(kar )

In health care, the application of professional skill, support, and concern to provide health benefits to a person or a community.

acute c.Health care delivered to patients who have experienced sudden illness or injury, or who are recovering from a procedure or operation. Acute care generally occurs in the prehospital or hospital setting or in the emergency department and is usually focused on the immediate, critical problems of the patient.

adult day c.

ABBR: ADC

adult foster c.Long-term care for adults who are unable to live alone due to physical, emotional, or developmental impairments. This care is offered in a variety of settings, including a facility that resembles a family residence. Such a facility may have fewer regulations than a nursing home.

best supportive c.Ideal patient care, e.g., health care that meets the patient's nutritional, psychological, physical, medical, surgical, and social needs.

c. left undone Missed nursing care.

charity c.Care provided to patients who are not expected to be able to pay for the services they receive.

SEE: bad debt.

cluster c.A system of home care for older adults that allows the needs of many clients who live in proximity to be met by a team of workers.

concierge c.Concierge medicine.

culturally competent c.The provision of health care with understand ing of and respect for people of all ages, nationalities, races, beliefs, and customs.

custodial c.Assistance provided to a person who cannot manage to live independently, and who struggles to fulfill basic activities of daily living.

day c.The supervision of dependents during working hours. The goals of day care are to provide adequate, affordable care for young children or dependent adults, esp. while the primary caregivers are at work.

developmentally appropriate c.Care that suits the patient's stage of life by meeting his or her cognitive, emotional, and social needs.

due c.1The kind of care that a competent, responsible, and interested provider will give to an individual in need.2Care that meets generally accepted community stand ards.

emergency cardiac c.

ABBR: ECC

SEE: advanced cardiac life support; basic life support; cardiopulmonary resuscitation.

end-of-life c.

ABBR: EOLC

SEE: hospice.

evidence-based health c.Evidence-based medicine.

family-centered c.The integration and collaboration of family members with the patient care team, esp. in the care of dependent infants, children, or adults with complex or continuing health care needs.

Family and friends are increasingly needed to provide patient care. Although researchers have identified the “typical caregiver” as a 46-year-old female with some college education, in actuality anyone in the patient’s circle may be called upon to provide care. The care provided may vary from helping with driving or shopping; managing treatment and medications; providing assistance with activities of daily living, such as bathing, feeding, toileting; and transferring the patient; or helping the patient make health care decisions and choices. The health care professional should identify the primary caregiver(s), recognize the level of stress occurring in the relationship, and develop a partnership to reduce the burden of care and prevent caregiver exhaustion and burnout. In addition to psychosocial support, the family caregiver may benefit from practical instruction about how to perform caregiving activities. Health care professionals should be available to step in when situational demand s exceed the family caregiver’s capabilities, and to step back when the family’s support is what is needed most. Caregivers need to seek their own support from family, friends, community agencies, support groups, or/or their religious or spiritual community.

foster c.The care of individuals who cannot live independently (such as children, homeless families, or frail older people) in a group or private home.

futile c.In clinical practice, esp. in the care of patients at the end of life, any intervention that will not improve a patient's health, well-being, comfort, or prognosis.

SEE: advance directive; hospice.

health c.All of the services made available by medical professionals to promote, maintain, or preserve life and well-being. Its major objectives are to relieve pain; treat injury, illness, and disability; and provide comfort and hope.

guided c.Complex patient care provided by family members with direction and support from health care professionals.

home health c.The provision of equipment and services to patients in their homes to restore and maintain their maximal levels of comfort, function, and health.

hospital-at-home c.A form of community-based treatment in which acute medical problems are actively addressed in the patient's home by trained health care specialists in place of similar care provided in-hospital. It has been used to treat both medical issues (such as congestive heart failure, chronic obstructive pulmonary disease, or end-of-life care) and also postoperative recuperation. Although hospital-at-home care has been proposed as a low-cost alternative to inpatient care, its cost structure is not clearly more favorable than inpatient treatment.

informal c.1Care provided to the very young, the very old, the weak, the poor, and the sick by family, friends, neighbors, and concerned citizens, rather than by trained, licensed, or certified health care professionals.2Health care advice that is given by trained, licensed, and certified health care professionals without a thorough examination. Such care is rarely documented.

intensive c.1Care of critically ill patients by continuous monitoring of various body functions.2An intensive care unit.

kangaroo c.The placing of a newborn directly onto the mother's skin to enhance bonding, regulate body temperature, improve the infant's oxygenation, or increase the mother's production of milk. SYN: kangaroo mothering.

long-term c.

ABBR: LTC

SEE: Nursing Diagnoses Appendix.

SEE: nursing home.

low-value c.Health care services that are unlikely to benefit individual patients or the community at large.

managed c.Any of the methods of financing and organizing the delivery of health care in which costs are contained by controlling the provision of benefits and services. Physicians, hospitals, and other health care agencies contract with the system to accept a predetermined monthly payment for providing services to patients who are enrolled in a managed care plan. Enrollee access to care may be limited to the physicians and other health care providers who are affiliated with the plan. In general, managed care agencies attempt to control costs by overseeing and altering the behavior of their providers. Clinical decision making is influenced by a variety of administrative incentives and constraints. Incentives affect the health care provider's financial return for professional services. Constraints include specific rules, regulations, practice guidelines, diagnostic and treatment protocols, and algorithms. Care is overseen by quality assurance procedures and utilization reviews.

SEE: cost awareness; cost-effectiveness; gatekeeper; Health Maintenance Organization; managed competition; resource-based relative value scale.

measurement-based c.Care, esp. psychiatric care, that is supported and guided by the use of stand ardized assessment tools, such as self-rated questionnaires.

medical c.The use of medical skills to benefit a patient.

missed nursing c.Incomplete or delayed patient ambulation, discharge planning, education, feeding, hygiene, medication administration, monitoring and surveillance, and /or personal or familial support. Common causes of missed care include distractions and emergencies, insufficient staffing, management errors, or bad team dynamics.SYN: care left undone.

mobile integrated health c.Paramedicine.

monitored anesthesia c.

ABBR: MAC

mouth c.Personal and bedside care of the oral cavity including the gingivae, teeth, lips, epithelial covering of the mucosa, pharynx, and tongue. People who are normally able to provide their own oral hygiene may require help in maintaining a healthy oral environment when they are ill. The intensity and frequency of care is dictated by the patient's comfort; the severity of the illness; potential or existing irritation or inflammation secondary to trauma or therapy; and the patient's state of consciousness, level of cooperation, and ability for self-care.

SEE: stomatitis.

nurse-led c.Health care managed by and provided primarily by advanced practitioner nurses. Many community health centers are led by advanced practitioner nurses.

personal c.Self-care (2).

post-acute c.Professional health care provided to patients after their discharge from a hospital, e.g., at home, in nursing homes, or in facilities that offer rehabilitative services.

preference-sensitive c.Optional or elective care that a patient chooses from a list of alternatives, esp. when one alternative is not definitively known to be superior to the others. In preference-sensitive care, the values of the patient in making the choice are paramount.

prehospital c.The care a patient receives from an emergency medical service before arriving at the hospital. This is usually done by emergency medical technicians and paramedics.

SEE: out-of-hospital..

prenatal c.The regular monitoring and management of the health status of the pregnant woman and her fetus during gestation. Comprehensive care is based on a thorough review of the woman's medical, surgical, obstetrical and gynecological, nutritional, and social history, and that of the family for indications of genetic or other risk factors. Laboratory analyses provide important data describing the woman's current health status and indications for treatment and anticipatory guidance. Periodic gynecological visits are scheduled to evaluate changes in blood pressure, weight, fundal height, fetal heart rate, and fetal activity, and to assess for any signs of emerging health problems. To enable the patient's active participation in care and to facilitate early diagnosis and prompt treatment of emerging problems, emphasis is placed on anticipatory guidance and patient teaching. The health care professional describes and discusses nutrition and diet (including the importance of folate supplementation), self-management of common minor complaints; alerts the patient to signs to report promptly to the primary caregiver; helps patients gain access to resources available for preparation for childbirth, breastfeeding, newborn care, and parenting; and provides support and counseling.

SEE: pregnancy; prenatal diagnosis; table - Common Tests Performed Prenatally.

prepaid c.Managed care in which a patient or group contracts for all its health care services in advance instead of paying for each service when it is delivered.

primary c.Integrated, accessible, basic health care provided where the patient first seeks medical assistance by clinicians responsible for most of the patient's personal health care, including health maintenance, therapy during illnesses, and consultation with specialists.

relationship-centered c.Health care that explicitly recognizes the importance of patients, their supporters, their community, their providers, and their health care administrators as they jointly affect the experience of health, disease prevention, and treatment.

residential c.Care provided in a live-in facility other than the patient's home. The very young, the very old, and those with physical infirmities or behavioral or substance abuse problems are often treated in residential care centers.

respiratory c.The evaluation, treatment, and rehabilitation of patients with cardiopulmonary disease by respiratory therapy professionals working under a physician's supervision.

respite c.Provision of short-term care to older adults, disabled, or chronically ill of a community to allow caregivers temporary relief from their responsibilities. The care may be provided either in the patient's home, church, community center, nursing home, or caregiver's home.

restorative c.Rehabilitation (1).

secondary medical c.Medical care of a patient by a physician acting as a consultant. The provider of primary medical care usually refers the patient for expert or specialty consultation or for a second opinion.

secondary nursing c.Nursing care aimed at early recognition and treatment of disease. It includes general nursing intervention and teaching of early signs of disease so that prompt medical care by a physician, nurse practitioner, speech therapist, or other appropriate provider can be obtained.

SEE: preventive nursing.

simultaneous c.In patients with potentially terminal illnesses, the combined or alternating use of palliative and curative therapies.

skilled c.Medical care provided by licensed professionals working under the direction of a physician.

stepped c.Treatment that follows a predetermined or algorithmic sequence. The simplest, most affordable, or most broadly effective treatment regimen is used first. If that fails or causes side effects, other options are employed until an endpoint is reached.

supply-sensitive c.The use of health care personnel, technologies, or imaging because of their availability rather than their appropriateness. A small city that has a neurosurgeon at its hospital is more likely to receive patients referred for neurosurgery than another town in which brain surgery is not regionally accessible. More than half of all spending on Medicare is thought to be supply sensitive.

survivorship c.A plan for patient follow-up that links the treatments a patient has received from an oncologist with his or her needs after intensive cancer treatments have been completed. With about 10 million cancer survivors and the numbers rising in the U.S., survivors are living longer and receiving more fragmented care. A follow-up care plan helps communicate to the patient and his or her future health care providers details of cancer staging, treatment, and disease surveillance that may otherwise be misunderstood or overlooked. According to the Institute of Medicine, such a plan should include the following elements: 1) a clear, concisely written statement of the patient's diagnosis, the methods used in treatment (such as what specific chemotherapeutic drugs and what doses of radiation), and the expected or potential effects of that treatment; 2) detailed information about the need for specific follow-up services and a timetable specifying when such services should be delivered; 3) information about secondary disease prevention (including the detection of cancer recurrence and the need for monitoring for secondary cancers); 4) information about the availability of support services and agencies in the patient's community; and 5) information for the patient about legal protection after diagnosis, including regarding employment and insurance.

Survivor care plans are often drawn up and given to patients by oncologists or advanced practice nurses. They should address concerns about nutrition, physical activity, exercise, and mobility; elimination; cognition and perception; pain and discomfort; sleep and rest; self-perception; relationships with spouse, parents, children, other family members, and friends; and sexuality and reproductive issues.

tactical combat casualty c.

ABBR: TCCC

team-based c.Patient care provided jointly and in a coordinated fashion by two or more nursing teams, allied health specialists, or physicians.

tender loving care

ABBR: TLC

tertiary medical c.A level of medical care in a facility staffed and equipped to administer comprehensive care. This care is usually provided in a large hospital to which the patient has been referred or transferred. It includes techniques and methods of therapy and diagnosis involving equipment and personnel that are not economically feasible in a smaller institution because of underutilization.

tracheostomy c.Management of the tracheostomy wound and the airway device.

The patient should be suctioned as often as necessary to remove secretions. Sterile technique is maintained throughout the procedure. Before suctioning, the patient should be aerated well, which can be accomplished by using an Ambu bag attached to a source of oxygen. The patency of the suction catheter is tested by aspirating sterile normal saline through it. The catheter is inserted without applying suction, until the patient coughs. Suction is then applied intermittently and the catheter withdrawn in a rotating motion. The lungs are auscultated by assessing the airway, and the suctioning procedure is repeated until the airway is clear. Each suctioning episode should take no longer than 15 sec, and the patient should be allowed to rest and breathe between suctioning episodes. The suction catheter is cleansed with sterile normal saline solution, as is the oral cavity if necessary. The inner cannula should be cleansed or replaced after each aspiration. Metal cannulas should be cleansed with sterile water.

An emergency tracheotomy kit is kept at the bedside at all times. A Kelly clamp is also kept at the bedside to hold open the tracheostomy site in an emergency. Unless ordered otherwise, cuffed tracheostomy tubes must be inflated if the patient is receiving positive-pressure ventilation. In other cases, the cuff is kept deflated if the patient has problems with aspiration. The dressing and tape are changed every 8 hr, using aseptic technique. Skin breakdown is prevented by covering tracheostomies with an oval dressing between the airway device and the skin. To apply neck tapes, two lengths of twill tape approx. 10 in (25 cm) long are obtained; the end of each is folded and a slit is made 0.5 in (1.3 cm) long about 1 in (2.5 cm) from the fold. The slit end is slipped under the neck plate and the other end of the tape pulled through the slit. This is repeated for the other side. The tape is wrapped around the neck and secured with a square knot on the side. Neck tapes should be left in place until new tapes are attached. Tracheal secretions are cultured as ordered; their color, viscosity, amount, and abnormal odor, if any, are observed. The site is inspected daily for bleeding, hematoma formation, subcutaneous emphysema, and signs of infection. Appropriate skin care is provided. The medical care team should help alleviate the patient's anxiety and apprehension and communicate openly with the patient. The patient's response is documented.

SEE: Suctioning: Tracheostomy, Portable Open System

See video

transitional c.Health care services provided to patients after hospitalization in an acute care facility before they are ready to return to their homes. Transitional care shortens acute hospital stays, decreases health care costs, and provides a period for recuperation for patients still unable to thrive independently. Facilities used in transitional care include rehabilitation units, long-term care hospitals, subacute care facilities, hospice services, and some home care services.

uncompensated c.Health care provided to those who are uninsured and unable to pay for the services they receive. In the U.S., most uncompensated care is provided for in a relatively small number of urban hospitals.

unscheduled care Acute care for which patients seek timely access to health care providers. SYN: urgent care.

urgent c.Unscheduled care.

wound c.Any technique that enhances the healing of skin abrasions, blisters, cracks, craters, infections, lacerations, necrosis, and /or ulcers. Wound care involves 1) local care to the skin, with débridement and dressings; 2) careful positioning of the affected body part to avoid excessive pressure on the wound; 3) application of compression or medicated band ages; 4) treatment of edema or lymphedema; 5) treatment of infection; 6) optimization of nutrition and of blood glucose levels; 7) the use of supports and cushions; and 8) maximization of blood flow and oxygen. Website: Association for the Advancement of Wound Care: www.aawcone.org/patientresources.shtml