AACN ACNPC-AG key terms

A prioritized list of possible conditions that could explain a patient's presenting signs and symptoms, ranked by likelihood and danger so that testing and treatment target the most consequential possibilities first.

The estimated chance that a patient has a particular condition before any test result is known, based on history, examination, and local epidemiology. It helps clinicians decide whether a test can meaningfully change management.

Illness in older adults that lacks classic symptoms, such as an infection presenting as confusion or a fall rather than fever. Recognition requires a low threshold for evaluation and attention to functional change.

Multifactorial conditions common in older adults, including falls, delirium, incontinence, frailty, and pressure injuries. They rarely have a single cause and often reflect combined effects of aging, disease, and environment.

A state of reduced physiologic reserve that increases vulnerability to stressors and adverse outcomes such as falls, hospitalization, and death. It is assessed through gait speed, grip strength, weight loss, exhaustion, and activity level.

An acute, fluctuating disturbance of attention and awareness often triggered by infection, medications, pain, or hospitalization. It is a medical emergency associated with falls, prolonged stays, and increased mortality.

A brief validated tool that identifies delirium in critically ill patients by assessing acute onset or fluctuation, inattention, altered consciousness, and disorganized thinking. It requires trained bedside administration and is repeated during care.

The ratio of heart rate to systolic blood pressure. A value above 0.9 suggests occult hypoperfusion and predicts deterioration better than routine vital signs alone in bleeding or septic patients.

Bedside ultrasound performed by the treating clinician to answer focused questions such as cardiac function, lung congestion, or abdominal free fluid. It rapidly narrows the differential and guides procedures.

Sepsis is life-threatening organ dysfunction caused by a dysregulated response to infection, identified by an acute rise in SOFA score. Septic shock adds vasopressor need and elevated lactate despite adequate fluids.

A bedside screen for sepsis using respiratory rate 22 or higher, altered mentation, and systolic blood pressure 100 mm Hg or lower. It flags patients at risk but does not by itself define sepsis.

The likelihood that a patient's cardiac output will rise meaningfully after a fluid bolus. It is assessed with dynamic measures such as passive leg raise or pulse pressure variation rather than static pressures alone.

A set of actions started within one hour of recognizing sepsis: measure lactate, obtain blood cultures, give broad-spectrum antibiotics, begin fluids, and use vasopressors for persistent hypotension. Rapid timing aims to reduce mortality.

The decline in blood lactate over time, reflecting improved tissue perfusion and response to resuscitation. Failure to clear suggests ongoing hypoperfusion, inadequate source control, or a continuing shock state.

A medication that constricts blood vessels to raise mean arterial pressure when fluids alone do not restore adequate perfusion. Norepinephrine is first-line for most forms of shock.

A ventilator strategy using low tidal volumes near 6 mL/kg predicted body weight, limited plateau pressures, and appropriate positive end-expiratory pressure. It reduces ventilator-induced lung injury and mortality in acute respiratory distress syndrome.

Acute respiratory failure within one week of a known trigger, with bilateral opacities not fully explained by heart failure and hypoxemia graded by the ratio of arterial oxygen partial pressure to inspired oxygen fraction.

Placing a patient face down for prolonged periods to improve oxygenation in moderate to severe acute respiratory distress syndrome. It reduces mortality when combined with lung-protective ventilation in appropriately selected patients.

A structured regimen of intravenous fluids, insulin infusion, and electrolyte replacement, especially potassium, with monitoring of glucose, ketones, and anion gap until resolution. It prevents cerebral edema and rebound ketosis.

A hyperglycemic emergency marked by severe hyperosmolality, profound dehydration, and altered mental status without significant ketosis. Treatment centers on aggressive fluid replacement and gradual correction of glucose and electrolytes.

A spectrum of myocardial ischemia including ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina. Immediate priorities are risk stratification, antiplatelet therapy, and reperfusion when indicated.

Controlled cooling, often to 32 to 36 degrees Celsius, after cardiac arrest or certain neurologic injuries to reduce reperfusion injury. It requires sedation, shivering control, and slow rewarming.

A list of medications potentially inappropriate for older adults because of risks such as falls, confusion, or bleeding. It supports safer prescribing and deprescribing during transitions of care.

The planned, supervised withdrawal of medications whose harms now outweigh their benefits, especially in older adults with changing goals or limited life expectancy. It requires tapering, monitoring, and patient engagement.

The use of multiple medications, often five or more, that raises the risk of interactions, adverse effects, and nonadherence. Assessment should focus on whether each drug has a clear, current indication.

An ongoing conversation about a person's values, goals, and preferences for future medical care, documented and revisited over time. It prepares patients and surrogates for decisions during serious illness.

A portable medical order form that translates a seriously ill patient's treatment preferences into actionable orders for resuscitation, hospitalization, and comfort care across settings. It complements but does not replace an advance directive.

Conditions where people live, work, and receive care, including income, housing, food access, transportation, and social support. They shape disease risk, adherence, and readmission after acute illness.

A person's ability to obtain, understand, and use health information to make decisions. Low health literacy increases medication errors and hospital use, so plain language and teach-back are essential.

Coordinated actions that ensure continuity and safety as patients move between hospital, home, rehabilitation, or long-term care. Elements include medication reconciliation, timely follow-up, and clear discharge instructions.

A person authorized to make health care decisions for a patient who lacks capacity, using the patient's known values and, when these are unknown, the patient's best interests. Authority and limits vary by state law.

A patient's clinical ability to understand relevant information, appreciate consequences, reason through options, and communicate a choice. Capacity is decision-specific and assessed by the clinician, not established by signing a form.

A process of disclosing diagnosis, proposed treatment, risks, benefits, alternatives, and consequences of refusal, then confirming voluntary agreement. It requires patient capacity and may involve a surrogate decision-maker.

A structured communication format covering situation, background, assessment, and recommendation. It reduces omissions and hierarchy barriers during handoffs and urgent consultations.

An organizational approach that encourages reporting errors and near misses while distinguishing human error, at-risk behavior, and reckless conduct for a fair, proportionate response. It supports learning and patient safety.

A systematic, data-driven approach to closing gaps between current and desired care using cycles such as plan-do-study-act. It engages frontline teams and measures whether changes produce lasting improvement.

The patient's prioritized health outcomes and acceptable burdens of treatment, clarified through discussion and used to guide decisions. They should be revisited whenever prognosis, preferences, or clinical status changes.

A judgment that an intervention cannot achieve its intended physiologic or patient-centered goal. Disagreements require careful communication, ethics consultation, and respect for surrogate authority within legal limits.