid-clavicular line; caused by contraction of the left ventricle atheroma: fibrous cap composed of smooth muscle cells that forms over lipid deposits within arterial vessels and protrudes into the lumen of the vessel, narrowing the lumen and obstructing blood flow; also called plaque atherosclerosis: abnormal accumulation of lipid deposits and fibrous tissue within arterial walls and the lumen atrioventricular (AV) node: secondary pacemaker of the heart, located in the right atrial wall near the tricuspid valve automaticity: ability of the cardiac cells to initiate an electrical impulse baroreceptors: nerve fibers located in the aortic arch and carotid arteries that are responsible for reflex control of the blood pressure cardiac catheterization: an invasive procedure used to measure cardiac chamber pressures and assess patency of the coronary arteries cardiac conduction system: specialized heart cells strategically located throughout the heart that are responsible for methodically generating and coordinating the transmission of electrical impulses to the myocardial cells cardiac output: amount of blood pumped by each ventricle in liters per minute cardiac stress test: a test used to evaluate the functioning of the heart during a period of increased oxygen demand cardioversion: electrical current administered in synchrony with the patient’s own QRS complex to stop a dysrhythmia chronotropy: rate of impulse formation conduction: transmission of electrical impulses from one cell to another contractility: ability of the cardiac muscle to shorten in response to an electrical impulse coronary artery bypass graft (CABG): a surgical procedure in which a blood vessel from another part of the body is grafted onto the occluded coronary artery below the occlusion in such a way that blood flow bypasses the blockage creatine kinase (CK): an enzyme found in human tissues; one of the three types of CK is specific to heart muscle and may be used as an indicator of heart muscle injury defibrillation: electrical current administered to stop a dysrhythmia, not synchronized with the patient’s QRS complex depolarization: process by which cardiac muscle cells change from a more negatively charged to a more positively charged intracellular state . electrical activation of a cell caused by the influx of sodium into the cell while potassium exits the cell diastole: period of ventricular relaxation resulting in ventricular filling dromotropy: conduction velocity dyslipidemia: abnormal blood lipid levels, including high total, low-density lipoprotein, and triglyceride levels as well as low high-density lipoprotein levels dysrhythmia: disorder of the formation or conduction (or both) of the electrical impulse within the heart, altering the heart rate, heart rhythm, or both and potentially causing altered blood flow (also referred to as arrhythmia) ejection fraction: percentage of the end-diastolic blood volume ejected from the ventricle with each heartbeat elective replacement indicator (ERI): a signal produced by a pace-maker when it is interrogated to indicate a near-depleted battery glomerular filtration rate (GFR): flow rate of filtered fluid through the kidney, an indicator of renal function hemodynamic monitoring: use of pressure monitoring devices to directly measure cardiovascular function high-density lipoprotein (HDL): a protein-bound lipid that transports cholesterol to the liver for excretion in the bile; composed of a higher proportion of protein to lipid than low-density lipoprotein; exerts a beneficial effect on the arterial wall hypertension: blood pressure that is persistently greater than 140/90 mm Hg hypertensive emergency: a situation in which blood pressure is severely elevated and there is evidence of actual or probable target organ damage hypertensive urgency: a situation in which blood pressure is severely elevated but there is no evidence of target organ damage hypotension: a decrease in blood pressure to less than 100/60 mm Hg that compromises systemic perfusion implantable cardioverter defibrillator (ICD): a device implanted into the chest to treat dysrhythmias inhibited: in reference to pacemakers, term used to describe the pacemaker withholding an impulse (not firing) inotropy: force of myocardial contraction ischemia: insufficient tissue oxygenation isolated systolic hypertension: a condition mostly commonly seen in the elderly in which the systolic pressure is greater than 140 mm Hg and the diastolic pressure is within normal limits (less than 90 mm Hg) low-density lipoprotein (LDL): a protein-bound lipid that transports cholesterol to tissues in the body; composed of a lower proportion of protein to lipid than highdensity lipoprotein; exerts a harmful effect on the arterial wall metabolic syndrome: a cluster of metabolic abnormalities including insulin resistance, obesity, dyslipidemia, and hypertension that increase the risk of cardiovascular disease monotherapy: medication therapy with a single medication murmurs: sounds created by abnormal, turbulent flow of blood in the heart myocardial infarction (MI): death of heart tissue caused by lack of oxygenated blood flow myocardial ischemia: condition in which heart muscle cells receive less oxygen than needed myocardium: muscle layer of the heart responsible for the pumping action of the heart normal heart sounds: sounds produced when the valves close; normal heart sounds are S1 (atrioventricular valves) and S2 (semi- lunar valves) opening snaps: abnormal diastolic sound generated during opening of a rigid AV valve leaflet P wave: the part of an electrocardiogram (ECG) that reflects conduction of an electrical impulse through the atrium; atrial depolarization paroxysmal dysrhythmia: a dysrhythmia that has a sudden onset and/or termination and is usually of short duration percutaneous coronary intervention (PCI): an invasive procedure in which a catheter is placed in a coronary artery, and one of several methods is employed to remove or reduce a blockage within the artery percutaneous transluminal coronary angioplasty (PTCA): a type of percutaneous coronary intervention in which a balloon is inflated within a coronary artery to break an atheroma and open the vessel lumen, improving coronary artery blood flow postural (orthostatic) hypotension: a significant drop in blood pressure (usually 10 mm Hg systolic or more) after an upright posture is assumed PP interval: the duration between the beginning of one P wave and the beginning of the next P wave; used to calculate atrial rate and rhythm PR interval: the part of an ECG that reflects conduction of an electrical impulse from the sino-atrial (SA) node through the atrio-ventricular (AV) node preload: degree of stretch of the cardiac muscle fibers at the end of diastole primary hypertension: also called essential hypertension; denotes high blood pressure from an unidentified cause proarrhythmic: an agent (e.g., a medication) that causes or exacerbates a dysrhythmia pulmonary vascular resistance: resistance to right ventricular ejection of blood QRS complex: the part of an ECG that reflects conduction of an electrical impulse through the ventricles; ventricular depolarization QT interval: the part of an ECG that reflects the time from ventricular depolarization through repolarization radioisotopes: unstable atoms that emit small amounts of energy in the form of gamma rays; used in cardiac nuclear medicine studies rebound hypertension: blood pressure that is controlled with medication and that becomes uncontrolled (abnormally high) with the abrupt discontinuation of medication repolarization: return of the cell to resting state, caused by reentry of potassium into the cell while sodium exits the cell. process by which cardiac muscle cells return to a more negatively charged intracellular condition, their resting state RR interval: the duration between the beginning of one QRS complex and the beginning of the next QRS complex; used to calculate ventricular rate and rhythm S1: the first heart sound produced by closure of the atrio-ventricular (mitral and tricuspid) valves S2: the second heart sound produced by closure of the semilunar (aortic and pulmonic) valves S3: an abnormal heart sound detected early in diastole as resistance is met to blood entering either ventricle; most often due to volume overload associated with heart failure S4: an abnormal heart sound detected late in diastole as resistance is met to blood entering either ventricle during atrial contraction; most often caused by hypertrophy of the ventricle secondary hypertension: high blood pressure from an identified cause, such as renal disease sensitivity: the level that the intra-cardiac electrical activity must exceed in order to be sensed by a pacemaker sinoatrial (SA) node: primary pacemaker of the heart, located in the right atrium sinus rhythm: electrical activity of the heart initiated by the sinoatrial (SA) node ST segment: the part of an ECG that reflects the end of the QRS complex to the beginning of the T wave stent: a woven mesh that provides structural support to a coronary vessel, preventing its closure stroke volume: amount of blood ejected from the ventricle per heartbeat sudden cardiac death: abrupt cessation of effective heart activity summation gallop: the abnormal sound created during tachycardia by the presence of an S3 and S4 supraventricular tachycardia (SVT): a rhythm that originates in the conduction system above the ventricles systemic vascular resistance: resistance to left ventricle ejection systole: period of ventricular contraction resulting in ejection of blood from the ventricles into the pulmonary artery and aorta systolic click: abnormal systolic sound created by the opening of a calcified aortic or pulmonic valve during ventricular contraction telemetry: the process of continuous electrocardiographic monitoring by the transmission of radio waves from a battery-operated transmitter worn by the patient T wave: the part of an ECG that reflects repolarization of the ventricles thrombolytic: an agent or process that breaks down blood clots TP interval: the part of an ECG that reflects the time between the end of the T wave and the beginning of the next P wave; used to identify the isoelectric line triggered: in reference to pacemakers, term used to describe the release of an impulse in response to some stimulus troponin: myocardial protein; measurement is used to assess heart muscle injury U wave: the part of an ECG that may reflect Purkinje fiber repolarization; usually it is not seen unless a patient’s serum potassium level is low Valsalva maneuver: forcible exhalation against a closed glottis followed by a rise in intrathoracic pressure and subsequent possible dramatic rise in arterial pressure; may occur during straining at stool ventricular tachycardia (VT): a rhythm that originates in the ventricles INFLAMMATORY DISORDERS allograft: heart valve replacement made from a human heart valve (synonym: homograft) annuloplasty: repair of a cardiac valve’s outer ring aortic valve: semilunar valve located between the left ventricle and the aorta autograft: heart valve replacement made from the patient’s own heart valve (e.g., the pulmonic valve is excised and used as an aortic valve) cardiomyopathy: disease of the heart muscle chordae tendineae: nondistensible fibrous strands connecting papillary muscles to atrioventricular (mitral, tricuspid) valve leaflets chordoplasty: repair of the chordae tendineae commissurotomy: splitting or separating fused cardiac valve leaflets heterograft: heart valve replacement made of tissue from an animal heart valve (synonym: xenograft) homograft: heart valve replacement made from a human heart valve (synonym: allograft) leaflet repair: repair of a cardiac valve’s movable “flaps” (leaflets) mitral valve: atrioventricular valve located between the left atrium and left ventricle orthotopic transplantation: the recipient’s heart is removed and a donor heart is grafted into the same site; the patient has one heart prolapse (of a valve): stretching of an atrio-ventricular heart valve leaflet into the atrium during systole pulmonic valve: semilunar valve located between the right ventricle and the pulmonary artery regurgitation: backward flow of blood through a heart valve stenosis: narrowing or obstruction of a cardiac valve’s orifice total artificial heart: mechanical device used to aid a failing heart, assisting the right and left ventricles tricuspid valve: atrio-ventricular valve located between the right atrium and right ventricle valve replacement: insertion of a device at the site of a malfunctioning heart valve to restore blood flow in one direction through the heart valvuloplasty: repair of a stenosed or regurgitant cardiac valve by commissurotomy, annuloplasty, leaflet repair, or chordoplasty (or a combination of procedures) ventricular assist device: mechanical device used to aid a failing right or left ventricle xenograft: heart valve replacement made of tissue from an animal heart valve (synonym: heterograft) HEART DISEASES acute decompensated heart failure: acute exacerbation of heart failure, with signs and symptoms resulting in markedly lower systemic perfusion afterload: the resistance to ejection of blood from a ventricle anastomosis: junction of two vessels aneurysm: a localized sac or dilation of an artery formed at a weak point in the vessel wall angioplasty: an invasive procedure that uses a balloon-tipped catheter to dilate a stenotic area of a blood vessel ankle-brachial index (ABI) or ankle-arm index (AAI): ratio of the ankle systolic pressure to the arm systolic pressure; an objective measurement of arterial disease that provides quantification of the degree of stenosis anuria: urine output of less than 50 mL/24 h arteriosclerosis: diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles thicken ascites: an accumulation of serous fluid in the peritoneal cavity atherosclerosis: inflammatory process involving the accumulation of lipids, calcium, blood components, carbohydrates, and fibrous tissue on the intimal layer of a large or medium-sized artery bruit: sound produced by turbulent blood flow through an irregular, tortuous, stenotic, or dilated vessel cardiac output (CO): the amount of blood pumped out of the heart in 1 minute cardiac resynchronization therapy (CRT): a treatment for heart failure in which a device paces both ventricles to synchronize contractions compliance: the elasticity or amount of “give” when blood enters the ventricle congestive heart failure (CHF): a fluid overload condition (congestion) associated with heart failure contractility: the force of ventricular contraction; related to the number and state of myocardial cells diastolic heart failure: the inability of the heart to pump sufficiently because of an alteration in the ability of the heart to fill; current term used to describe a type of heart failure dissection: separation of the weakened elastic and fibromuscular elements in the medial layer of an artery duplex ultrasonography: combines B-mode gray-scale imaging of tissue, organs, and blood vessels with capabilities of estimating velocity changes by use of a pulsed Doppler ejection fraction (EF): percentage of blood volume in the ventricles at the end of diastole that is ejected during systole; a measurement of contractility heart failure (HF): the inability of the heart to pump sufficient blood to meet the needs of the tissues for oxygen and nutrients; signs and symptoms of pulmonary and systemic congestion may or may not be present intermittent claudication: a muscular, cramp-like pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest ischemia: deficient blood supply left-sided heart failure (left ventricular failure): inability of the left ventricle to fill or pump (empty) sufficient blood to meet the needs of the tissues for oxygen and nutrients; traditional term used to describe patient’s symptoms of heart failure oliguria: diminished urine output; less than 500 mL/24 h orthopnea: shortness of breath when laying flat paroxysmal nocturnal dyspnea (PND): shortness of breath that occurs suddenly during sleep pericardiocentesis: procedure that involves aspiration of fluid from the pericardial sac pericardiotomy: surgically created opening of the pericardium preload: the amount of myocardial stretch just before systole caused by the volume of blood presented to the ventricle pulmonary edema: abnormal accumulation of fluid in the interstitial spaces and alveoli of the lungs pulseless electrical activity (PEA): condition in which electrical activity is present but there is not an adequate pulse or blood pressure pulsus paradoxus: systolic blood pressure that is more than 10 mm Hg higher during exhalation than during inspiration; difference is normally less than 10 mm Hg rest pain: persistent pain in the foot or digits when the patient is resting, indicating a severe degree of arterial insufficiency right-sided heart failure (right ventricular failure): inability of the right ventricle to fill or pump (empty) sufficient blood to the pulmonary circulation rubor: reddish blue discoloration of the extremities; indicative of severe peripheral arterial damage in vessels that remain dilated and unable to constrict stenosis: narrowing or constriction of a vessel stroke volume (SV): amount of blood pumped out of the ventricle with each contraction systolic heart failure: inability of the heart to pump sufficiently because of an alteration in the ability of the heart to contract; current term used to describe a type of heart failure. HEMATOLOGICAL DISORDERS absolute neutrophil count: a calculation of the number of circulating neutrophils, derived from the total white blood cells (WBCs) and the percentage of neutrophils counted in a microscope’s visual field anemia: decreased red blood cell (RBC) count anergy: diminished reactivity to antigens (transient or complete) angiogenesis: formation of new blood vessels angular cheilosis: cracking sore at corner of mouth aplasia: lack of cellular development (e.g., of cells within the bone marrow) band cell: slightly immature neutrophil blast cell: primitive WBC cytokines: hormones produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses D-dimer: test to measure fibrin breakdown; considered more specific than fibrin degradation products in the diagnosis of disseminated intravascular coagulation differentiation: development of functions and characteristics that are different from those of the parent stem cell erythrocyte: see red blood cell erythrocyte sedimentation rate: laboratory test that measures the rate of settling of RBCs; elevation is indicative of inflammation; also called the “sed rate” erythroid cells: any cell that is or will become a mature RBC erythropoiesis: process of formation of RBCs erythropoietin: hormone produced primarily by the kidney; necessary for erythropoiesis fibrin: filamentous protein; basis of thrombus and blood clot fibrinogen: protein converted into fibrin to form thrombus and clot fibrinolysis: process of breakdown of fibrin clot granulocyte: granulated WBC (neutrophil, eosinophil, basophil); sometimes used synonymously with neutrophil haptoglobin: blood protein synthesized by liver; binds free hemoglobin released from erythrocytes, which is then removed by the reticuloendothelial system hematocrit: percentage of total blood volume consisting of RBCs hematopoiesis: complex process of the formation and maturation of blood cells hemoglobin: iron-containing protein of RBCs; delivers oxygen to tissues hemolysis: destruction of RBCs; can occur within or outside of the vasculature hemosiderin: iron-containing pigment derived from breakdown of hemoglobin hemostasis: intricate balance between clot formation and clot dissolution histiocytes: cells present in all loose connective tissue, capable of phagocytosis hypochromia: pallor within the RBC caused by decreased hemoglobin content left shift, or shift to the left: increased release of immature forms of WBCs from the bone marrow in response to need leukocyte: see white blood cell leukemia: uncontrolled proliferation of WBCs, often immature leukopenia: less-than-normal amount of WBCs in circulation lymphocyte: form of WBC involved in immune functions lymphoid: pertaining to lymphocytes lysis: destruction of cells macrophage: reticuloendothelial cells capable of phagocytosis microcytosis: smaller-than-normal RBCs monocyte: large WBC that becomes a macrophage when it leaves the circulation and moves into body tissues myeloid: pertaining to non-lymphoid blood cells that differentiate into RBCs, platelets, macrophages, mast cells, and various WBCs myelopoiesis: formation and maturation of cells derived from myeloid stem cell neutropenia: lower-than-normal number of neutrophils neutrophil: fully mature WBC capable of phagocytosis; primary defense against bacterial infection normochromic: normal RBC color, indicating normal amount of hemoglobin normocytic: normal size of RBC nucleated RBC: immature form of RBC; portion of nucleus remains within the RBC oxyhemoglobin: combined form of oxygen and hemoglobin; found in arterial blood pancytopenia: abnormal decrease in WBCs, RBCs, and platelets petechiae: tiny capillary hemorrhages phagocytosis: process of cellular ingestion and digestion of foreign bodies plasma: liquid portion of blood plasminogen: protein converted to plasmin to dissolve thrombi and clots platelet: thrombocyte; a cellular component of blood involved in blood coagulation poikilocytosis: variation in shape of RBCs polycythemia: excess RBCs red blood cell (RBC): erythrocyte; a cellular component of blood involved in the transport of oxygen and carbon dioxide reticulocytes: slightly immature RBCs, usually only 1% of total circulating RBCs reticuloendothelial system: complex system of cells throughout body capable of phagocytosis serum: portion of blood remaining after coagulation occurs stem cell: primitive cell, capable of self-replication and differentiation into myeloid or lymphoid stem cell thrombin: enzyme necessary to convert fibrinogen into fibrin clot thrombocyte: see platelet thrombocytopenia: lower-than-normal platelet count thrombocytosis: higher-than-normal platelet count white blood cell (WBC): leukocyte; one of several cellular components of blood involved in defense of the body; subtypes include neutrophils, eosinophils, basophils, monocytes, and lymphocytes DIGESTIVE AND GASTROINTESTINAL SYSTEM abscess: localized collection of purulent material surrounded by inflamed tissues, typically associated with signs of infection absorption: phase of the digestive process that occurs when small molecules, vitamins, and minerals pass through the walls of the small and large intestine and into the bloodstream achalasia: absent or ineffective peristalsis (wavelike contraction) of the distal esophagus accompanied by failure of the esophageal sphincter to relax in response to swallowing resulting in difficulty swallowing, regurgitation, and sometimes pain achlorhydria: lack of hydrochloric acid in digestive secretions of the stomach amylase: pancreatic enzyme; aids in the digestion of carbohydrates (starch) antireflux valve: valve that prevents return or backward flow of fluid antrectomy: removal of the pyloric (anrum) portion of the stomach with anastomosis (surgical connection) to the duodenum (gastro-duodenostomy or Billroth I) or anastomosis to the jejunum (gastro-jejunostomy or Billroth II) anus: last section of the GI tract; outlet for waste products from the system aspiration: removal of substance by suction; breathing of fluids or foods into the trachea and lungs bariatric: relating to obesity; term derives from two Greek words meaning ‘weight’ and ‘treatment’ bolus: a feeding administered into the stomach in large amounts and at designated intervals borborygmus: rumbling noise caused by the movement of gas through the intestines central venous access device (CVAD): a device designed and used for long-term administration of medications and fluids into central veins cholecystectomy: removal of the gallbladder cholecystitis: inflammation of the gallbladder cholecystojejunostomy: anastomosis of the jejunum to the gallbladder to divert bile flow cholecystokinin-pancreozymin (CCK-PZ): hormone; major stimulus for digestive enzyme secretion; stimulates contraction of the gallbladder cholecystostomy: opening and drainage of the gallbladder choledochojejunostomy: anastomosis of common duct to jejunum choledocholithiasis: stones in the common duct choledocholithotomy: incision of common bile duct for removal of stones choledochostomy: opening into the common duct cholelithiasis: calculi in the gallbladder chyme: mixture of food with saliva, salivary enzymes, and gastric secretions that is produced as the food passes through the mouth, esophagus, and stomach colostomy: surgical opening into the colon by means of a stoma to allow drainage of bowel contents; one type of fecal diversion constipation: subjectively described infrequency or irregularity of defecation, with or without an abnormal hardening of feces that makes their passage difficult and sometimes painful, with or without a decrease in fecal volume cyclic feeding: periodic infusion of feedings given over a short period (8 to 18 hours) decompression (intestinal): removal of gastric or intestinal contents to prevent gas and fluid distention digestion: phase of the digestive process that occurs when digestive enzymes and secretions mix with ingested food and when proteins, fats, and sugars are broken down into their component smaller molecules dissolution therapy: use of medications to break up/dissolve gallstones diverticulitis: inflammation of a diverticulum from obstruction (by fecal matter), resulting in abscess formation diverticulosis: presence of several diverticula in the intestine; common in middle age diverticulum: saclike out pouching of the lining of the bowel protruding through the muscle of the intestinal wall, usually caused by high intraluminal pressure dumping syndrome: physiologic response to rapid emptying of gastric contents into the jejunum, manifested by nausea, weakness, sweating, palpitations, syncope and possibly diarrhea; occurs in patients who have had partial gastrectomy and gastrojejunostomy duodenum: the first part of the small intestine, which arises from the pylorus of the stomach and extends to the jejunum dyspepsia: indigestion; upper abdominal discomfort associated with eating dysphagia: difficulty swallowing dysplasia: abnormal change in cells elimination: phase of digestive process that occurs after digestion and absorption, when waste products are evacuated from the body endocrine: secreting internally; hormonal secretion of a ductless gland endoscopic retrograde cholangiopancreatography (ERCP): an endoscopic procedure using fiber optic technology to visualize the biliary system enteral nutrition: nutritional formula feedings introduced through a tube directly into the gastrointestinal tract enteroclysis: fluoroscopic x-ray of the small intestine; a tube is placed from the nose or mouth through the esophagus and the stomach to the duodenum, a barium-based liquid contrast material is infused through the tube, and x-rays are taken as it travels through the duodenum esophagogastroduodenoscopy (EGD): passage of a fiber optic tube through the mouth and throat into the digestive tract for visualization of the esophagus, stomach, and small intestine; biopsies can be performed esophagus: collapsible tube connecting the mouth to the stomach, through which food passes as it is ingested exocrine: secreting externally; hormonal secretion from excretory ducts fecal incontinence: involuntary passage of feces fibroscopy (gastrointestinal): intubation of a part of the GI system with a flexible, lighted tube to assist in diagnosis and treatment of diseases of that area fissure: normal or abnormal fold, groove, or crack in body tissue fistula: anatomically abnormal tract that arises between two internal organs or between an internal organ and the body surface gastric: refers to the stomach gastric outlet obstruction: any condition that mechanically impedes normal gastric emptying; there is obstruction of the channel of the pylorus and duodenum through which the stomach empties gastritis: inflammation of the stomach gastroesophageal reflux: back-flow of gastric or duodenal contents into the esophagus gastrostomy: surgical creation of an opening into the stomach for the purpose of administering foods and fluids helicobacter pylori: a spiral-shaped gram-negative bacterium that colonizes the gastric mucosa; is involved in most cases of peptic ulcer disease hematemesis: vomiting of blood hemorrhoids: dilated portions of the anal veins; can occur internal or external to the anal sphincter hernia: protrusion of an organ or part of an organ through the wall of the cavity that normally contains it histamine-2 (H2) receptor antagonist: a pharmacologic agent that inhibits histamine action at the H2 receptors of the stomach, resulting in inhibition of gastric acid secretion hydrochloric acid: acid secreted by the glands in the stomach; mixes with chyme to break it down into absorbable molecules and to aid in the destruction of bacteria ileostomy: surgical opening into the ileum by means of a stoma to allow drainage of bowel contents; one type of fecal diversion inflammatory bowel disease (IBD): group of chronic disorders (most common are ulcerative colitis and Crohn’s disease) that result in inflammation or ulceration (or both) of the bowel lining; associated with abdominal pain, diarrhea, fever, and weight loss ingestion: phase of the digestive process that occurs when food is taken into the GI tract via the mouth and esophagus intravenous fat emulsion (IVFE): an oil-in-water emulsion of oils, egg phospholipids, and glycerin intrinsic factor: a gastric secretion that combines with vitamin B12 so that the vitamin can be absorbed intubation: the insertion or placement of a tube into a body structure or passageway irritable bowel syndrome (IBS): functional disorder that affects frequency of defecation and consistency of stool; is associated with no specific structural or biochemical alterations; associated with crampy abdominal pain and bloating jejunum: second portion of the small intestine, which extends from the duodenum to the ileum Kock pouch: type of continent ileal reservoir created surgically by making an internal pouch with a portion of the ileum and placing a nipple valve flush with the stoma laparoscopic cholecystectomy: removal of gallbladder through an endoscopic procedure large intestine: the portion of the GI tract into which waste material from the small intestine passes as absorption continues and elimination begins; consists of several parts—ascending segment, transverse segment, descending segment, sigmoid colon, and rectum lavage: flushing of the stomach with water or other fluids with a gastric tube to clear it ligament of Treitz: suspensory ligament of the duodenum; important anatomic landmark used to divide the gastrointestinal tract into an upper and lower portion lipase: pancreatic enzyme; aids in the digestion of fats lithotripsy: use of shock waves to break up or disintegrate stones (in both the gallbladder and urinary tract) lumen: the channel within a tube or catheter malabsorption: impaired transport across the mucosa melena: tarry or black stools; indicative of blood in stools morbid obesity: more than twice ideal body weight, 100 pounds or more over ideal body weight, or body mass index exceeding 40 kg/m2 nasoduodenal tube: tube inserted through the nose into the proximal portion of the small intestine (i.e., duodenum) nasoenteric tube: tube inserted through the nose into the stomach and beyond the pylorus into the small intestine nasogastric (NG) tube: tube inserted through the nose into the stomach nasojejunal tube: tube inserted through the nose into the second portion of the small intestine (i.e., jejunum) odynophagia: pain on swallowing omentum: fold of the peritoneum that surrounds the stomach and other organs of the abdomen orogastric tube: tube inserted through the mouth into the stomach osmolality: ionic concentration of fluid pancreaticojejunostomy: joining of the pancreatic duct to the jejunum by side-toside anastomosis; allows drainage of the pancreatic secretions into the jejunum pancreatitis: inflammation of the pancreas; may be acute or chronic parenteral nutrition (PN): method of supplying nutrients to the body by an intravenous route parotitis: inflammation of the parotid gland pepsin: a gastric enzyme that is important in protein digestion percutaneous endoscopic gastrostomy (PEG): a feeding tube inserted endoscopically into the stomach periapical abscess: abscessed tooth peripherally inserted central catheter (PICC): a device used for intermediate-term intravenous therapy peristalsis: wavelike movement that occurs involuntarily in the alimentary canal peritoneum: thin membrane that lines the inside of the wall of the abdomen and covers all the abdominal organs peritonitis: inflammation of the lining of the abdominal cavity, usually as a result of a bacterial infection of an area in the gastrointestinal tract with leakage of contents into the abdominal cavity pH: the degree of acidity or alkalinity of a substance or solution proton pump inhibitors: pharmacologic agents that block acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium adenoside triphosphatase pump system at the secretory surface of gastric parietal cells; most potent inhibitors of gastric acid secretion pyloroplasty: surgical procedure to increase the opening of the pyloric orifice pyrosis: heartburn pulorus: opening between the stomach and the duodenum pyrosis: heartburn radiopaque: can be easily localized on x-ray secretin: hormone responsible for stimulating secretion of pancreatic juice; also used as an aid in diagnosing pancreatic exocrine disease and in obtaining desquamated pancreatic cells for cytological examination serosa: thin membrane that covers the outer surface of the stomach; visceral peritoneum covering the outer surface of the stomach sialadenitis: inflammation of the salivary glands small intestine: longest portion of the GI tract, consisting of three parts—duodenum, jejunum, and ileum— through which food mixed with all secretions and enzymes passes as it continues to be digested and begins to be absorbed into the bloodstream steatorrhea: frothy, foul-smelling stools with a high fat content; results from impaired digestion of proteins and fats due to a lack of pancreatic juice in the intestine. Fat present in both feces and/or urine stenosis: narrowing or tightening of an opening or passage in the body stoma: artificially created opening between a body cavity (e.g., intestine) and the body surface stomach: distensible pouch into which the food bolus passes to be digested by gastric enzymes stomatitis: inflammation of the oral mucosa stylet: a stiff wire placed in a catheter or other tube that allows the tube to maintain its shape during insertion temporomandibular disorders: a group of conditions that cause pain or dysfunction of the temporo-mandibular joint (TMJ) and surrounding structures tenesmus: ineffective and sometimes painful straining to eliminate either feces or urine total nutrient admixture (TNA): an admixture of lipid emulsions, proteins, carbohydrates, electrolytes, vitamins, trace minerals, and water trypsin: pancreatic enzyme; aids in digestion of proteins vagotomy syndrome: dumping syndrome; gastrointestinal symptoms, such as diarrhea and abdominal cramping, resulting from rapid gastric emptying Valsalva maneuver: forcible exhalation against a closed glottis followed by a rise in intrathoracic pressure and subsequent possible dramatic rise in arterial pressure; may occur during straining at stool xerostomia: dry mouth wound-ostomy-continence (WOC) nurse: nurse specially educated in the appropriate management of fecal and urinary diversions; guides patients, their families, surgeons, and nurses by recommending appropriate use of skin, wound, ostomy, and continence products; formerly called enterostomal therapist Zollinger-Ellison tumor: hyper secretion of gastric acid that produces peptic ulcers as a result of a non–beta-cell tumor of the pancreatic islets METABOLIC AND ENDOCRINE acromegaly: disease process resulting from excessive secretion of somatotropin; causes progressive enlargement of peripheral body parts addisonian crisis: acute adrenocortical insufficiency; characterized by hypotension, cyanosis, fever, nausea/vomiting, and classic signs of shock; precipitated by stress or abrupt withdrawal of therapeutic glucocorticoids Addison’s disease: chronic adrenocortical insufficiency secondary to destruction of the adrenal glands adrenalectomy: surgical removal of one or both adrenal glands adrenocorticotropic hormone (ACTH): hormone secreted by the anterior pituitary, essential for growth and development adrenogenital syndrome: masculinization in women, feminization in men, or premature sexual development in children; result of abnormal secretion of adrenocortical hormones, especially androgens androgens: hormones secreted by the adrenal cortex; stimulate activity of accessory male sex organs and development of male sex characteristics basal metabolic rate: chemical reactions occurring when the body is at rest c alcitonin: hormone secreted by the parafollicular cells of the thyroid gland; participates in calcium regulation asterixis: involuntary flapping movements of the hands associated with metabolic liver dysfunction balloon tamponade: use of balloons placed within the esophagus and proximal portion of the stomach and inflated to compress bleeding vessels (esophageal and gastric varices) Budd-Chiari syndrome: hepatic vein thrombosis resulting in non-cirrhotic portal hypertension Chvostek’s sign: spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia cirrhosis: a chronic liver disease characterized by fibrotic changes and the formation of dense connective tissue within the liver, subsequent degenerative changes, and loss of functioning cells constructional apraxia: inability to draw figures in two or three dimensions corticosteroids: hormones produced by the adrenal cortex or their synthetic equivalents; also referred to as adrenal-cortical hormone and adreno-corticosteroid; consist of glucocorticoids, mineralocorticoids, and androgens cretinism: stunted body growth and mental development appearing during the first year of life as a result of congenital hypothyroidism Cushing’s syndrome: group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex; characterized by truncal obesity, “moon face,” acne, abdominal striae, and hypertension diabetes insipidus: condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin dwarfism: generalized limited growth resulting from insufficient secretion of growth hormone during childhood endocrine: secreting internally; hormonal secretion of a ductless gland euthyroid: state of normal thyroid hormone production e exophthalmos: abnormal protrusion of one or both eyeballs fetor hepaticus: sweet, slightly fecal odor to the breath, presumed to be of intestinal origin; prevalent with the extensive collateral portal circulation in chronic liver disease fulminant hepatic failure: sudden, severe onset of acute liver failure that occurs within 8 weeks after the first symptoms of jaundice glucocorticoids: steroid hormones secreted by the adrenal cortex in response to ACTH; produce a rise of liver glycogen and blood glucose goiter: enlargement of the thyroid gland; usually caused by an iodine-deficient diet Graves’ disease: a form of hyperthyroidism; characterized by a diffuse goiter and exophthalmos hepatic encephalopathy: central nervous system dysfunction resulting from liver disease; frequently associated with elevated ammonia levels that produce changes in mental status, altered level of consciousness, and coma hormones: chemical transmitter substances produced in one organ or part of the body and carried by the bloodstream to other cells or organs on which they have a specific regulatory effect; produced mainly by endocrine glands hypophysectomy: removal or destruction of all or part of the pituitary gland mineralocorticoid: steroid of the adrenal cortex myxedema: severe hypothyroidism characterized by an accumulation of mucopolysaccharides in interstitial tissues, a masklike expression, puffy eyelids, loss of eyebrow hair, thick lips, and a broad tongue negative feedback: regulating mechanism in which an increase or decrease in the level of a substance decreases or increases the function of the organ producing the substance orthotopic liver transplantation (OLT): grafting of a donor liver into the normal anatomic location, with removal of the diseased native liver oxytocin: hormone secreted by the posterior pituitary; causes myometrial contraction at term and milk release during lactation pheochromocytoma: chromaffin cell tumor, usually benign, located in the adrenal medulla; characterized by secretion of catecholamines resulting in hypertension, severe headache, profuse sweating, visual blurring, anxiety, and nausea portal hypertension: elevated pressure in the portal circulation resulting from obstruction of venous flow into and through the liver sclerotherapy: the injection of substances into or around esophagogastric varices to cause constriction, thickening, and hardening of the vessel and thus to stop bleeding syndrome of inappropriate antidiuretic hormone (SIADH) secretion: excessive secretion of antidiuretic hormone (ADH) from the pituitary gland despite low serum osmolality level thyroidectomy: surgical removal of all or part of the thyroid gland thyroiditis: inflammation of the thyroid gland; may lead to chronic hypothyroidism or may resolve spontaneously thyroid-stimulating hormone: released from the pituitary gland; causes stimulation of the thyroid, resulting in release of T3 and T4 thyroid storm: severe life-threatening hyperthyroidism precipitated by stress; characterized by high fever, extreme tachycardia, and altered mental state thyrotoxicosis: condition produced by excessive endogenous or exogenous thyroid hormone thyroxine (T4): thyroid hormone; active iodine compound formed and stored in the thyroid; deiodinated in peripheral tissues to form triiodothyronine; maintains body metabolism in a steady state triiodothyronine (T3): thyroid hormone; formed and stored in the thyroid; released in smaller quantities, biologically more active and with faster onset of action than T4; widespread effect on cellular metabolism Trousseau’s sign: carpopedal spasm induced when blood flow to the arm is occluded using a blood pressure cuff or tourniquet, causing ischemia to the distal nerves; suggestive sign for latent tetany in hypocalcemia variceal banding: procedure that involves the endoscopic placement of a rubber band–like device over esophageal varices to ligate the area and stop bleeding vasopressin: ADH secreted by the posterior pituitary; causes contraction of smooth muscle, particularly blood vessels xenograft: transplantation of organs from one species to another xocrine: secreting externally; hormonal secretion from excretory ducts DIABETES continuous glucose monitoring system (CGMS): a device worn for 72 hours that continuously monitors blood glucose levels; the data are downloaded and analyzed for blood glucose patterns for that time period; presently used diagnostically to elicit patterns and tailor treatment continuous subcutaneous insulin infusion, insulin pump: a small device that delivers insulin on a 24-hour basis as basal insulin; it is also programmed by the patient to deliver a bolus dose before eating a meal in an attempt to mimic normal pancreatic function diabetes mellitus: a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both diabetic ketoacidosis (DKA): a metabolic derangement in type 1 diabetes that results from a deficiency of insulin; highly acidic ketone bodies are formed, resulting in acidosis; usually requires hospitalization for treatment and is usually caused by nonadherence to the insulin regimen, concurrent illness, or infection fasting plasma glucose (FPG): blood glucose determination obtained in the laboratory after fasting for more than 8 hours gestational diabetes mellitus (GDM): any degree of glucose intolerance with its onset during pregnancy glycated hemoglobin (glycosylated hemoglobin, Hgb A1C or A1C):a long-term measure of glucose control that is a result of glucose attaching to hemoglobin for the life of the red blood cell (120 days). The goal of diabetes therapy is a normal to nearnormal level of glycated hemoglobin, the same as in the non-diabetic population hyperglycemia: elevated blood glucose level; fasting level greater than 110 mg/dL (6.1 mmol/L); 2-hour postprandial level greater than 140 mg/dL (7.8 mmol/L) hyperglycemic hyperosmolar nonketotic syndrome (HHNS): a metabolic disorder of type 2 diabetes resulting from a relative insulin deficiency initiated by an intercurrent illness that raises the demand for insulin; associated with polyuria and severe dehydration hypoglycemia: low blood glucose level (less than 60 mg/dL [less than 2.7 mmol/L]) impaired fasting glucose (IFG), impaired glucose tolerance (IGT): a metabolic stage intermediate between normal glucose homeostasis and diabetes; now referred to as pre-diabetes insulin: a hormone secreted by the beta cells of the islets of Langerhans of the pancreas that is necessary for the metabolism of carbohydrates, proteins, and fats; a deficiency of insulin results in diabetes mellitus islet cell transplantation: an investigational procedure in which purified islet cells from cadaver donors are injected into the portal vein of the liver, with the goal of having these cells secrete insulin and cure type 1 diabetes ketone: a highly acidic substance formed when the liver breaks down free fatty acids in the absence of insulin; the result is diabetic ketoacidosis medical nutrition therapy (MNT): nutritional therapy prescribed by the physician for management of diabetes nephropathy: a long-term complication of diabetes in which the kidney cells are damaged; characterized by microalbuminuria in early stages and progressing to endstage renal disease neuropathy: a long-term complication of diabetes resulting from damage to the nerve cell pre-diabetes: impaired glucose metabolism in which blood glucose concentrations fall between normal levels and those considered diagnostic for diabetes; includes IFG and IGT, not clinical entities in their own right but risk factors for future diabetes and cardiovascular disease retinopathy: a long-term complication of diabetes in which the microvascular system of the eye is damaged self-monitoring of blood glucose (SMBG): a method of capillary blood glucose testing in which the patient pricks his or her finger and applies a drop of blood to a test strip that is read by a meter sulfonylurea: a classification of oral antidiabetic medication for treating type 2 diabetes; stimulates insulin secretion and insulin action thiazolidinedione: a class of oral anti-diabetic medications that reduce insulin resistance in target tissues, enhancing insulin action without directly stimulating insulin secretion type 1 diabetes: a metabolic disorder characterized by an absence of insulin production and secretion from autoimmune destruction of the beta cells of the islets of Langerhans in the pancreas; formerly called insulin-dependent, juvenile, or type I diabetes type 2 diabetes: a metabolic disorder characterized by the relative deficiency of insulin production and a decreased insulin action and increased insulin resistance; Formerly called non–insulin-dependent, adult-onset, or type II diabetes GENITO-URINARY TRACT acute nephritic syndrome: type of renal failure with glomerular inflammation acute renal failure: sudden rapid deterioration of kidney function that is sometimes reversible acute tubular necrosis: type of acute renal failure in which there is actual damage to the kidney tubules aldosterone: hormone synthesized and released by the ad- renal cortex; causes the kidneys to reabsorb sodium antidiuretic hormone: hormone secreted by the posterior pituitary gland; causes the kidneys to reabsorb more water; also called vasopressin anuria: total urine output less than 50 mL in 24 hours arteriovenous fistula: type of vascular access for dialysis; created by surgically connecting an artery to a vein arteriovenous graft: type of surgically created vascular access for dialysis by which a piece of biologic, semibiologic, or synthetic graft material connects the patient’s artery to a vein azotemia: abnormal concentration of nitrogenous wastes in the blood bacteriuria: bacteria in the urine; bacterial count higher than 100,000 colonies/mL (more than 105 colonies of bacteria per milliliter of urine) chronic kidney disease: chronic progressive and irreversible diseases of the kidneys continuous ambulatory peritoneal dialysis: method of peritoneal dialysis whereby a patient manually performs four or five complete exchanges or cycles throughout the day continuous cyclic peritoneal dialysis: method of peritoneal dialysis in which a peritoneal dialysis machine (cycler) automatically performs exchanges, usually while the patient sleeps continuous renal replacement therapy: variety of methods used to replace normal kidney function by circulating the patient’s blood through a filter and returning it to the patient creatinine: endogenous waste product of muscle energy metabolism cystectomy: removal of the urinary bladder cystitis: inflammation of the urinary bladder dialysate: solution that circulates through the dialyzer in hemodialysis and through the peritoneal membrane in peritoneal dialysis dialyzer: “artificial kidney” or dialysis machine; contains a semipermeable membrane through which particles of a certain size can pass diffusion: movement of solutes (waste products) from an area of higher concentration to an area of lower concentration diuresis: increased formation and secretion of urine dysuria: painful or difficult urination effluent: term used to describe the drained fluid from a peritoneal dialysis exchange end-stage renal disease: final stage of renal failure that results in retention of uremic waste products and the need for renal replacement therapies exchange (peritoneal dialysis): complete cycle of peritoneal dialysis includes fill, dwell, and drain phases frequency: voiding more frequently than every 3 hours glomerular filtration: plasma filtered at the glomerulus into the kidney tubules glomerulonephritis: inflammation of the glomerular capillaries glomerulus: tuft of capillaries forming part of the nephron through which filtration occurs hemodialysis: procedure during which a patient’s blood is circulated through a dialyzer to remove waste products and excess fluid hematuria: red blood cells in the urine ileal conduit: transplantation of the ureters to an isolated section of the terminal ileum, with one end of the ureters brought to the abdominal wall interstitial cystitis: inflammation of the bladder wall that eventually causes disintegration of the lining and loss of bladder elasticity interstitial nephritis: inflammation within the renal tissue micturition: urination or voiding nephron: structural and functional unit of the kidney responsible for urine formation nephrosclerosis: hardening of the renal arteries nephrotic syndrome: type of renal failure with increased glomerular permeability and massive proteinuria nephrotoxic: any substance, medication, or action that destroys kidney tissue neurogenic bladder: bladder dysfunction that results from a disorder or dysfunction of the nervous system; may result in either urinary retention or bladder over-activity, resulting in urinary urgency and urge incontinence nocturia: awakening at night to urinate oliguria: total urine output less than 500 mL in 24 hours osmosis: movement of water through a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration overflow incontinence: involuntary urine loss associated with over-distention of the bladder due to mechanical or anatomic bladder outlet obstruction peritoneal dialysis: procedure that uses the lining of the patient’s peritoneal cavity as the semipermeable membrane for exchange of fluid and solutes peritonitis: inflammation of the peritoneal membrane (lining of the peritoneal cavity) prostatitis: inflammation of the prostate gland proteinuria: protein in the urine pyelonephritis: inflammation of the renal pelvis pyuria: white blood cells in the urine renal clearance: volume of plasma that the kidneys can clear of a specific solute (e.g., creatinine); expressed in milliliters per minute renal glycosuria: recurring or persistent excretion of glucose in the urine residual urine: urine that remains in the bladder after voiding specific gravity: reflects the weight of particles dissolved in the urine; expression of the degree of concentration of the urine suprapubic catheter: a urinary catheter that is inserted through a suprapubic incision into the bladder tubular reabsorption: movement of a substance from the kidney tubule into the blood in the peritubular capillaries or vasa recta tubular secretion: movement of a substance from the blood in the peritubular capillaries or vasa recta into the kidney tubule ultrafiltration: process whereby water is removed from the blood by means of a pressure gradient between the patient’s blood and the dialysate urea nitrogen: nitrogenous end product of protein metabolism uremia: an excess of urea and other nitrogenous wastes in the blood ureterosigmoidostomy: transplantation of the ureters into the sigmoid colon, allowing urine to flow through the colon and out the rectum ureterovesical or vesicoureteral reflux: backward flow of urine from the bladder into one or both ureters urethritis: inflammation of the urethra urethrovesical reflux: backward flow of urine from the urethra into the bladder urinary casts: proteins secreted by damaged kidney tubules urinary incontinence: involuntary or uncontrolled loss of urine from the bladder sufficient to cause a social or hygienic problem urosepsis: sepsis resulting from infected urine, most often a UTI FEMALE REPRODUCTIVE SYSTEM abscess: a collection of purulent material acquired immunodeficiency syndrome (AIDS): a disease transmitted by body fluids that results in impaired immune response adjuvant chemotherapy: use of anticancer medications in addition to other treatments to delay or prevent a recurrence of the disease adjuvant hormonal therapy: use of synthetic hormones or other medications given after primary treatment to increase the chances of a cure by stopping or slowing the growth of certain cancers that are affected by hormone stimulation (sometimes called endocrine or antiestrogen therapy) adnexa: the fallopian tubes and ovaries amenorrhea: absence of menstrual flow androgens: hormones produced by the ovaries and adrenals that affect many aspects of female health, including follicle development, libido, oiliness of hair and skin, and hair growth aromatase inhibitors: medications that block the production of estrogens by the adrenal glands atypical hyperplasia: abnormal increase in the number of cells in a specific area within the ductal or lobular areas of the breast; this abnormal proliferation increases the risk for cancer Bartholin’s cyst: a cyst in a paired vestibular gland in the vulva benign proliferative breast disease: various types of atypical, yet noncancerous, breast tissue that increase the risk for breast cancer brachytherapy: radiation delivered by an internal device placed close to the tumor (lumpectomy site) BRCA1 and BRCA2: genes on chromosome 17 that, when damaged or mutated, increase a woman’s risk for breast and/or ovarian cancer compared with women without the mutation breast conservation treatment: surgery to remove a breast tumor and a margin of tissue around the tumor without removing any other part of the breast; may or may not include lymph node removal and radiation therapy candidiasis: infection caused by Candida species or yeast; also referred to as monilial vaginitis or yeast infection cervix: bottom (inferior) part of the uterus that is located in the vagina chandelier sign: pain on gentle movement of the cervix; associated with pelvic infection colporrhaphy: repair of the vagina condylomata: warty growths indicative of the human papillomavirus (HPV) conization: procedure in which a cone-shaped piece of cervical tissue is removed as a result of detection of abnormal cells; also called cone biopsy corpus luteum: site of a follicle that changes after ovulation to produce progesterone cryotherapy: destruction of tissue by freezing (e.g., with liquid nitrogen) cystocele: weakness of the anterior vaginal wall that allows the bladder to protrude into the vagina, bulging of the bladder downward into the vagina dose-dense chemotherapy: administration of chemotherapeutic agents at standard doses with shorter time intervals between each cycle of treatment douche: rinsing the vaginal canal with fluid ductal carcinoma in situ (DCIS): cancer cells starting in the ductal system of the breast not penetrating surrounding tissue dysmenorrhea: painful menstruation dyspareunia: difficult or painful sexual intercourse dysplasia: term related to abnormal cell changes found on Pap smear and cervical biopsy reports endocervicitis: inflammation of the mucosa and the glands of the cervix endometrial ablation: procedure performed through a hysteroscope in which the lining of the uterus is burned away or ablated to treat abnormal uterine bleeding endometriosis: condition in which endometrial tissue implants in other areas of the pelvis; may cause pain with menstruation (dysmenorrhea), scarring, and possible infertility endometrium: lining of the uterus enterocele: is a protrusion of the intestinal wall into the vagina estrogen: hormone that develops and maintains the female reproductive system estrogen and progesterone receptor assay: test to determine whether the breast tumor is nourished by hormones; this information helps to determine prognosis and treatment fibrocystic breast changes: term used to describe certain benign changes in the breast, typically associated with palpable nodularity, lumpiness, swelling, or pain fibroid tumor: usually benign tumor of the uterus that may cause irregular bleeding; also called myoma or leiomyoma fine-needle aspiration (FNA): removal of fluid for diagnostic analysis from a cyst or cells from a mass using a needle and syringe fistula: abnormal opening between two organs or sites (e.g., vesico-vaginal, between bladder and vagina; recto-vaginal, between rectum and vagina) follicle-stimulating hormone (FSH): hormone released by the pituitary gland to stimulate estrogen production and ovulation fornix: upper part of the vagina fundus: body of the uterus galactography: use of mammography after an injection of radiopaque dye to diagnose problems in the ductal system of the breast graafian follicle: cystic structure that develops on the ovary as ovulation begins gynecomastia: overdeveloped breast tissue typically seen in adolescent boys hymen: tissue that covers the vaginal opening partially or completely before vaginal penetration hyphae: microscopic findings that indicate monilia hysterectomy: surgical removal of the uterus hysteroscopy: a procedure performed using a long telescope-like instrument inserted through the cervix to diagnose uterine problems introitus: perineal opening to the vagina lactobacilli: vaginal bacteria that limit the growth of other bacteria by producing hydrogen peroxide laparoscope: surgical device inserted through a periumbilical incision to facilitate visualization and surgical procedures lichen sclerosus: benign disorder of the vulva that usually occurs when estrogen levels are low; characterized by itching liposomal therapy: chemotherapy delivered in a liposome, a nontoxic drug carrier lobular carcinoma in situ (LCIS): atypical change and proliferation of the lobular cells of the breast; previously considered a premalignant condition but now considered a marker of increased risk for invasive breast cancer loop electrocautery excision procedure (LEEP): procedure in which laser energy is used to remove a portion of cervical tissue after abnormal biopsy findings luteal phase: stage in the menstrual cycle in which the endometrium becomes thicker and more vascular luteinizing hormone (LH): hormone released by the pituitary gland that stimulates progesterone production lymphedema: chronic swelling of an extremity due to interrupted lymphatic circulation, typically from an axillary lymph node dissection mammoplasty: surgery to reconstruct or change the size or shape of the breast; can be performed for reduction or augmentation mastalgia: breast pain, usually related to hormonal fluctuations or irritation of a nerve mastitis: inflammation or infection of the breast menarche: beginning of menstrual function menopause: permanent cessation of menstruation resulting from the loss of ovarian follicular activity menstruation: sloughing and discharge of the lining of the uterus if conception does not take place modified radical mastectomy: removal of the breast tissue, nipple–areola complex, and a portion of the axillary lymph nodes mucopurulent cervicitis: inflammation of the cervix with exudate; almost always related to a chlamydial infection myomectomy: removal of uterine fibroids though an abdominal incision oophorectomy: surgical removal of an ovary ovaries: almond-shaped reproductive organs that produce eggs at ovulation and play a major role in hormone production ovulation: discharge of a mature ovum from the ovary Paget’s disease: form of breast cancer that begins in the ductal system and involves the nipple, areola, and surrounding skin pelvic exenteration: major surgical procedure in which the pelvic organs are removed pelvic inflammatory disease (PID): infection of uterus and fallopian tubes, usually from a sexually transmitted disease perimenopause: the period immediately prior to menopause and the first year after menopause perineorrhaphy: surgical repair of perineal lacerations polycystic ovary syndrome (PCOS): disorder in the hypothalamic-pituitary and ovarian network, resulting in chronic anovulation, androgen excess, and polycystic ovaries polyp (cervical or endometrial): growth of tissue on the cervix or endometrial lining; usually benign progesterone: hormone produced by the corpus luteum proliferative phase: stage in the menstrual cycle before ovulation when the endometrium proliferates prophylactic mastectomy: removal of the breast to reduce the risk of breast cancer in women considered to be at high risk rectocele: weakness of the posterior vaginal wall that allows the rectal cavity to protrude into the submucosa of the vagina, bulging of the rectum into the vagina salpingitis: inflammation of the fallopian tube salpingo-oophorectomy: removal of the ovary and its fallopian tube (removal of the fallopian tube alone is a salpingectomy) secretory phase: stage of the menstrual cycle in which the endometrium becomes thickened, more vascular, and edematous sentinel lymph node: first lymph node(s) in the lymphatic basin that receives drainage from the primary tumor in the breast; identified by a radioisotope and/or blue dye stereotactic core biopsy: computer-guided method of core needle biopsy that is useful when masses in the breast cannot be felt but can be visualized using mammography surgical biopsy: Surgical removal of all or a portion of a mass for microscopic examination by a pathologist tissue expander followed by permanent implant: series of breast-reconstructive surgeries after a mastectomy; involves stretching the skin and muscle before inserting the permanent implant total mastectomy: removal of the breast tissue and nipple–areola complex transverse rectus abdominis myocutaneous (TRAM) flap: method of breast reconstruction in which a flap of skin, fat, and muscle from the lower abdomen, with its attached blood supply, is rotated to the mastectomy site ultrasonography: imaging method using high-frequency sound waves to diagnose whether masses are solid or fluid filled uterine prolapse: relaxation of pelvic tone that allows the cervix and uterus to descend into the lower vagina vaginal vault: term used to describe the vagina following a hysterectomy, which involves removal of the uterus including the cervix vaginitis: inflammation of the vagina, usually secondary to infection vestibulitis: inflammation of the vulvar vestibule, or tissue around the opening of the vagina, that often causes pain with intercourse (dyspareunia) vestibulodynia: most common type of vulvodynia, characterized by sharp pain in response to pressure applied to the vestibular area of the vulva. vulvar dystrophy: thickening or lesions of the vulva; usually causes itching and may require biopsy to exclude malignancy vulvectomy: removal of the tissue of the vulva vulvitis: inflammation of the vulva, usually secondary to infection or irritation vulvodynia: painful condition that affects the vulva MALE REPRODUCTIVE SYSTEM androgen deprivation therapy (ADT): surgical (orchiectomy) or medical castration (e.g., with luteinizing hormone–releasing hormone agonists) benign prostatic hyperplasia (BPH): noncancerous enlargement or hypertrophy of the prostate; the most common pathologic condition in older men brachytherapy: delivery of radiation therapy through internal implants called seeds to a localized area of tissue circumcision: excision of the foreskin, or prepuce, of the glans penis cryosurgery of the prostate: localized treatment of the prostate by application of freezing temperatures cystostomy: surgical creation of an opening into the urinary bladder cryptorchidism: most common congenital defect in males; characterized by failure of one or both of the testes to descend into the scrotum epididymitis: infection of the epididymis that usually descends from an infected prostate or urinary tract; also may develop as a complication of gonorrhea erectile dysfunction: also called impotence; the inability to either achieve or maintain an erection sufficient to accomplish sexual intercourse hydrocele: a collection of fluid, generally in the tunica vaginalis of the testis, although it also may collect within the spermatic cord minimally invasive therapy: treatments such as laparoscopic and robotic prostatectomy, cryotherapy, and high-intensity focused ultrasound (HIFU); are less invasive than other procedures with less morbidity, lower blood loss, and more rapid recovery orchiectomy: surgical removal of one or both of the testes orchitis: inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors penile cancer: malignancy that can involve the glans, the body of the penis, the urethra, and regional or distant lymph nodes Peyronie’s disease: buildup of fibrous plaques in the sheath of the corpus cavernosum, causing curvature of the penis when it is erect phimosis: condition in which the foreskin is constricted so that it cannot be retracted over the glans; can occur congenitally or from inflammation and edema priapism: an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels prostate cancer: A common type of cancer in men; involves the prostate gland prostatectomy: open or laparoscopic surgical removal of the entire prostate, the prostate urethra, the attached seminal vesicles plus the ampulla of the vas deferens prostate-specific antigen (PSA): substance that is produced by the prostate gland; is used in combination with digital rectal examination to screen for prostate cancer prostatism: obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections prostatitis: inflammation of the prostate gland caused by infectious agents (bacteria, fungi, mycoplasma) or various other problems (e.g., urethral stricture, prostatic hyperplasia) spermatogenesis: production of sperm in the testes testicular cancer: cancer of one or both testes testosterone: male sex hormone secreted by the testes; induces and preserves the male sex characteristics transurethral resection of the prostate (TURP): resection of the prostate through endoscopy; the surgical and optical instrument is introduced directly through the urethra to the prostate, and the gland is then removed in small chips with an electrical cutting loop varicocele: an abnormal dilation of the veins of the pampiniform venous plexus in the scrotum (the network of veins from the testis and the epididymis, which constitute part of the spermatic cord) vasectomy: also called male sterilization; ligation and transection of part of the vas deferens, with or without removal of a segment of the vas, to prevent the passage of the sperm from the testes IMMUNE SYSTEM AND INFECIOUS DISEASES agammaglobulinemia: disorder marked by an almost complete lack of immunoglobulins or antibodies agglutination: clumping effect occurring when an antibody acts as a cross-link between two antigens allergen: substance that causes manifestations of allergy allergy: inappropriate and often harmful immune system response to substances that are normally harmless alpha-interferon: protein substance that the body produces in response to infection anaphylaxis: clinical response to an immediate immunologic reaction between a specific antigen and antibody angioneurotic edema: condition marked by development of urticaria and an edematous area of skin, mucous membranes, or viscera antibody: a protein substance developed by the body in response to and interacting with a specific antigen antigen: substance that induces the production of antibodies antigenic determinant: the specific area of an antigen that binds with an antibody combining site and determines the specificity of the antigen–antibody reaction antihistamine: medication that opposes the action of histamine apoptosis: programmed cell death that results from the digestion of deoxyribonucleic acid by endonucleases ataxia: loss of muscle coordination ataxia-telangiectasia: autosomal recessive disorder affecting T and B cell immunity primarily seen in children and resulting in a degenerative brain disease atopic dermatitis: type I hypersensitivity involving inflammation of the skin evidenced by itching, redness, and a variety of skin lesions atopy: term often used to describe immunoglobulin E–mediated diseases (i.e., atopic dermatitis, asthma, and allergic rhinitis) with a genetic component B cells: cells that are important for producing a humoral immune response B-cell lymphoma: common malignancy in patients with HIV/AIDS B lymphocytes: cells that are important in producing circulating antibodies bacteremia: laboratory-proven presence of bacteria in the bloodstream bradykinin: a substance that stimulates nerve fibers and causes pain candidiasis: yeast infection of skin or mucous membrane carrier: person who has an organism without apparent signs and symptoms; one who is able to transmit an infection to others CCR5: along with the CD4+ receptor, this cell surface molecule is used by HIV to fuse with the host’s cell membranes cellular immune response: the immune system’s third line of defense, involving the attack of pathogens by T cells colonization: microorganisms present in or on a host, without host interference or interaction and without eliciting symptoms in the host community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA): a strain of MRSA infecting per- sons who have not been treated in a health care setting complement: series of enzymatic proteins in the serum that, when activated, destroy bacteria and other cells cytokines: generic term for non-antibody proteins that act as intercellular mediators, as in the generation of immune response cytomegalovirus: a species-specific herpes virus that may cause retinitis in people with AIDS cytotoxic T cells: lymphocytes that lyse cells infected with virus; also play a role in graft rejection EIA (enzyme immunoassay): a blood test that can determine the presence of antibodies to HIV in the blood or saliva; also referred to as emerging infectious diseases: human infectious diseases with incidence increased within the past two decades or potential increase in the near future eosinophil: granular leukocyte enzyme-linked immunosorbent assay (ELISA). Positive results must be validated, usually with Western blot test. epitope: any component of an antigen molecule that functions as an antigenetic determinant by permitting the attachment of certain antibodies erythema: diffuse redness of the skin fungemia: a bloodstream infection caused by a fungal organism genetic engineering: emerging technology designed to enable replacement of missing or defective genes hapten: incomplete antigen health care–associated infection (HAI): an infection not present or incubating at the time of admission to the health care setting; this term is replacing the term “nosocomial infection,” which refers only to those infections acquired in a hospital helper T cells: lymphocytes that attack foreign invaders (antigens) directly histamine: substance in the body that causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle HIV-1: retrovirus isolated and recognized as the etiologic agent of AIDS HIV-2: retrovirus identified in 1986 in AIDS patients in West Africa HIV encephalopathy: degenerative neurologic condition characterized by a group of clinical presentations including loss of coordination, mood swings, loss of inhibitions, and widespread cognitive dysfunctions; formerly referred to as AIDS dementia complex (ADC) host: an organism that provides living conditions to support a microorganism human papillomavirus (HPV): viruses that cause various warts, including plantar and genital warts; some strains of HPV can also cause cervical cancer humoral immune response: the immune system’s second line of defense; often termed the antibody response hypersensitivity: abnormal heightened reaction to a stimulus of any kind hypogammaglobulinemia: lack of one or more of the five immunoglobulins; caused by B-cell deficiency immune: person with protection from a previous infection or immunization who resists reinfection when re- exposed to the same agent immune reconstitution inflammatory syndrome: a syndrome that results from rapid restoration of pathogen-specific immune responses to opportunistic infections; most often occurs after starting antiretroviral therapy immune response: the coordinated response of the components of the immune system to a foreign agent or organism immune system: the collection of organs, cells, tissues, and molecules that mediate the immune response immunity: the body’s specific protective response to a foreign agent or organism; resistance to disease, specifically infectious diseases immunocompromised host: person with a secondary immunodeficiency and associated immunosuppression immunoglobulins: a family of closely related proteins capable of acting as antibodies immunopathology: study of diseases resulting in dysfunctions within the immune system immunoregulation: complex system of checks and balances that regulates or controls immune responses incubation period: time between contact and onset of signs and symptoms infection: condition in which the host interacts physiologically and immunologically with a microorganism infectious disease: the consequences that result from invasion of the body by microorganisms that can produce harm to the body and potentially death interferons: proteins formed when cells are exposed to viral or foreign agents; capable of activating other components of the immune system Kaposi’s sarcoma: malignancy that involves the epithelial layer of blood and lymphatic vessels latency: time interval after primary infection when a microorganism lives within the host without producing clinical evidence latent reservoir: the integrated HIV provirus within the CD4+ T cell during the resting memory state; does not express viral proteins and is invisible to the immune system and antiviral medications. leukotrienes: a group of chemical mediators that initiate the inflammatory response lymphokines: substances released by sensitized lymphocytes when they come in contact with specific antigens macrophage: large immune cell that devours invading pathogens and other intruders; can harbor large quantities of HIV without being killed, acting as a reservoir of the virus mast cells: connective tissue cells that contain heparin and histamine in their granules memory cells: cells that are responsible for recognizing anti- gens from previous exposure and mounting an immune response methicillin-resistant Staphylococcus aureus (MRSA): Staphylococcus aureus bacterium that is not susceptible to extended-penicillin antibiotic formulas, such as methicillin, oxacillin, or nafcillin; MRSA may occur in a health care or in a community setting monocyte: large white blood cell that ingests microbes or other cells and foreign particles. When a monocyte enters tissues, it develops into a macrophage. Mycobacterium avium complex: opportunistic infection caused by mycobacterial organisms that commonly causes a respiratory illness but can also infect other body systems natural killer (NK) cells: lymphocytes that defend against microorganisms and malignant cells normal flora: persistent nonpathogenic organisms colonizing a host null lymphocytes: lymphocytes that destroy antigens already coated with the antibody opportunistic infection: illness caused by various organisms, some of which usually do not cause disease in people with normal immune systems opsonization: the coating of antigen–antibody molecules with a sticky substance to facilitate phagocytosis p24 antigen: blood test that measures viral core protein; accuracy of test is limited because the p24 antibody binds with the anti- gen and makes it undetectable panhypoglobulinemia: general lack of immunoglobulins in the blood peripheral neuropathy: disorder characterized by sensory loss, pain, muscle weakness, and wasting of muscles in the hands or legs and feet phagocytic cells: cells that engulf, ingest, and destroy foreign bodies or toxins phagocytic immune response: the immune system’s first line of defense, involving white blood cells that have the ability to ingest foreign particles Pneumocystis pneumonia or Pneumocystis jiroveci pneumonia (PCP): common opportunistic lung infection caused by an organism, believed to be a fungus based on its structure polymerase chain reaction: a sensitive laboratory technique that can detect and quantify HIV in a person’s blood or lymph nodes primary infection: 4 to 7 week period of rapid viral replication immediately following infection; also known as acute HIV infection progressive multifocal leuko-encephalopathy: opportunistic infection that infects brain tissue and causes damage to the brain and spinal cord prostaglandins: unsaturated fatty acids that have a wide assortment of biologic activity protease inhibitor: medication that inhibits the function of protease, an enzyme needed for HIV replication provirus: viral genetic material in the form of DNA that has been integrated into the host genome. When it is dormant in human cells, HIV is in a proviral form. reservoir: any person, plant, animal, substance, or location that provides living conditions for microorganisms and that enables further dispersal of the organism retrovirus: a virus that carries genetic material in RNA instead of DNA and contains reverse transcriptase reverse transcriptase: enzyme that transforms single-stranded RNA into a doublestranded DNA rhinitis: inflammation of the nasal mucosa serotonin: chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor severe combined immunodeficiency disease: disorder involving a complete absence of humoral and cellular immunity resulting from an X-linked or autosomal genetic abnormality Standard Precautions: strategy of assuming all patients may carry infectious agents and using appropriate barrier precautions for all health care worker–patient interactions stem cells: precursors of all blood cells; reside primarily in bone marrow suppressor T cells: lymphocytes that decrease B-cell activity to a level at which the immune system is compatible with life susceptible: not possessing immunity to a particular pathogen T cells: cells that are important for producing a cellular immune response telangiectasia: vascular lesions caused by dilated blood vessels thymic hypoplasia: T-cell deficiency that occurs when the thymus gland fails to develop normally during embryogenesis; also known as DiGeorge syndrome T lymphocytes: cells that can cause graft rejection, kill foreign cells, or suppress production of antibodies transient flora: organisms that have been recently acquired and are likely to be shed in a relatively short period Transmission-Based Precautions: precautions used in addition to Standard Precautions when contagious or epidemiologically significant organisms are recognized; the three types of Transmission-Based Precautions are Air- borne, Droplet and Contact Precautions urticaria: hives vancomycin-resistant Enterococcus (VRE): Enterococcus bacterium that is resistant to the antibiotic vancomycin vancomycin-resistant Staphylococcus aureus (VRSA): Staphylococcus aureus bacterium that is not susceptible to vancomycin viral load test: measures the quantity of HIV RNA in the blood viral set point: amount of virus present in the blood after the initial burst of viremia and the immune response that follows virulence: degree of pathogenicity of an organism wasting syndrome: involuntary weight loss of 10% of baseline body weight with chronic diarrhea or chronic weakness and documented fever Western blot assay: a blood test that identifies antibodies to HIV and is used to confirm the results of an EIA (ELISA) test window period: time from infection with HIV until seroconversion detected on HIV antibody test Wiskott-Aldrich syndrome: immunodeficiency characterized by thrombocytopenia and the absence of T and B cells DERMATOLOGY acantholysis: separation of epidermal cells from each other due to damage or abnormality of the intracellular substance AlloDerm: processed dermis from human cadaver skin; can be used as dermal layer for skin grafts autograft: a graft derived from one part of a patient’s body and used on another part of that same patient’s body balneotherapy: a bath with therapeutic additives Biobrane: synthetic dressing composed of a nylon, Silastic membrane combined with a collagen derivative carboxyhemoglobin: a compound of carbon monoxide and hemoglobin, formed in the blood with exposure to carbon monoxide carbuncle: localized skin infection involving several hair follicles cheilitis: inflammation of the lips (when dry, cracking, inflamed skin occurs at the corners of the mouth it is called angular cheilitis; when caused by sun exposure it is called solar cheilitis) collagen: a protein present in skin, tendon, bone, cartilage, and connective tissue comedones: the primary lesions of acne, caused by sebum blockage in the hair follicle contracture: shrinkage of burn scar through collagen maturation cultured epithelial autograft (CEA): autologous epidermal cells that proliferate in culture and then are regrafted onto the patient cytotoxic: destructive of cells débridement: removal of necrotic or dead tissue by mechanical, surgical, or autolytic means until surrounding healthy tissue is exposed dermatitis: any inflammation of the skin dermatosis: any abnormal skin lesion donor site: the area from which skin is taken to provide a skin graft for another part of the body epidermopoiesis: development of epidermal cells eschar: devitalized tissue resulting from a burn escharotomy: a linear excision made through eschar to release constriction of underlying tissue excision: surgical removal of tissue fasciotomy: an incision made through the fascia to release constriction of underlying muscle fibrinolytic: a substance that acts to break up fibrin, the fine filaments of blood clots furuncle: localized skin infection of a single hair follicle heterograft: graft (i.e., pigskin) obtained from an animal of a species other than that of the recipient; also called a xenograft homograft: a graft transferred from one human (living or cadaveric) to another human; also called allograft hypertrophic scar: excessive scar formation that rises above the level of the skin hydrophilic: a material that absorbs moisture hydrophobic: a material that repels moisture hydrotherapy: cleansing of wounds through use of bath, shower, shower cart table, or immersion hygroscopic: a material that absorbs moisture from the air Integra: synthetic dermal substitute lichenification: thickening of the horny layer of the skin liniments: lotions with added oil for increased softening of the skin mitogenic: a substance that stimulates mitosis or cell division and reproduction plasmapheresis: removal of whole blood from the body, separation of its cellular elements by centrifugation, and reinfusion of them suspended in saline or some other plasma substitute, thereby depleting the body’s own plasma without depleting its cells pyodermas: bacterial skin infections rule of nines: method for calculating body surface area burned by dividing the body into multiples of nine striae: band like streaks on the skin, distinguished by color, texture, depression, or elevation from the tissue in which they are found; usually purplish or white suspensions: liquid preparations in which powder is suspended, requiring shaking before use tinea: a superficial fungal infection on the skin or scalp xerosis: overly dry skin NEUROLOGY accommodation: process by which the eye adjusts for near distance (e.g., reading) by changing the curvature of the lens to focus a clear image on the retina akathisia: restlessness, urgent need to move around, and agitation anterior chamber: space in the eye bordered anteriorly by the cornea and posteriorly by the iris and pupil aphakia: absence of the natural lens aqueous humor: watery fluid that fills the anterior and posterior chambers of the eye astigmatism: refractive error in which light rays are spread over a diffuse area rather than sharply focused on the retina, a condition caused by differences in the curvature of the cornea and lens binocular vision: normal ability of both eyes to focus on one object and fuse the two images into one blindness: inability to see, usually defined as corrected visual acuity of 20/400 or less, or a visual field of no more than 20 degrees in the better eye bradykinesia: very slow voluntary movements and speech bullous keratopathy: corneal edema with painful blisters in the epithelium due to excessive corneal hydration chemosis: edema of the conjunctiva chorea: rapid, jerky, involuntary, purposeless movements of the extremities or facial muscles, including facial grimacing cones: retinal photoreceptor cells essential for visual acuity and color discrimination dementia: a progressive organic mental disorder characterized by personality changes, confusion, disorientation, and deterioration of intellect associated with impaired memory and judgment diplopia: seeing one object as two; double vision dyskinesia: impaired ability to execute voluntary movements dysphonia: abnormal voice quality caused by weakness and incoordination of muscles responsible for speech emmetropia: absence of refractive error enucleation: complete removal of the eyeball and part of the optic nerve evisceration: removal of the intraocular contents through a corneal or scleral incision; the optic nerve, sclera, extraocular muscles, and sometimes, the cornea are left intact exenteration: surgical removal of the entire contents of the orbit, including the eyeball and lids hyperemia: “red eye” resulting from dilation of the vasculature of the conjunctiva hyperopia: farsightedness; a refractive error in which the focus of light rays from a distant object is behind the retina hyphema: blood in the anterior chamber hypopyon: collection of inflammatory cells that has the appearance of a pale layer in the inferior anterior chamber of the eye injection: congestion of blood vessels keratoconus: cone-shaped deformity of the cornea limbus: junction of the cornea and sclera micrographia: small and often illegible handwriting miotics: medications that cause pupillary constriction mydriatics: medications that cause pupillary dilation myopia: nearsightedness; a refractive error in which the focus of light rays from a distant object is anterior to the retina neovascularization: growth of abnormal new blood vessels neurodegenerative: a disease, process, or condition that leads to deterioration of normal cells or function of the nervous system nystagmus: involuntary oscillation of the eyeball papilledema: swelling (edema) of the optic disc (nerve) due to increased intracranial pressure paresthesia: a sensation of numbness, tingling, or a “pins and needles” sensation photophobia: ocular pain on exposure to light posterior chamber: space between the iris and vitreous proptosis: downward displacement of the eyeball resulting from an inflammatory condition of the orbit or a mass within the orbital cavity ptosis: drooping eyelid radiculopathy: disease of a spinal nerve root, often resulting in pain and extreme sensitivity to touch refraction: determination of the refractive errors of the eye and correction by lenses rods: retinal photoreceptor cells essential for bright and dim light sciatica: inflammation of the sciatic nerve, resulting in pain and tenderness along the nerve through the thigh and leg scotomas: blind or partially blind areas in the visual field spondylosis: ankylosis or stiffening of the cervical or lumbar vertebrae strabismus: a condition in which there is deviation from perfect ocular alignment sympathetic ophthalmia: an inflammatory condition created in the fellow eye by the affected eye (without useful vision); the condition may become chronic and result in blindness (of the fellow eye) trachoma: a bilateral chronic follicular conjunctivitis of childhood that leads to blindness during adulthood, if left untreated vitreous humor: gelatinous material (transparent and colorless) that fills the eyeball behind the lens HEARING AND BALANCE DISORDERS acute otitis media: inflammation in the middle ear lasting less than 6 weeks agnosia: loss of ability to recognize objects through a particular sensory system; may be visual, auditory, or tactile akinetic mutism: unresponsiveness to the environment; the patient makes no movement or sound but sometimes opens the eyes altered level of consciousness: condition of being less responsive to and aware of environmental stimuli aneurysm: a weakening or bulge in an arterial wall aphasia: inability to express oneself or to understand language apraxia: inability to perform previously learned purposeful motor acts on a voluntary basis ataxia: inability to coordinate muscle movements, resulting in difficulty in walking, talking, and performing self-care activities autonomic dysreflexia: a life-threatening emergency in spinal cord injury patients that causes a hypertensive emergency; also called autonomic hyperreflexia autonomic nervous system: division of the nervous system that regulates the involuntary body functions autoregulation: ability of cerebral blood vessels to dilate or constrict to maintain stable cerebral blood flow despite changes in systemic arterial blood pressure axon: portion of the neuron that conducts impulses away from the cell body Babinski reflex (sign): a reflex action of the toes, indicative of abnormalities in the motor control pathways leading from the cerebral cortex brain death: irreversible loss of all functions of the entire brain, including the brain stem brain injury: an injury to the skull or brain that is severe enough to interfere with normal functioning brain injury, closed (blunt): occurs when the head accelerates and then rapidly decelerates or collides with another object and brain tissue is damaged, but there is no opening through the skull and dura brain injury, open: occurs when an object penetrates the skull, enters the brain, and damages the soft brain tissue in its path (penetrating injury), or when blunt trauma to the head is so severe that it opens the scalp, skull, and dura to expose the brain bulbar paralysis: immobility of muscles innervated by cranial nerves with their cell bodies in the lower portion of the brain stem cholesteatoma: tumor of the middle ear or mastoid, or both, that can destroy structures of the temporal bone chronic otitis media: repeated episodes of acute otitis media causing irreversible tissue damage and persistent tympanic membrane perforation clonus: abnormal movement marked by alternating contraction and relaxation of a muscle occurring in rapid succession coma: prolonged state of unconsciousness complete spinal cord lesion: a condition that involves total loss of sensation and voluntary muscle control below the lesion concussion: a temporary loss of neurologic function with no apparent structural damage to the brain conductive hearing loss: loss of hearing in which efficient sound transmission to the inner ear is interrupted by some obstruction or disease process contusion: bruising of the brain surface craniectomy: a surgical procedure that involves removal of a portion of the skull craniotomy: a surgical procedure that involves entry into the cranial vault Cushing’s response: the brain’s attempt to restore blood flow by increasing arterial pressure to overcome the increased intracranial pressure Cushing’s triad: three classic signs—bradycardia, hypertension, and bradypnea— seen with pressure on the medulla as a result of brain stem herniation deafness: partial or complete loss of the ability to hear decerebration: an abnormal body posture associated with a severe brain injury, characterized by extreme extension of the upper and lower extremities decortication: an abnormal posture associated with severe brain injury, characterized by abnormal flexion of the upper extremities and extension of the lower extremities delirium: transient loss of intellectual function, usually due to systemic problems dendrite: portion of the neuron that conducts impulses toward the cell body diplopia: double vision, or the awareness of two images of the same object occurring in one or both eyes dizziness: altered sensation of orientation in space dysarthria: defects of articulation due to neurologic causes dyskinesia: impaired ability to execute voluntary movements dysphagia: difficulty swallowing, causing the patient to be at risk for aspiration dysphonia: voice impairment or altered voice production endolymphatic hydrops: dilation of the endolymphatic space of the inner ear; the pathologic correlate of Ménière’s disease epidural monitor: a sensor placed between the skull and the dura to monitor intracranial pressure epilepsy: a group of syndromes characterized by paroxysmal transient disturbances of brain function exostoses: small, hard, bony protrusions in the lower posterior bony portion of the ear canal expressive aphasia: inability to express oneself; often associated with damage to the left frontal lobe area fiberoptic monitor: a system that uses light refraction to determine intracranial pressure flaccidity: displaying lack of muscle tone; limp, floppy halo vest: a lightweight vest with an attached halo that stabilizes the cervical spine head injury: an injury to the scalp, skull, and/or brain hemianopsia: blindness of half of the field of vision in one or both eyes hemiplegia/hemiparesis: weakness/paralysis of one side of the body, or part of it, due to an injury in the motor area of the brain herniation: abnormal protrusion of tissue through a defect or natural opening incomplete spinal cord lesion: a condition in which there is preservation of the sensory or motor fibers, or both, below the lesion infarction: a zone of tissue deprived of blood supply intracranial pressure: pressure exerted by the volume of the intracranial contents within the cranial vault Korsakoff’s syndrome: disorder characterized by psychosis, disorientation, delirium, insomnia, and hallucinations labyrinthitis: inflammation of the labyrinth of the inner ear locked-in syndrome: condition resulting from a lesion in the pons in which the patient lacks all distal motor activity (paralysis) but cognition is intact Ménière’s disease: condition of the inner ear characterized by a triad of symptoms: episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss middle ear effusion: fluid in the middle ear without evidence of infection microdialysis: procedure in which an intracranial catheter is inserted near an injured area of brain to measure lactate, pyruvate, glutamate, and glucose levels migraine headache: a severe, unrelenting headache often accompanied by symptoms such as nausea, vomiting, and visual disturbances Monro-Kellie hypothesis: theory that states that due to limited space for expansion within the skull, an increase in any one of the cranial contents—brain tissue, blood, or cerebrospinal fluid—causes a change in the volume of the others myringotomy (i.e., tympanotomy): incision in the tympanic membrane neurogenic bladder: bladder dysfunction that results from a disorder or dysfunction of the nervous system; may result in either urinary retention or bladder over activity neuropathy: general term indicating a disorder of the nervous system nystagmus: involuntary rhythmic eye movement ossiculoplasty: surgical reconstruction of the middle ear bones to restore hearing otalgia: sensation of fullness or pain in the ear otitis externa (i.e., external otitis): inflammation of the external auditory canal otorrhea: drainage from the ear otosclerosis: a condition characterized by abnormal spongy bone formation around the stapes paraplegia: paralysis of the lower extremities with dysfunction of the bowel and bladder from a lesion in the thoracic, lumbar, or sacral region of the spinal cord parasympathetic nervous system: division of the autonomic nervous system active primarily during non-stressful conditions, controlling mostly visceral functions paresthesia: a sensation of numbness or tingling or a “pins and needles” sensation penumbra region: area of low cerebral blood flow persistent vegetative state: condition in which the patient is wakeful but devoid of conscious content, without cognitive or affective mental function photophobia: inability to tolerate light position (postural) sense: awareness of position of parts of the body without looking at them; also referred to as proprioception presbycusis: progressive hearing loss associated with aging primary headache: a headache for which no specific organic cause can be found primary injury: initial damage to the brain that results from the traumatic event prion: a particle smaller than a virus that is resistant to standard sterilization procedures receptive aphasia: inability to understand what someone else is saying; often associated with damage to the temporal lobe area reflex: an automatic response to stimuli rhinorrhea: drainage from the nose rigidity: increase in muscle tone at rest characterized by increased resistance to passive stretch Romberg test: test for cerebellar dysfunction requiring the patient to stand with feet together, eyes closed and arms extended; inability to maintain the position, with either significant stagger or sway, is a positive test secondary headache: headache identified as a symptom of another organic disorder (e.g., brain tumor, hypertension) secondary injury: an insult to the brain subsequent to the original traumatic event seizures: paroxysmal transient disturbance of the brain resulting from a discharge of abnormal electrical activity sensorineural hearing loss: loss of hearing related to damage of the end organ for hearing or cranial nerve VIII, or both spasticity: muscular hyper tonicity with increased resistance to stretch often associated with weakness, increased deep tendon reflexes, and diminished superficial reflexes (sustained increase in tension of a muscle when it is passively lengthened or stretched) spinal cord injury: an injury to the spinal cord, vertebral column, supporting soft tissue, or intervertebral disks caused by trauma spongiform: having the appearance or quality of a sponge status epilepticus: episode in which the patient experiences multiple seizure bursts with no recovery time in between subarachnoid screw or bolt: device placed into the subarachnoid space to measure intracranial pressure sympathetic nervous system: division of the autonomic nervous system with predominantly excitatory responses; the “fight-or-flight” system tetraplegia (quadriplegia): paralysis of both arms and legs, with dysfunction of bowel and bladder from a lesion of the cervical segments of the spinal cord tinnitus: subjective perception of sound with internal origin; unwanted noises in the head or ear transection: severing of the spinal cord itself; transection can be complete (all the way through the cord) or incomplete (partially through) transsphenoidal: surgical approach to the pituitary via the sphenoid sinuses tympanoplasty: surgical repair of the tympanic membrane ventriculostomy: a catheter placed in one of the lateral ventricles of the brain to measure intracranial pressure and allow for drainage of fluid vertigo: an illusion of movement in which the individual or the surroundings are sensed as moving (usually rotation) MUSCULOSKELETAL FUNCTION abduction: movement away from the center or median line of the body adduction: movement toward the center or median line of the body allograft: tissue harvested from a donor for use in another person amputation: removal of a body part, usually a limb or part of a limb arthroscope: surgical scope injected into the joint to examine or repair atonic: without tone; denervated muscle that atrophies atrophy: shrinkage-like decrease in the size of a muscle autograft: tissue harvested from one area of the body and used for transplantation to another area of the same body avascular necrosis: death of tissue secondary to a decrease or lack of perfusion brace: externally applied device to support the body or a body part, control movement, and prevent injury bursa: fluid-filled sac found in connective tissue, usually in the area of joints bursitis: inflammation of a fluid-filled sac in a joint callus: cartilaginous/fibrous tissue at fracture site cancellous bone: lattice-like bone structure; trabecular bone cartilage: tough, elastic, avascular tissue at ends of bone cast: rigid external immobilizing device molded to contours of body part cast syndrome: psychological (claustrophobic reaction) or physiologic (superior mesenteric artery syndrome) responses to confinement in body cast clonus: rhythmic contraction of muscle continuous passive motion (CPM) device: a device that promotes range of motion, circulation, and healing contracture: abnormal shortening of muscle or fibrosis of joint structures contusion: blunt force injury to soft tissue cortical bone: compact bone crepitus: grating or crackling sound or sensation; may occur with movement of ends of a broken bone or irregular joint surface débridement: surgical removal of contaminated and devitalized tissues and foreign material delayed union: prolongation of expected healing time for a fracture diaphysis: shaft of long bone disarticulation: amputation through a joint dislocation: complete separation of joint surfaces edema: soft tissue swelling due to fluid accumulation effusion: excess fluid in joint endosteum: a thin, vascular membrane covering the marrow cavity of long bones and the spaces in cancellous bone epiphysis: end of long bone external fixator: external metal frame attached to bone fragments to stabilize them fascia (epimysium): fibrous tissue that covers, supports, and separates muscles fasciculation: involuntary twitch of muscle fibers flaccid: limp; without muscle tone fracture: a break in the continuity of a bone fracture reduction: restoration of fracture fragments into anatomic alignment heterotopic ossification: misplaced formation of bone hypertrophy: enlargement; increase in size of muscle involucrum: new bone growth around a sequestrum isometric contraction: muscle tension increased, length unchanged, no joint motion isotonic contraction: muscle tension unchanged, muscle shortened, joint moved joint: area where bone ends meet; provides for motion and flexibility joint capsule: fibrous tissue that encloses bone ends and other joint surfaces kyphosis: increase in the convex curvature of the spine lamellae: mature compact bone structures that form concentric rings of bone matrix; lamellar bone ligament: fibrous band connecting bones lordosis: increase in lumbar curvature of the spine malunion: healing of a fractured bone in a malaligned position neurovascular status: neurologic (motor and sensory components) and circulatory functioning of a body part nonunion: failure of fractured bones to heal together open reduction with internal fixation (ORIF): open surgical procedure to repair and stabilize a fracture ossification: process in which minerals (calcium) are deposited in bone matrix osteoblast: bone-forming cell osteoclast: bone resorption cell osteocyte: mature bone cell osteogenesis: bone formation osteomyelitis: infection of the bone osteon: microscopic functional bone unit osteotomy: surgical cutting of bone paresthesia: abnormal sensation (e.g., burning, tingling, numbness) pastic: having greater-than-normal muscle tone periosteum: fibrous connective tissue covering bone phantom limb pain: pain perceived in an amputated section radiculopathy: disease of a nerve root remodeling: process that ensures bone maintenance through simultaneous bone resorption and formation resorption: removal/destruction of tissue, such as bone RICE: acronym for rest, ice, compression, elevation sprain: an injury to ligaments and muscles and other soft tissues at a joint sciatica: sciatic nerve pain; pain travels down back of thigh into foot scoliosis: lateral curving of the spine s sequestrum: dead bone in abscess cavity sling: bandage used to support an arm splint: device designed specifically to support and immobilize a body part in a desired position strain: a musculotendinous stress injury subluxation: partial separation of joint surfaces synovium: membrane in joint that secretes lubricating fluid tendinitis: inflammation of muscle tendons tendon: cord of fibrous tissue connecting muscle to bone tone (tonus): normal tension (resistance to stretch) in resting muscle trabeculae: lattice-like bone structure; cancellous bone traction: application of a pulling force to a part of the body trapeze: overhead assistive device to promote patient mobility in bed EMERGENCY antivenin: antitoxin manufactured from venom of poisonous snakes to assist the patient’s immune system response to an envenomation biological warfare: use of a biological agent, such as anthrax, as a WMD carboxyhemoglobin: hemoglobin that is bound to carbon monoxide and therefore is unable to bind with oxygen, resulting in hypoxemia chemical warfare: use of a chemical agent, such as chlorine, as a WMD corrosive poison: alkaline or acidic agent; causes tissue destruction after contact cricothyroidotomy: surgical opening of the cricothyroid membrane to obtain an airway that is maintained with a tracheostomy or endotracheal tube decontamination: process of removing, or rendering harmless, contaminants that have accumulated on personnel, patients, and equipment diagnostic peritoneal lavage: instillation of lactated Ringer’s or normal saline solution into the abdominal cavity to detect red blood cells, white blood cells, bile, bacteria, amylase, or gastrointestinal contents indicative of abdominal injury emergent: triage category signifying potentially life-threatening injuries or illnesses requiring immediate treatment envenomation: injection of a poisonous material by sting, spine, bite, or other means fasciotomy: surgical incision of the extremity to the level of the fascia to relieve pressure and restore neurovascular function to the extremity Hare traction: portable in-line traction applied to the lower extremity to manage femur or hip fractures or dislocations mass casualty incident (MCI): situation in which the number of casualties exceeds the number of resources material safety data sheet (MSDS): provides information to employees and health care providers regarding specific chemical agents; includes chemical name, physical data, chemical ingredients, fire and explosive hazard data, health and reactive data, spill or leak procedures, special protection information, and special precautions; also known as the Worker’s Right to Know minor: triage category signifying non–life-threatening injuries or illnesses that can be routinely managed in a clinic or physician’s office or that require no medical care nonurgent: triage category signifying episodic or minor injury or illness in which treatment may be delayed several hours or longer without increased morbidity nuclear warfare: use of nuclear contamination as a WMD personal protective equipment (PPE): equipment beyond standard precautions; may include level A, B, C, and D equipment resuscitation: triage category signifying life-threatening injuries or illnesses requiring immediate intervention terrorism: unlawful use of violence or threats of violence against people in order to coerce or intimidate triage: process of assessing patients to determine management priorities urgent: triage category signifying serious illness or injury that is not immediately life-threatening weapons of mass destruction (WMD): weapons used to cause widespread death and destruction