Advance directive: Instructions from a decisionally capable individual regarding decisions about future medical treatment in the even he or she becomes decisionally incapable. An advance directive may specify medical treatment the individual consents to or refuses, designate a surrogate decision maker, or both.
Advanced cardiac life support: Sophisticated procedures use to restore and/or maintain breathing and circulation in a person who has experienced cardiac and/or respiratory arrest. Procedures include the administration of drugs, electric shock, and intubation.
Alzheimer's disease: The most common form of dementia, a chronic organic brain disease leading to severe, progressive loss of brain functional and eventual death. Amyotrophic lateral sclerosis (ALS): A motor neuron disease characterized by progressive weakening and wasting of the muscles that usually causes death within 2 to 5 years. Also called "Lou Gehrig's disease."
Anemia: A condition in which the blood is deficient in red blood cells, hemoglobin, or total volume. Associated with a lack of well-being in patients with chronic renal failure.
Antibiotic: Any one of many drugs that can inhibit or destroy microorganisms, and that is administered to cure or control numerous kinds of infections.
Arrhythmia: Any variation from normal, regular rhythm. Usually refers to abnormalities of cardiac rhythm, including ventricular fibrillation, tachycardia, and bradycardia.
Arteriovenous fistula: A surgically created connection between an artery and a vein, commonly used as part of the blood access system for hemodialysis.
Artificial airway: Surgically created route for passage of air into and out of the lungs.
Asystole: Absence of electrical activity in the heart.
Atherosclerosis: A common condition, in which the deposits of fibrous and cellular tissue, cholesterol, and fat accumulate in the arteries, impeding the blood flow.
Autonomy: It is the principle that independent actions and choices of an individual should not be constrained by others.
Basic life support: The relatively simple resuscitation procedures used to restore and maintain breathing and circulation in a person who has experience cardiac or respiratory arrest. Procedures include clearing the victim's airway, administering mouth-to-mouth resuscitation, and manually compressing the chest to stimulate the heart.
Beneficence: Mercy, kindness, or charity to others. It is the principle that one has a duty to convey benefits or to help others further their importance and legitimate interests.
Best interest (standard): A legal standard to guide surrogate decisionmaking. By this standard, the surrogate makes the decision from the point of view of a hypothetical "reasonable person," on the basis of objective, socially shared criteria.
Biocompatible: Able to exist in harmony with living tissues, unlikely to cause infection, wear, or other deleterious effects.
Brain death: Irreversible cessation of all function of the entire brain, including the brainstem, as evidenced by loss of all reflexes and electrical activity. Since 1970, many states have enacted legislation recognizing brain death as a criteria for determining death.
Cardiopulmonary resuscitation (CPR): A range of technologies used to restore and maintain blood circulation and breathing in a person who has experienced cardiac and/or respiratory arrest.
Cardiovascular disease: Any of a diverse group of diseases characterized by the debilitation of the heart and/or blood vessels.
Caregivers: All persons who administer care to patients, i.e., health professionals including physicians, nurses, and allied health personnel; and lay persons, especially family members.
Case law: The aggregate of reported cases that form a body of jurisprudence, or the law of a particular subject as evidenced or decided by the decided cases, in distinction to statutes and other sources of law.
Catheter: A long, thin tube through which fluids may be introduced (e.g., nutritional formulas, drugs, blood) or drained (e.g., urine, blood) in the course of diagnosis or treatment.
Charges: The amount billed for products or services.
Chronic illness: An illness characterized by extended duration or frequent recurrence, and slow development. Chronic illnesses vary in severity and impact on a person's functional capacity. Some chronic illnesses are life-threatening and require continual medical treatment.
Chronic obstructive pulmonary disease (COPD): A diagnostic term that designated several diseases characterized by chronic airflow limitation: asthma, chronic bronchitis, emphysema, and less common diseases such as bronchiectasis and cystic fibrosis. COPD is a major cause of respiratory failure in elderly persons. Also called chronic obstructive lung disease.
Chronic renal failure: An irreversible condition in which the kidneys function at about one-quarter or less than normal level.
Chronological age: An individual's numerical age, dating from the time of his or her birth.
Code: Hospital terminology to designate the extent of resuscitative measures to be taken in the event of sudden cardiac arrest.
Code blue: A hospital's emergency call for professionals to respond to a patient in cardiac arrest.
Cognitive ability: The ability to comprehend, remember, reason, and judge information. In the context of this assessment, the content and the stability of cognitive ability are of major importance.
Cognitive impairment: Diminished cognitive ability.
Comorbidity: The simultaneous occurrence of multiple medical conditions or disease in a single person.
Competence: In this assessment, any adult who has not been determined by a court to be incompetent, as there is legal presumption of competence.
Continuous ambulatory peritoneal dialysis (CAPD): A method of peritoneal dialysis at maximizes patient ambulatory and self-care. CAPD is performed continuously, with exchange of dialysis fluid every 4 to 8 hours. CAPD is the most popular form of peritoneal dialysis and the most widely used form of home dialysis.
Continuous cycling peritoneal dialysis (CCPD): A recently developed form of peritoneal dialysis that combines nightly use of a machine to cycle the dialysate in and out of the peritoneal cavity and daytime use of ambulatory peritoneal dialysis (CAPD).
Critically ill: A patient who is experiencing an acute life-threatening episode or who is believed to be in an imminent danger of such an episode. A critically ill patient is medically unstable and, if not treated, likely to decline.
Decisionally incapable: A patient who is assessed, usually without the involvement of a court, to lack the mental capacity to make a particular decision.
Decubitus ulcers: Lesions or cavities on the skin frequently caused by lying in bed for a long period of time. Also called bed sores or pressure sores.
Defibrillator: An electrical device use to terminate atrial or ventricular fibrillation. High-voltage electrical shock is delivered to the heart through two paddles placed on the patient's chest.
Dementia: Severe impairment of mental functions and global cognitive abilities of long duration (months to years) in an alert individual. Some forms (especially Alzheimer's disease) are permanent; others are reversible.
Diabetes mellitus: A chronic disease characterized by inadequate secretion or utilization of insulin, by elevated blood sugar or the presence of sugar in the urine, by thirst, hunger, and weight loss. Long-term complications include disorders of the kidney, circulatory system, and retina.
Diagnosis-related groups (DRGs): Diagnostic categories used by Medicare (Part A) as case-mix measures, under the prospective hospital payment system. Categories are drawn from the International Classification of Diseases and modified by the presence of a surgical procedure, patient age, comorbidities or complications, and other criteria.
Dialysate: The fluid into which impurities removed from the blood by dialysis are passed. Also called "dialysis fluid."
Dialysis: In general, any process in which components of a liquid or solution are separated on the basis of the selective movement of different kinds of molecules through a semipermeable membrane. In renal dialysis, impurities are separated and removed from the blood. The two types of renal dialysis are hemodialysis and peritoneal dialysis.
Dialyzer: A machine for performing hemodialysis. It consists of a compartment for the blood, a compartment for the dialysate, and a semipermeable membrane separating the two.
Distributive justice: Theories and principles for the fair allocation of resources in general and scarce resources in particular.
Do-Not-Intubate (DNI): A directive by a physician to withhold cardiopulmonary resuscitation in the event that a patient experiences cardiac or respiratory arrest. Also called "no code."
Durable power of attorney: A legal instrument empowering a designated person to act on another's behalf. Unlike the traditional power of attorney, the "durable" power does not lapse if the person who executed it becomes decisionally incapable. Originally intended to permit financial or property transactions, durable powers of attorney are also used to delegate medical decisionmaking authority.
Electrocardiogram (ECG or EKG): A graphic record of the electrical activity of the heart as detected by an electrocardiograph machine.
Endotracheal tube: A tube designed to be inserted through the natural opening of a patient's trachea (windpipe), usually for mechanical ventilation. The two types of endotracheal tubes are nasotracheal tubes (inserted through the trachea via the patient's nose) and orotracheal tubes (inserted via the patient's mouth).
End-stage renal disease (ESRD): A late stage of chronic renal failure in which kidney function in less than 10 percent of normal, and regular dialysis or kidney transplantion is required to maintain life.
Enternal nutrition: The infusion of nutrients into a person's stomach or intestine via tubes placed through the nose or a surgical opening into the gastrointestinal tract. (Through the term is sometimes defined to include oral nutrition supplements, in this assessment it refers only to tube feeding.) Compare parenteral nutrition.
Ethics committee: Consultative committee in hospital or other institution whose role is to analyze ethical dilemmas and to advise and educate healthcare providers, patients, and families regarding difficult treatment decisions.
Euthanasia: An act intended to cause the merciful death of a person who is suffering from what is believed to be an incurable condition.
Extubation: Removal for any reason from a patient of nasogastric, tracheostomy, or other tube used in treatment.
Geriatrician: A physician who possesses special knowledge of geriatrics or geriatric medicine.
Geriatrics: The medical knowledge of physical disability in older persons--including the prevention, diagnosis, and treatment of disorders. Also called "geriatric medicine."
Gerontology: The study of aging in all its aspects, including biological, psychological, sociological, economic, and historical perspectives.
Glomerulonephritis: Acute or chronic inflammation of the kidneys characterized by inflammation of the capillary loops in the glomeruli. A serious risk for chronic renal failure.
Guardian: A person appointed by a court to protect the interests of a person who is decisionally incapable.
Hemofiltration: An extracorporeal process of filtering the blood to correct various imbalances.
Hospice: A method of care that provides supportive medical and social services for dying individuals and their families. Hospice service can be provided in the patient's home, a nursing home, hospital, a special hospice facility, or a combination of these.
Hydration: The addition of water, as by intravenous fluids, to the body.
Hypercapnia: Elevated concentration of carbon dioxide in the blood. Also called "hypercarbia."
Hypertension: A common and significant cardiovascular disorder characterized by persistently high arterial blood pressure. Important risk factor for life-threatening conditions, including cardiac arrest, stroke, and chronic renal failure.
Hypoxia: Deficiency of oxygen in the tissues.
Incidence: The number of new occurrences of a disease in a specific population and period of time. Incidence is often expressed as a rate (e.g., the number of new cases of pneumonia per 1,000 nursing home residents during a 12-month period).
Incompetent: A person who has been determined by a court of law to be unable to make and articulate rational decisions.
Infection: An illness caused by an organism such as a bacterium, virus, or fungus.
Informed consent: A legal term that refers to a person's consent to a proposed medical intervention after being provided information deemed relevant to that decision. The information that is legally required include: diagnosis, nature and purpose of proposed intervention, risks and consequences of proposed treatment, probability that the treatment will be successful, feasible treatment alternatives, and prognosis if the treatment is not given.
Intensive care unit (ICU): A special hospital unit for complex treatment and continuous monitoring of critically ill patients.
Intermittent peritoneal dialysis: A form of peritoneal dialysis that involves the use of a machine to pump sterile dialysate into a patient's peritoneal cavity and to remove the spent dialysate. Typically performed for 10 to 12 hours, 3 nights a week.
Intravenous: Through a vein. Intravenous procedures are commonly used for nutritional support, and for administration of antibiotics and other drugs.
Intravenous feeding: Nutritional support provided through a vein.
Intubation: Insertion of a tube into a body canal or hollow organ, e.g., insertion of an endotracheal tube into the trachea for mechanical ventilation.
Life-sustaining technologies: Drugs, medical devices, or procedures that can keep individuals alive who would otherwise die within a foreseeable, though usually uncertain, time.
Living will: A document in which a decisionally capable person expresses in advance his or her wish not to receive certain life-sustaining treatments in the even that he or she becomes decisionally incapable in the future.
Mechanical ventilation: The use of a machine to take over the role of a patient's respiratory muscles, inducing rhythmic inflation and emptying of the lungs, to permit adequate transportation of oxygenation and ventilation.
Medicaid: A joint Federal/State program that provides medical benefits for certain low-income persons. Medicaid eligibility, coverage, and reimbursement regulations are determined by each State with Federal guidelines and very significantly among States.
Medicare: A nationwide, federally administered health insurance program that pays for medical care for elderly and disabled beneficiaries and persons with end-stage renal disease. Part A (Hospital Insurance) covers hospital care, some posthospital nursing home care, and some home health care services. Part B (Supplementary Medical Insurance) covers physician services, hospital outpatient services, outpatient physical therapy and speech pathology services, and various other limited ambulatory services and supplies such as durable medical equipment. Part B also covers home health services for Medicare beneficiaries who have Part B coverage only.
Morbidity: Ill health. Within a population, the number of sick persons or cases of disease in a specified period of time.
Myocardial infarction: Damage to a portion of the myocardium (heart muscle) as a result of insufficient blood to the heart. Commonly called "heart attack."
Natural death acts: State statutes that authorize living wills.
Negative pressure ventilator: A device that induces breathing by the application of negative (i.e., below atmospheric) pressure. These relatively simple devices are effective for some medically stable patients with paralysis of the respiratory muscles. The iron lung is a well-known early example.
Nonmaleficence: Generally associated with the maxim "primum non nocere" (above all, do no harm). In ethics, it is the principle that one has a duty not to inflict evil, harm, or risk of harm.
Nosocomial: An infection or disease acquired in a hospital or other healthcare facility.
Nutritional support: Artificial methods of providing nourishment and fluids.
Oxygenation: The delivery of oxygen to the blood.
Palliative care: Care intended to keep a patient comfortable, but not intended to prolong life.
Parens patriae: A legal term that refers to the sovereign power of guardianship over persons who are disabled, such as minors, insane, or incompetent persons. Grants courts authority to appoint a guardian.
Parenteral nutrition: Refers to any form of nutrition that does not utilize the gastrointestinal tract but usually refers to the infusion of nutrients directly into the bloodstream via catheter. One form of parenteral nutrition is total parenteral nutrition. Payment: The dollar amount actually paid for a product or service. Also called "expenditure."
Peritoneal dialysis: One of two major forms of renal dialysis. Dialysis occurs inside the patient's peritoneum.
Peritoneum: The semipermeable membrane lining the abdominal cavity. In peritoneal dialysis, this is the membrane through which impurities are passed from the blood to the dialysate.
Peritonitis: Inflammation of the peritoneum. Peritonitis is the single most important complication of peritoneal dialysis.
Pneumonia: An acute or chronic inflammation of the lungs, caused by exposure to a wide variety of microbial pathogens or to toxic substances. Pneumonia is one of the five leading causes of death in the elderly population.
Polypharmacy: The concurrent use of multiple medications by one patient.
Positive pressure ventilator: A ventilator that delivers respiratory gas to a patient by the application of positive (i.e., above atmosphere) pressure to the patient's airway.
Prevalence: In epidemiology, the number of existing cases of a disease present during a particular time period and in relation to the size of the population. Often expressed as a rate, e.g., the prevalence of diabetes per 1,000 persons per year.
Prognosis: An informed judgement about the likely course and probable outcome of a disease based on knowledge of the fact of a particular case.
Prospective payment: A method of payment for medical care in which the amount of payment is set prior to the delivery of the services. The basis of Medicare Part A (hospital) payment since 1983.
Renal dialysis: See dialysis.
Rental failure: Acute or chronic loss of renal function to a level that is incompatible with life. Also called "kidney failure."
Respect for persons: In ethics, the principle that individuals should be treated as ends in themselves and never merely as means to the ends or goals of others.
Respiratory: See ventilator.
Respiratory arrest: Complete cessation of effective breathing.
Respiratory failure: Life-threatening condition in which the respiratory system does not provide adequate oxygenation and/or ventilation.
Respiratory insufficiency: Acute of chronic, life-affecting disorder in oxygenation and/or ventilation.
Respiratory intensive care unit (RICU): A specialized unit in an acute care hospital for critically ill patients requiring mechanical ventilation and continuous monitoring of respiration.
Resuscitation: Procedures for the restoration of heart rhythm and maintenance of blood flow and breathing following cardiac or respiratory arrest. See also advance cardiac life support and basic life support.
Resuscitation policies: Guidelines adopted by some hospitals, nursing homes, and other institutions to govern decisions about the use of resuscitation.
Retrospective cost-based reimbursement: A method of payment for healthcare services in which the amount of payment to a healthcare provider or patient is based on the costs that were already incurred in providing the services. Compare prospective payment.
Substituted judgement (standard): A legal standard for surrogate decisionmaking. By this standard, the surrogate makes the decision on the basis of what is know about the patient's personal values and preferences. Compare best interest.
Surrogate decisionmaker: A person who is designated to make decisions on behalf of a person who is incapable of making decisions. A surrogate decisionmaker may be selected in advance of a person's becoming decisionally incapable by means of durable power of attorney or living will or may be selected after a patient has become decisionally incapable.
Time-limited trial: Clinical trial of a treatment for a pre-determined time period.
Total parenteral nutrition (TPN): An intravenous feeding technique that is capable of supplying sufficient nutrients to maintain a person's normal weight and growth over a prolonged period.
Tracheostomy: An artificial opening in a patient's trachea, which is created by cutting through the patient's neck into the trachea, often for the purpose of inserting a tube for mechanical ventilation.
Tube feeding: See enteral nutrition.
Urinary tract infections: Any infection of one or more parts of the urinary tract.
Ventilator: A mechanical device that assists or replaces the natural mechanisms for breathing The terms ventilator and respirator are used interchangeably, but ventilator is currently the preferred term.
Ventilatory dependent: A patient who must rely on a ventilator for survival, whether for a short time, intermittently but frequently, or constantly.
Ventricular fibrillation: Twitching or beating of the ventricles of the heart in an uncoordinated pattern, without effective contraction and cardiac output. The form of arrhythmia that most frequently precedes cardiac arrest.
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Last update 7/21/96